Hamilton Depression Scale: what is it and how does it work?

We review how this instrument for measuring the severity of depression works.

When we talk about depression, we are talking about one of the most prevalent and well-known mental disorders worldwide, 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 affectation 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 with the aim of serving as a method of to detect the severity of depressive symptoms in patients previously diagnosed with depression.and the existence of changes in the patient's condition over time. Thus, its main objectives are the assessment of severity, the evaluation of the effects of possible treatments on each of the components it evaluates and the detection of relapses.

This means that the Hamilton Depression Scale is not intended for diagnosis, but for the evaluation of the condition of patients who have previously been diagnosed with major depression. However, despite this being 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 scoring

This instrument consists of a total of 22 items (although the initial one consisted of 22 items). (although the initial one consisted of 21 and later a reduced version of 17 was also developed), grouped into six main factors. These items consist of one item that the subject has to rate on a scale ranging from zero to four points. Among these items we mainly find different symptoms of depression, such as feelings of guilt, suicidality, agitation, genital symptoms or hypochondria, which will end up being assessed in the six factors mentioned above.

Specifically, the factors in question are the assessment of somatic anxiety, weight (it should not be forgotten that in depression the presence of eating disorders is frequent), cognitive alteration, diurnal variation (if there is diurnal worsening for example), slowing down, and sleep disturbances. However, not all of these factors are of equal importance. not all these factors have the same importanceThe different aspects have different weights and are weighted differently in the score (for example, cognitive alteration and slowing down are valued more and agitation and insomnia less).

This scale was initially designed to be applied externally by a professional, although it can also be completed by the subject being evaluated. In addition to the scale itself, which is completed during a clinical interview, external information such as that from relatives or the environment can also be used as a complement. or the environment can also be used as a complement.

Interpretation

The interpretation of this test is relatively simple. The total score ranges from 0 to 52 points (this being the maximum score), with most of the items having five possible responses (from 0 to 4) with the exception of some items with lower weighting (which range from 0 to 2).

This total score has different cut-off points, with a score of 0-7 indicating that the subject is not depressed, a score of 8-13 indicating the existence of mild depression, 14-18 moderate depression, 91-22 severe depression and over 23 very severe and at risk of suicide.

When assessing not the severity of depression but the existence of changes due to different the existence of changes due to different aspects, among them a possible treatmentIt should be taken into account that a response to treatment is considered to have occurred if there is a decrease of at least 50% of the initial score, and a remission with scores below 7.

Advantages and disadvantages

Compared to other tests that assess depressive symptomatology, the Hamilton Depression Scale has the advantage of assessing non-cognitive items that other scales do not usually take into account. that other scales do not usually take into account, as well as illiterate subjects or those with other disorders.

However, it also has certain disadvantages: technically it does not allow diagnosis as it was not designed for this purpose (although it does allow evaluation of the altered aspects of depression) and it gives excessive weight to somatic aspects that can be confused with independent medical problems. Moreover, in its original version it does not include such relevant elements as anhedonia (since it was elaborated before the emergence of the DSM-III diagnostic criteria).

Bibliographical references

• Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry,23: 56-62.
• NICE (2004). Depression: management of depression in primary and secondary care- NICE guidance.
• Purriños, M.J. (n.d.) Hamilton Depression Rating Scale (HDDRS). Epidemiology Service. General Direction of Public Health. Galician Health Service.
• Sanz, L.J. and Álvarez, C. (2012). Assessment in Clinical Psychology. Manual CEDE de Preparación PIR. 05. CEDE: Madrid.