BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet Test: Hamilton Rating Scale for Depression (HRSD) Year: 1960 Domain: Psychological Assessment Tool Category: Mental Health Test Category (Bio, Psycho or Social): Psychological Variations/Translations: Other versions include a 17, 21 and 24 item scale. This test has also been translated other languages: French, Spanish, Dutch, Cantonese, Arabic, Russian, Japanese, and Hindi. Setting: Clinical Method of Delivery: Semi-structured clinical interview. Description: This test is designed to assess the severity of depression in patients already diagnosed with depressive disorder. It covers depressive state and is intended primarily for use as a research tool. The HRSD contains 21 ratings measured on a three (0 to 2) or five (0 to 4) point scale. The first 17 items are used in scoring the instrument, and the final four provide more detail on the clinical characteristics of the depression. Scoring/Interpretation: Two raters should be used. One who interviews the patients and the other adds questions where appropriate. When the interview is complete, the two raters complete rating forms independently and later compare scores and discuss differences. Relatives or significant others should also be interviewed. The ratings cover depressive symptoms during the past few days or a week. The intensity and frequency of symptoms are also considered. Themes that are difficult to quantify are rated grossly on a 0 to 2 scale: 0=symptom absent, 1=slight or doubtful and 2=clearly present. Other items are graded on a 0 to 4 scale in terms of increasing intensity: 0=symptom absent, 1=doubtful, 2=mild, 3=moderate and 4=severe. Half points may also be used. A total score sums the item responses and ranges from 0 to 52 points with rising severity of depression. By general consensus, scores lower than 7 indicate absence of depression, 18 to 24 moderate, and 25 or above represent severe depression. Time to Administer: 30 minutes Availability: Available in source article (Hamilton, 1960). Software: N/A Website: N/A Quantitative/Qualitative: Quantitative Validity (Quantitative): The content validity of this test has been criticized because of it being restricted and of its covering more than just the severity of depression. Another criticism is that its content is mixed, such that some items cover severity, whereas others classify depression rather than measure its severity. This scale has been tested against clinical ratings of severity. The 17 item version was significantly related to globally assessed severity of depression on the Montgomery-Asberg Depression Scale with a correlation of 0.71. Correlations with the Minnesota Multiphasic Personality Inventory were low, at 0.27 and 0.34. Reliability (Quantitative): From a World Health Organization study in five countries, an alpha internal consistency was reported showing figures of alpha=0.48 at baseline, rising to 0.85 after 11 days of treatment. The inter-rater reliability for the HRSD total score is high showing a correlation of 0.90 between pairs of ratings for 70 people. The intraclass test-retest reliability at 3 weeks was 0.72 for the 17 item version, 0.70 for the 21 item version, and 0.69 for an abbreviated five item version. References: Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Paychiatry; 23, 56-62. McDowell, I. (2006). Measuring Health: A guide to rating scales and questionnaires 3rd Ed. New York: Oxford University Press. Comments: The HRSD has been the most frequently used clinical rating scale for depression in the past 40 years.