The Hamilton Depression Rating Scale
The Hamilton Depression Rating Scale is the most widely used provider administered depression assessment scale. This assessment scale for treatment is the oldest and efficient form of clinical treatment for depression (Rohan, Rough & Vacek 2017). The rating scale has been proven to be useful in rating the patient’s depression level before, during, and after treatment. The Hamilton Depression Rating Scale, also known as that Ham-D, has a 17- original item to measure the patient’s level of depression. A later 21-item version added four items to intend the subtype of the depression. This discussion will describe the Hamilton Depression Rating Scale’s psychometric properties and the best time to use the treatment.
Psychiatrist Dr. Max Hamilton created The Hamilton Rating Scale for Depression in the 1950s (Sharp, 2015). It was initially designed for inpatient hospitals with melancholic and physical symptoms of depression. It is also used to determine the performance of psychiatric medication, especially the first group of antidepressants. Over 40 years, the assessment was used to evaluate the patient’s mental status and assist diagnosing patients experiencing moderate to severe depression for a week or more. The patient’s interview should take 15 to 20 minutes, containing 17-21 items, and scored on a point system from 0-4. The first 17 items on The Hamilton Depression Rating Scale measures the depression symptoms. The additional four items for the 21-point scale measures factors that may be related to depression, but not known as severe, such as obsession, compulsive, and paranoia symptoms. The scoring system is based on the 17-item scale, the suggested ranges consist of 0-7 normal, 8-16 mild depression, and 17-23 moderated depression and scores over 24 are suggested severe depression.
Hamilton’s depression scale is used to rate depression in patients that are taking antidepressants. This form of assessment helps determine the outcome of the medication. It also helps determine if the dose should be increased or changed to a new medication. Besides, The Hamilton Depression Rating Scale provides proof to healthcare providers that mental illnesses are treatable and not indefinite (Worbys, 2013). A study conducted to evaluate further discrimination between placebo and active drugs to prove a dose-response relationship in patients with severe depression has caused concern when treating a patient with mental illnesses (Bech, 2010).
An improvement in the Hamilton Depression Scale Score during an assessment trial does not indicate that antidepressant has improved the patient medical status. The form of assessment is not statistically proven. Many statistical versus clinical significance problems occur when analyzing placebo-controlled trials, including dose-response relationships (Bech, 2010). The insufficient statistical data makes it challenging to determine if the Hamilton Depression Scale is efficient in evaluating the patient’s response when prescribed an antidepressant.
Despite the lack of statistical data, The Hamilton Depression Rate Scale has proven to determine patients’ effects from depression (Bech, 2010). Psychotherapy is a great way to evaluate the patient’s mental status further. As a PMHNP, not to base the final assumption based on the patient’s score after completing the Hamilton Depression Rating Scale but instead, us the scale to further treat the patient’s mental status.
Bech, P. (2006). Rating scales in depression: limitations and pitfalls. Dialogues in clinical neuroscience, 8(2), 207–215.
Worboys, M. (2013). The Hamilton Rating Scale for Depression: The making of a “gold standard” and the unmaking of a chronic illness, 1960-1980. Chronic illness, 9(3), 202–219. https://doi.org/10.1177/1742395312467658
Sharp, R. (2015). The Hamilton Rating Scale for Depression, Occupational Medicine, Volume 65, Issue 4, June 2015, Page 340, https://doi.org/10.1093/occmed/kqv043
Rohan, K., Rough, J., Vacek, P.(2018).A Protocol for the Hamilton Rating Scale for Depression: Item Scoring Rules, Rater Training, and Outcome Accuracy with Data on its Application in a Clinical Trial .J affects order, 200(6),111-118.
Discussion: Assessment Tools
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
Analyze psychometric properties of assessment tools
Evaluate appropriate use of assessment tools in psychotherapy
Compare assessment tools used in psychotherapy
Note: By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.
Review this week’s Learning Resources and reflect on the insights they provide.
Consider the assessment tool assigned to you by the Course Instructor.
Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues by comparing your assessment tool to theirs.
I enjoyed reading your post about the Hamilton Depression Rating Scale. Your scale has been around for about 70 years, and it is still used to this day. I was given the MMSE tool that was created about 25 years after your tool in 1975. The Mini‐Mental State Examination (MMSE) is one of the most known and used short screening tools for providing an overall measure of cognitive impairment in clinical, research, and community settings (Arevalo-Rodriguez et al., 2015). This test can assess a person’s memory, attention, and language (Alzheimer’s Society, (n.d.)). However, unlike your tool, it can not be used to assess the efficacy of psychopharmacologic medications because this test measures a person’s mental abilities. Since there is no cure for dementia, practitioners treat patients intending to attempt to slow the progression of dementia. However, your tool can determine how well medication works because it can track if a patient is getting better, remaining the same, or getting worse. With dementia, we can only try to slow the deterioration, but they will not get better.
