If we are talking about depression, we are talking about one of the most common and well-known mental disorders in the world, causing a high level of suffering in those who suffer from it. Throughout history, a large number of tools and instruments have emerged to assess the existence and impact caused by this problem. One of them is the Hamilton Depression Scale.
The Hamilton Depression Scale: Main Features
The Hamilton Depression Scale is an assessment instrument designed by Max Hamilton and published in 1960, created to serve as a method of detect the severity of depressive symptoms in previously diagnosed patients, As well as the existence of changes in the patient’s condition over time. Thus, its main objectives are the evaluation of this severity, the evaluation of the effects of possible treatments on each of the components that it evaluates and the detection of relapses.
This means that the Hamilton Depression Scale is not intended for diagnosis, but for assessing the condition of patients who have previously been diagnosed with major depression. However, although this was its original purpose, it has also been applied to assess the presence of depressive symptoms in other problems and conditions, such as dementia.
Structure and punctuation
This instrument consists of a total of 22 elements (Although the initial one consisted of 21 and later a reduced version of 17 was developed), grouped in six main factors. These items consist of an item that the subject must rate on a scale from zero to four points. Among these items, we mainly find different symptoms of depression, such as feelings of guilt, suicide, agitation, genital symptoms or hypochondria, which will eventually be evaluated on the six factors mentioned above.
More precisely, the factors in question which arise are the evaluation of somatic anxiety, weight (it should not be forgotten that in depression the presence of eating disorders is frequent), cognitive disorders, variations diurnal (if there is worsening during the day, for example), slowing down and sleep disturbances. However not all of these factors are equally important, Having different aspects a different weight and a different weighting in the score (for example cognitive disorders and slowing down are valued more and less agitation and insomnia).
This is a scale initially proposed to be applied externally by a professional, although it is also possible to complete it by the same subject being assessed. In addition to the scale itself, which is completed throughout a clinical interview, external information such as that from parents can also be used or the environment as a complement.
The interpretation of this test is relatively straightforward. The total score goes from 0 to 52 points (this being the maximum score), most of the items having five possible answers (from 0 to 4) with the exception of certain items with a lower weighting (which go from 0 to 2 ).
This total score has different thresholds, considering from 0 to 7 that the subject does not present depression, that a score of 8 to 13 supposes the existence of a slight depression, from 14 to 18 a moderate depression, of 91 at 22 a serious and over 23 very serious and at risk of suicide.
When assessing not the severity of depression but the existence of changes due to various aspects, including possible treatmentIt should be noted that there has been a response to this if there is a decrease of at least 50% in the initial score and a dismissal with scores below 7.
Advantages and disadvantages
Compared to other tests that assess symptoms of depression, Hamilton Depression Scale has the advantage of assessing non-cognitive items that other scales generally do not take into account, in addition to illiterate subjects or with other modifications.
However, it also has certain drawbacks: it does not technically allow the diagnosis because it is not intended for this purpose (although it allows to assess the altered aspects of depression) and gives an excessive weight to the somatic aspects which can be mistaken for unrelated medical problems. Also, in its original version, it does not include relevant elements such as anhedonia (as it was developed before the appearance of the diagnostic criteria for DSM-III).
- Hamilton, M. (1960). A depression rating scale. J Neurol Neurosurg Psychiatry, 23: 56-62.
- NICE (2004). Depression: Treatment of depression in primary and secondary care.
- Purriños, MJ (sf) Hamilton Scale – Hamilton Depression Rating Scale (HDDRS). Epidemiology Department. General Directorate of Public Health. Galician health service.
- Sanz, LJ and Álvarez, C. (2012). Assessment in clinical psychology. CEDE PIR preparation manual. 05. CEDE: Madrid.