Hamilton Depression Scale (HAMD)

1. Depressed Mood

Please select

Depressed Mood

None

Only expressed when asked

Spontaneously expressed in speech

Can be seen from expressions, gestures, voice, or desire to cry, without words

Patient's spontaneous and non-spontaneous language (expressions, actions) almost entirely reflects this emotion

2. Guilt

Please select

Guilt

None

Blaming oneself, feeling that one has burdened others

Believing that one has sinned, or repeatedly thinking about past mistakes and faults

Believing that the current illness is a punishment for one's mistakes, or having delusions of guilt

Delusions of guilt accompanied by accusatory or threatening hallucinations

3. Suicide

Please select

Suicide

None

Feels that living has no meaning

Wishes to be dead, or often thinks about death-related matters

Negative thoughts (suicidal ideation)

Severe suicidal behavior

4. Difficulty Falling Asleep

Please select

Difficulty Falling Asleep

None

Reports occasional difficulty falling asleep, unable to sleep within half an hour of going to bed

Reports difficulty falling asleep every night

5. Sleep Not Deep

Please select

Sleep Not Deep

None

Light sleep with many nightmares

Woke up in the middle of the night (before midnight) (not including bathroom trips)

6. Early Awakening

Please select

Early Awakening

None

Awakes earlier than usual by 1 hour, but can fall back asleep

Cannot fall back asleep after waking up early

7. Work and Interest

Please select

Work and Interest

None

Mentioned only when asked

Spontaneously expresses loss of interest in activities, work, or study, feeling lethargic, indecisive, unable to persist, or needing to force oneself to work or engage in activities

Less than 3 hours of work or entertainment in the hospital

Stopped working due to current illness; hospitalized patients do not participate in any activities or cannot complete daily tasks without help

8. Psychomotor Retardation: refers to slowed thinking and speech, difficulty concentrating, and reduced initiative.

Please select

Psychomotor Retardation: refers to slowed thinking and speech, difficulty concentrating, and reduced initiative.

None

Mild retardation found during mental examination

Significant retardation found during mental examination

Difficulties during mental examination

Completely unable to answer questions (stupor)

9. Agitation

Please select

Agitation

None

Appears somewhat restless during examination

Clearly restless or fidgety

Cannot sit still, stood up during examination

Rubbing hands, biting fingers, pulling hair, biting lips

10. Psychic Anxiety

Please select

Psychic Anxiety

None

Mentioned only when asked

Spontaneously expresses

Facial expressions and speech show obvious worry

Obvious panic

11. Somatic Anxiety: refers to physiological symptoms of anxiety, including dry mouth, abdominal distension, diarrhea, belching, abdominal cramps, palpitations, headaches, hyperventilation and sighing, as well as frequent urination and sweating.

Please select

Somatic Anxiety: refers to physiological symptoms of anxiety, including dry mouth, abdominal distension, diarrhea, belching, abdominal cramps, palpitations, headaches, hyperventilation and sighing, as well as frequent urination and sweating.

None

Mild

Moderate, with definite symptoms as described above

Severe, significant symptoms affecting daily life or requiring additional treatment

Severely affects daily life and activities

12. Gastrointestinal Symptoms

Please select

Gastrointestinal Symptoms

None

Decreased appetite but can eat without prompting from others

Needs prompting or requests from others to eat or requires laxatives or digestive aids

13. General Symptoms

Please select

General Symptoms

None

Feeling of heaviness in limbs, back, or neck, back pain, headache, muscle pain, general weakness or fatigue

Symptoms mentioned above are significant

14. Sexual Symptoms: refers to decreased libido, menstrual irregularities, etc.

Please select

Sexual Symptoms: refers to decreased libido, menstrual irregularities, etc.

No symptoms, or cannot be certain, or not applicable to the assessed individual.

Mild

Severe

15. Hypochondria

Please select

Hypochondria

None

Excessive concern about health

Repeatedly thinking about health issues

Hypochondriacal delusions

Hypochondriacal delusions accompanied by hallucinations

16. Weight Loss

Please select

Weight Loss

None

Weight loss of more than 1 pound within a week

Weight loss of more than 2 pounds within a week

17. Insight

Please select

Insight

Aware of being ill, exhibiting depression

Aware of being ill but attributes it to poor diet, environmental issues, excessive work, viral infection, or need for rest

Completely denies being ill

18. Day-Night Variation (If symptoms worsen in the morning or evening, indicate which one first, then rate the degree of variation)

Please select

Day-Night Variation (If symptoms worsen in the morning or evening, indicate which one first, then rate the degree of variation)

None

Mild variation

Severe variation

19. Depersonalization or Derealization: Refers to feelings of unreality or nihilistic delusions.

Please select

Depersonalization or Derealization: Refers to feelings of unreality or nihilistic delusions.

None

Only mentioned when asked

Spontaneously reported

Nihilistic delusions

Nihilistic delusions accompanied by hallucinations

20. Paranoid Symptoms

Please select

Paranoid Symptoms

None

Suspiciousness

Beliefs of being connected to others

Delusions of reference or persecution

Delusions of reference or persecution accompanied by hallucinations

21. Obsessive Symptoms: Refers to obsessive thoughts and behaviors.

Please select

Obsessive Symptoms: Refers to obsessive thoughts and behaviors.

None

Only mentioned when asked

Spontaneously reported

22. Feeling of Decreased Ability

Please select

Feeling of Decreased Ability

None

Only mentioned when asked

Patient actively expresses feeling of decreased ability

Needs encouragement, guidance, and comfort to complete daily tasks or personal hygiene

Needs assistance for dressing, grooming, eating, making the bed, or personal hygiene

23. Feelings of Hopelessness

Please select

Feelings of Hopelessness

None

Sometimes doubts "if things will get better," but can accept after explanation

Continuously feels "there is no hope," but can accept after explanation

Feels hopeless, pessimistic, and desperate about the future, cannot dismiss after explanation

Repeatedly expresses "my illness will not get better" or similar remarks

24. Feelings of Worthlessness

Please select

Feelings of Worthlessness

None

Rarely has thoughts of worthlessness

Can describe worthlessness but does not emphasize it

Expresses worthlessness and believes they are not worth anything

Repeatedly expresses thoughts of worthlessness

25. Feelings of Regret

Please select

Feelings of Regret

None

Sometimes expresses regret, but can accept explanation

Frequently expresses regret, but can accept explanation

Regularly expresses strong feelings of regret and remorse

Frequently expresses feelings of regret and remorse to a serious extent

Score:

Results Interpretation

Total score < 8: Normal;

Total score between 8 and 20: Possible depression;

Total score between 20 and 35: Definitely has depression;

Total score > 35: Severe depression.

The Hamilton Depression Scale (HAMD), developed by Hamilton, is the most commonly used scale for assessing depression in clinical settings. The scale consists of 24 items, is straightforward, has clear standards, and is easy to master. It is suitable for adults with depressive symptoms. The total score can reflect the severity of the illness and effectively measure treatment outcomes, making it a classic and recognized tool for assessing depression.

Most items on the HAMD use a 0-4 point scoring method. The scoring standards are: (0) None; (1) Mild; (2) Moderate; (3) Severe; (4) Extremely severe. A few items use a 0-2 point scoring method, with the grading standards being: (0) None; (1) Mild to moderate; (2) Severe.

The assessment should be conducted jointly by two trained raters. Generally, interviews and observations are used, and after the assessment is completed, the two raters score independently.

If it is necessary to compare changes in depressive symptoms and condition before and after treatment, the assessment should be conducted at the time of enrollment or one week prior, and again 2-6 weeks after treatment for comparison.

References

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.