Hamilton's Depression Scale
(This is Hamilton's Depression Scale - inc. the doctor's manual.)
Score sheet
|
No.
|
Symptom
|
Score
|
|
|
1*
|
Depressed mood
|
0-4
|
|
|
2*
|
Feelings of guilt and self-reproach
|
0-4
|
|
|
3
|
Suicidal impulses
|
0-4
|
|
|
4
|
Difficulties falling asleep
|
0-2
|
|
|
5
|
Disturbed sleep
|
0-2
|
|
|
6
|
Early waking
|
0-2
|
|
|
7*
|
Work and interests
|
0-4
|
|
|
8*
|
Psychomotor inhibition
|
0-4
|
|
|
9
|
Psychomotor agitation
|
0-4
|
|
|
10*
|
Anxiety, psychical components
|
0-4
|
|
|
11
|
Anxiety, somatic components
|
0-4
|
|
|
12
|
Gastrointestinal symptoms
|
0-2
|
|
|
13*
|
Somatic symptoms in general
|
0-2
|
|
|
14
|
Sexual disturbances
|
0-2
|
|
|
15
|
Hypochondria
|
0-4
|
|
|
16
|
Lack of appreciation of one's disease
|
0-2
|
|
|
17
|
Weight loss
|
0-2
|
|
|
* Depression factor (HAM-D6)
|
Total score
|
0-52
|
|
Symptoms which score from 0 to 2:
0 = no occurence
1 = mild degree
2 = medium to severe degree
Symptoms which score from 0 to 4:
0 = no occurence
1 = mild degree
2 = moderate degree
3 = pronounced degree
4 = maximum degree
Result:
Between 13 and 17 = mild depression
Between 18 and 24 = moderate depression
Between 25 and 52 = severe depression
Manual
1. Depressed mood
This item covers the verbal as well as non-verbal expressions of the patient's experience of sadness, melancholy, despondency, helplessness and hopelessness.
0: Not present.
1: A slight tendency to feeling subdued, uneasy, in a bad mood.
2: Clearer signs of depressed mood; seems moderately depressed but doesn't seem hopeless.
3: Very depressed mood possibly with non-verbal signs (e.g. crying). Expresses hopelessness.
4: Severely depressed mood with clear signs of hopelessness and helplessness.
2. Feelings of guilt and self-reproach
This item covers reduced self-respect with feelings of guilt.
0: Not marked by reduced self-estimation, lack of confidence or feelings of guilt.
1: Feels inferior in relation to family, friends or work colleagues with reference to the proportion to which he/she has caused inconvenience during the actual depressive condition.
2: Signs of actual feelings of guilt, as the patient is preoccupied with relationships from the time before the actual depressive condition (minor omissions or errors).
3: Feels that the actual depressive condition was caused by omissions or errors in the past. Is however still able to realize rationally that this is hardly right.
4: The feelings of guilt together with the perception that the actual depressive condition is a punishment, cannot even be corrected rationally (delusion).
3. Suicidal impulses
0: Not present.
1: The patient feels that life is not worth living but doesn't have a death wish.
2: The patient wishes to die (e.g. not to wake up the next morning) but doesn't have any active plans to take his or her own life.
3: Has uncertain but active plans to take his or her own life.
4: Has certain plans to take his or her own life.
4. Difficulties falling asleep
Inquiries into the last 3 nights' sleep are made regardless of whether sleeping medicine has been taken or not.
0: Not present.
1: Has lain awake in bed at least one night for more than ½ hour from the point at which he/she wanted to fall asleep and until sleep occurred.
2: Has lain in bed every night for over ½ hour from the point at which he/she wanted to fall asleep.
5. Disturbed sleep
The patient wakes up once or more times between midnight and 5 am the next morning. Inquiries about the last 3 nights' sleep are made regardless of whether sleeping medicine has been taken or not.
0: Not present.
1: Has woken up once or twice during the last few nights.
2: Has woken up every night.
6. Sleep disturbances, early morning waking.
The patient wakes up before he/she was meant to. Inquiries about the last 3 nights sleep are made regardless of whether sleeping medicine has been taken or not.
0: Not present.
1: Has once woken up an hour or more before he/she was meant to.
2: Has constantly woken up an hour or more before he/she was meant to.
7. Work and interests
0: No problems.
1: Slight difficulties with managing the day-to-day activities (in or outside the home).
