Hamilton Depression Scale: What It Is And How It Works
If 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 evaluate the existence and impact caused by this problem. One of them is the Hamilton Depression Scale
The Hamilton Depression Scale: main characteristics
The Hamilton Depression Scale is an evaluation instrument designed by Max Hamilton and published in 1960, created with the objective of serving as a method of detect the severity of depression symptoms in previously diagnosed patients , as well as the existence of changes in the patient’s condition over time. In this way, its main objectives are the assessment of said severity, the assessment 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 objective, it has also been applied to evaluate the presence of depressive symptoms in other problems and conditions, such as dementia.
Structure and punctuation
This instrument consists of a total 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 an element that the subject has to evaluate on a scale that ranges between zero and 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 end up being assessed in the six factors mentioned above.
Specifically, the factors in question that are raised are the assessment of somatic anxiety, weight (we must not forget that in depression the presence of eating disorders is common), cognitive alteration, diurnal variation (if there is diurnal worsening, for example) , slowing down, and sleep disturbances. However Not all of these factors are equally important with the different aspects having a different weight and being weighted differently in the score (for example, cognitive impairment and slowdown are valued more and agitation and insomnia are valued less).
This is a scale initially proposed to be applied externally by a professional, although it is also possible to be completed by the evaluated subject himself. In addition to the scale itself, which is completed during a clinical interview, External information such as that from family members can also be used or the environment as a complement.
Interpretation
The interpretation of this test is relatively simple. The total score ranges between 0 and 52 points (this being the maximum score), most of the items having five possible answers (from 0 to 4) with the exception of some elements with lower weighting (which range from 0 to 4). 2).
This total score has different cut-off points, with 0-7 being considered that the subject does not present depression, a score of 8-13 represents the existence of mild depression, 14-18 represents moderate depression, and 91 to 22 represents 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 aspects, including a possible treatment it must be taken into account that it is considered that there has been a response to this if there is a decrease of at least 50% of the initial score, and a remission with scores less than 7.
Compared to other tests that assess depressive symptomatology, The Hamilton Depression Scale has the advantage of evaluating non-cognitive elements that other scales do not usually take into account, in addition to illiterate subjects or those with other disorders.
However, it also has certain drawbacks: technically it does not allow diagnosis as it is not designed with this objective (although it allows evaluating the altered aspects of depression) and it gives excessive weight to somatic aspects that can be confused with independent medical problems. Furthermore, in its original version it does not include elements as relevant as anhedonia (since it was developed before the emergence of the DSM-III diagnostic criteria).
