Depression scales
Hamilton Rating Scale for Depression (HAM-D)
Main reference: Hamilton M: A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry 23:56–62, 1960.
Type: Clinician-rated scale.
Main indications: Designed to measure the severity of depressive symptoms in patients with primary depressive illness, but has since been used to assess depressive symptoms in other groups.
Rating performed by: Trained clinician or trained mental health professional, on the basis of observation during interview. Rating should ideally take place at a fixed time to avoid the influence of diurnal variation.
Time period covered by scale: Clinical condition at the time of the interview.
Time required to complete rating: 15-20 minutes. Semi-structured interview.
Remarks: Hamilton published recommendations for rating each item in 1967. Most commonly used version is the 17-item. Is also useful for monitoring changes in depressive symptoms during treatment and in comparing the efficacy of various interventions. Not a diagnostic instrument.
Validity can be a problem in patient populations having concurrent somatic illnesses. There is some consensus for interpretation of the total scores: very severe, >23; severe, 19–22; moderate, 14–18; mild, 8–13; and no depression, 0-7.
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Bech–Rafaelsen Melancholia Scale (MES)
Main reference: Bech P: The Bech–Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders: a 20-year review of its use as outcome measure. Acta Psychiatrica Scandinavica 106:252–64, 2002.
Type: Clinician-rated symptom scale.
Main indications: Designed to assess and measure the severity of symptoms of depression, including depression in patients with comorbid medical conditions, and change in depressive state during treatment.
Rating performed by: Trained health professionals.
Time period covered by scale: At least three 3 days preceding the assessment; the time frame covered should be specified with the results.
Time required to complete rating: 10–15 minutes.
Remarks: Assesses 11 items (social life activities and interests, lowered mood, sleep disturbances, anxiety, introversion, concentration difficulties, tiredness, worthlessness and guilt, decreased verbal activity, suicidal thoughts, and decreased motor activity). Each item is scored on a scale of 0 (not present or no difficulties) to 4. The total score has been standardised so that scores of 6–9 indicate mild depression and scores >15 indicate major depression.
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Montgomery-Åsberg Depression Rating Scale (MADRS)
Main reference: Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134:382-389, 1979.
Type: Clinician-rated scale.
Main indications: Designed to be used in patients with major depressive disorder, both to measure the degree of severity of depressive symptoms, and particularly as a sensitive measure of change in symptom severity during the treatment of depression.
Rating performed by: Trained interviewer.
Time period covered by scale: Clinical condition at the time of the interview. Does not specify a time frame during which the patient should be rated.
Time required to complete rating: Approx. 15 minutes.
Remarks: Is a 10-item checklist. Widely used in drug-treatment trials, mainly because of its particular sensitivity to treatment effects. Since there is a comparative lack of emphasis on somatic symptoms, the scale is useful for the assessment of depression in people with physical illness. The following mean scores correlated with global severity measures, according to a study: very severe, 44; severe, 31; moderate, 25; mild, 15; and recovered, 7.
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Major depression inventory (MDI)
Main reference: Bech P, Rasmussen N, Olsen R, et al.: The sensitivity and specificity of the MDI using the present State Examination as the index of diagnostic validity. Journal of Affective Disorders 66:159–164, 2001.
Type: Self-rated questionnaire.
Main indications: Diagnosis of major depression, according to either the DSM-IV criteria or the ICD-10 criteria.
Rating performed by: The patient.
Time period covered by scale: The previous 2 weeks.
Time required to complete rating: 5–10 minutes.
Remarks: Well-researched inventory that has an acceptable specificity and sensitivity for identifying major depression. Patient questionnaire that involves marking boxes in response to 10 questions indicative of depressed mood, according to how much of the time the patient has experienced the feeling described in the question over the past 2 weeks. An answer of "more than half of the time" in at least 5 of the 10 questions is indicative of major depression. The MDI can also be scored according to DSM-IV and ICD-10 algorithms for depressive symptoms.
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Beck Depression Inventory (BDI)
Main reference: Beck AT, Ward CH, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 4:561–571, 1961. (A revised version is available at this website.)
Type: Symptom scale, which may be administered by a health professional or by the patient.
Main indications: Designed to measure attitude and symptoms that are characteristic of depression.
Rating performed by: Trained professional or self-administered.
Time period covered by scale: 2 weeks before the evaluation (1 week in the original version).
Time required to complete rating: 5–10 minutes.
Remarks: Rates 21 items, each with four or five response categories ordered by severity. Each item is scored on a scale of 0 (no problem) to 3. Total score is the simple sum of the 21 item scores. Generally, a score <9 indicates no or minimal depression, 10–18 indicates mild-to-moderate depression, 19–29 indicates moderate-to-severe depression, and >30 indicates severe depression. However, a score of 0–4 may suggest possible denial of depression and a score of 40–63 may suggest possible exaggeration of depression or a histrionic or borderline personality disorder. Reading age of about 10 is required for a patient who is self-administering the test.
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Hospital Anxiety Depression Scale (HAD)
Main reference: Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67:361–370, 1983.
Type: Self-administered rating scale of symptoms and functioning.
Main indications: Designed to assess the presence and severity of anxiety and depression in patients in non-psychiatric hospital settings. It may also be used in primary care or in the community.
Rating performed by: The patient.
Time period covered by scale: The past few days.
Time required to complete rating: 5–10 minutes.
Remarks: Can used by patients in either an in-patient or an out-patient setting. Anxiety and depression are assessed as separate components, each with seven items that are rated from 0 (no problem) to 3; scores are totalled for each component. A score of <7 in a component is taken as a normal result; a score of 8–10 indicates mild symptoms; 11–14 indicates moderate symptoms; and 15 or more indicates severe symptoms. The scores for the two components can also be added together to give a composite anxiety–depression score.
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Published on CNSforum 19 Aug 2004