2: Clearer signs of insufficiency but still to a moderate degree.
3: Has problems even with the most routine activities which are furthermore carried out at great effort.
4: Not able to carry out routine activities without help.
8. Psychomotor inhibition
0: Not present.
1: The patient's normal motor function is slightly reduced.
2: Clearer signs of reduced motor function, e.g. moderately reduced facial expression and movement or a moderately reduced urge to speak.
3: The interview was extended or difficult due to brief answers.
4: The interview was very difficult to complete due to the verbal inhibition and/or a much reduced movement activity.
9. Psychomotor agitation
0: Not present.
1: Slight motor unrest. A tendency for example to sit very restlessly or a tendency to scratch the head.
2: Clearer signs of motor unrest with wringing of the hands, moderate unrest when sitting but able to remain seated.
3: The patient has to stand up once during the interview.
4: The patient is so restless that he/she has to stand up and walk around several times during the interview.
10. Anxiety, psychical components
0: Not present.
1: Slight tendency to be worried and anxious.
2: Clearer signs of psychic anxiety; seem moderately worried, insecure or anxious but able to control the insecurity.
3: The psychic anxiety and worry are so pronounced that the patient once in a while has difficulty controlling his/her anxiety, is for example on the verge of a panic attack. Affects for example the patient's daily behaviour now and then.
4: The psychic anxiety is very pronounced. Affects the patient's daily behaviour more constantly.
11. Anxiety, somatic components
This item covers the physiological or autonomic anxiety phenomena. The psychic tension should be evaluated in Item 10.
0: Not present.
1: Slight tendency to somatic anxiety, for instance stomach unrest, sweat, tremor.
2: Clearer signs of somatic tension For example moderately pronounced stomach unrest, palpitations, sweat or tremor. Doesn't affect the patient's daily behaviour though.
3: The somatic anxiety is so pronounced that the patient has difficulty controlling it. Affects for example the patient's daily behaviour now and then.
4: The somatic anxiety is very pronounced; affects the patient's daily behaviour more constantly.
12. Gastrointestinal symptoms
The symptoms affect the whole gastrointestinal system. Dryness of the mouth, reduced appetite and sluggish bowel movement are amongst the most frequent symptoms. The abdominal unrest ("butterflies in the stomach") is regarded as an autonomic, somatic anxiety manifestation and should be evaluated in Item 11. The experience of "the stomach disappearing" is a nihilistic, paranoid hypochondriac manifestation and should be evaluated in Item 15.
0: Not present.
1: The patient has a slightly reduced appetite or a normal food intake but doesn't enjoy the food.
2: Moderate or severe reduction in appetite. The patient still eats though because he/she knows that it is important.
13. General somatic symptoms
This item is about the feeling of tiredness, exhaustion, reduced slackness but also about diffuse muscle pain for example in the neck or shoulder, back or limbs.
0: Not present.
1: Slight feeling of tiredness, muscle pain or for example headache.
2: Moderate or severe tiredness or muscle pain.
14. Sexual disturbances
This item covers reduced sexual drive or interest. It is often difficult to approach this, especially in elderly patients.
0: No disturbances.
1: Slight disturbances.
2: Moderate to severe disturbances.
15. Hypochondria (somatization)
0: Not present.
1: A slight preoccupation with the body's functions.
2: Clearer signs of worrying about the somatic condition. Seems moderately anxious about suffering from something physical, somatisizing the depression but at a "neurotic" level.
3: The hypochondria is more pronounced. The patient is for example convinced that he/she is suffering from something physical (e.g. fear of cancer) but can however briefly be brought to rationally understand that this isn't the case.
4: The hypochondria is so pronounced that we are dealing with a non-correctable paranoid idea. This idea often has a nihilistic character: "rotting away internally", "the stomach disappears".
16. Appreciation of one's disease
It only makes sense to evaluate this if the interviewer himself/herself believes that the patient is suffering from a depressive condition.
0: The patient agrees that he/she is suffering from depression or a similar mental illness.
1: The patient feels depressed but doesn't regard this as a disease.
2: The patient feels neither ill nor stressed. In this case, questions about paranoid feelings of guilt (item 2) or paranoid hypochondria (Item 15) should be asked.
17. Weight loss
Here information about the body weight in kg should, if possible, be obtained.
0: No weight loss.
1: A weight loss of less than 2 kg.
2: A weight loss equivalent to 2 kg or more