Hamilton Scale
Original Editor - Mila Andreew
Top Contributors - Angeliki Chorti, Khloud Shreif and Mila Andreew
Introduction
The Hamilton Rating Scales are widely used standardised outcome measures used for depression. [1] The creator of the scale, Max Hamilton was a senior lecturer in psychiatry at the University of Leeds in England, with a research interest on psychometrics and clinical statistics. He was also president of the British Psychological Society and received the Paul Hoch Prize for Distinguished Psychiatric Research from the American Psychopathological Association in 1980.
Versions
The original version of the Hamilton Rating Scale for Depression (HAM-D) was unstructured and provided general instructions for rating individual items. It was designed for completion after an unstructured clinical interview, and contained 17 items (HDRS17) on symptoms of depression experienced over the past week.[2]
Since the original proposal, modified versions of the HAM-D have been developed, which differ not only in the number of items, but also in modalities of administration. [1] More specifically, one can find structured versions, including item definitions, anchor points and semi-structured or structured interview questions in the literature.
The most commonly used versions in the studies are either a 17- or a 21-item scale. [3] The 21-item version includes additional four items (18–21 items) intended to identify a subtype of depression. [3]
There is an Interactive Voice Response version (IVR), a Seasonal Affective Disorder version (SIGH-SAD, and a Structured Interview Version (HDS-SIV). Numerous versions with varying lengths include the HDRS17, HDRS21, HDRS29, HDRS8, HDRS6, HDRS24, and HDRS7. [2]
The scale has been translated into a number of languages including French, German, Italian, Thai, and Turkish. [2]
Purpose
To stratify severity of depression, in order to guide treatment and inform progress in patients with already identified depressive disorder. [3]
Target Population
The original version of the HAM-D was originally developed for adults, hospital inpatients, and emphasised melancholic and physical symptoms of depression.[2]
Administration
This widely used instrument is a clinician-administered depression assessment scale. [2] A trained clinician with knowledge of the tool and symptoms of the depressive illness is required for administration. [3] Administration time is estimated around 15-30 minutes.[3]
Scoring
Variations in methods for scoring can be found by version. Item scoring is between 0 (not present) and 4 (severe) points using either a three-point or a five-point scale and summed up to obtain the total score. Total scoring is based only on the first 17 items. The HDRS17 uses a score of 0–7 to be within the normal limits or in clinical remission; a score of 20 or higher (indicating at least moderate severity) is usually required for entry into a clinical trial. [2]
Clinimetric Properties
The HAM-D has been suggested as a valid and sensitive clinimetric index. A comprehensive review was conducted in 2020 to examine the clinimetric properties of the different versions of the HAM-D. [1] When looking at the HAM-D versions with the best display the clinimetric properties of reliability, validity, and sensitivity to change, it was found that the structured versions of the HAM-D had the highest inter-rater and test-retest reliability. [1] Furthermore, the Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. [1]Thus, when using the HAM-D, unstructured forms should better be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial.[1]
Resources
Hamilton Depression Rating Scale (HDRS) - HDRS17
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Carrozzino D, Patierno C, Fava GA, Guidi J. The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions. Psychother Psychosom. 2020;89(3):133-50.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
- ↑ 3.0 3.1 3.2 3.3 3.4 Renemane L, Vrublevska J. Chapter 17 - Hamilton depression rating scale: Uses and applications. In: Ed(s): Colin RM, Lan-Anh H, Vinood BP, Preedy V, Rajendram R. The Neuroscience of Depression, Academic Press,2021, p. 175-83.