Alzheimer’s Society. (n.d.). The MMSE test. Retrieved September 09, 2020, from
Arevalo-Rodriguez, I., Smailagic, N., Roqué I Figuls, M., Ciapponi, A., Sanchez-Perez, E.,
Giannakou, A., Pedraza, O. L., Bonfill Cosp, X., & Cullum, S. (2015). Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). The Cochrane database of systematic reviews, 2015(3), CD010783. https://doi.org/10.1002/14651858.CD010783.pub2
Thank you for your post this week. While I was aware of the existence of the Hamilton Depression Rating Scale (HAM-D) I did not realize that there are different versions of the HAM-D available. The HAM-D17 and a short HAM-D6 are both available, and according to Kieslich da Silva et al. (2019), the HAM-D6 is helpful in identifying depressive symptoms that fall outside of MDD, such as bipolar depression and bipolar depression with mixed features. A benefit according to the same study, was that the HAM-D6 is a much more brief assessment tool than the HAM-D17. The assessment tool that I was assigned was the Mini-Mental State Exam (MMSE), which is a tool that was developed to help quickly assess the basic cognitive function by assessing the patient’s orientation, registration, calculation, and attention, as well as recall and language in a short 5-10 minute exam (Folstein et al., 1975). While the MMSE is not meant to replace a full mental status examination, it is a tool that gives providers some insight into the cognitive function of a client which may better direct the provider by giving a baseline impression before completing a full mental status examination. Of note, according to Folstein et al. (1975) the score on the MMSE can be impacted by someone dealing with depression for whom cognitive function has declined in relation to the depression. The MMSE presents a tool that could be administered at multiple appointments to help assess whether pharmacologic or psychotherapeutic interventions for the depression has impacted the cognitive abilities. In this scenario, both the HAM-D and the MMSE could both be utilized to help assess changes to the client’s depressive symptoms. It is helpful to be aware of these different tools that are available not only for assessment and diagnosis purposes, but they also offer means by which we can measurably compare the progress of a patient over time. References
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive
state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.
Kieslich da Silva, A., Reche, M., Lima, A. F. da S., Fleck, M. P. de A., Capp, E., & Shansis, F. M. (2019). Assessment of the
psychometric properties of the 17- and 6-item Hamilton Depression Rating Scales in major depressive disorder,
bipolar depression and bipolar depression with mixed features. Journal of Psychiatric Research, 108, 84–89.
Depression is a significant problem among elderly patients. The main issue is that depression is often overlooked as a normal aging process of underdiagnosed in the older adult population (Wheeler, 2014). Therefore, it is crucial to choose the right instruments for screening and diagnosing depression in the elderly clients. The Hamilton Depression Rating Scale (HDRS or HAM-D), which you have explored in your discussion, is one of the depression assessment tools widely used in geriatric settings. The Geriatric Depression Scale (GDS), which I presented in my discussion post, is another frequently used tool for evaluating depressive episodes in the elderly. Both the HDRS and GDS assess depressive symptoms in clinical populations. However, the GDS is a self-reported global tool for measuring depression in older adults while the HDRS rates the client’s level of depression before, during, and after treatment. As such, the GDS assesses depressive symptoms in the elderly while the HDRS moves further by quantifying the severity of depression (Rohan et al., 2018; Stone et al., 2019).
You have raised a critical issue in your discussion about evaluating the effectiveness of psychotherapy. I agree with you that the HDRS rates depression in clients taking antidepressants, which allows healthcare providers to assess the effectiveness of the therapy. The GDS has also proven effective in assessing the clinical severity of depression, as well as monitoring the complex and emotional responses of patients to therapy. However, personal review of research evidence has shown that the HAM-D and Beck Depression Inventory (BDI) are the best validated tools that quantitatively assess patient’s response to treatment. Furthermore, I found a paucity of research evidence that had validated the use of both the short and long versions of the GDS in assessing the efficacy of psychopharmacologic medications (Stone et al., 2019). A key takeaway from the discussion is that the GDS is suitable for screening while the HAM-D is useful in assessing the effectiveness of treatment.
Rohan, K., Rough, J., Evans, M., Ho, S.-Y., Meyerhoff, J., Roberts, L. M., & Vacek, P. (2018). A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, rater training, and outcome accuracy with data on its application in a clinical trial. Journal of Affective Disorders, 200(6),111-118. https://doi.org/10.1016/j.jad.2016.01.051
Stone, L. E., Granier, K. L., & Segal, D. L. (2019). Geriatric Depression Scale. In D. Gu & M. Dupre (eds) Encyclopedia of Gerontology and Population Aging. Springer.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). Springer Publishing Company
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