Hamilton Anxiety Rating Scale (HAM-A)

Description

Hamilton Depression Rating Scale is one of the earliest scales that was developed to assess the

symptoms of depression in a client. Similar to HAM-A, the HAM-D does not include prompt

questions. The scale rather has 17 groups, each assessing symptoms that are associated with

depression. The clinician rates the client based on the severity of the symptoms. The individual

scores are then summed up to provide the final rating of anxiety. Scores between 0 and 7

indicate the lack of depression, those between 8 and 13 indicate mild depression, those

between 14 and 18 indicate moderate depression, those between 19 and 22 indicate severe

depression, and scores equal to or greater than 23 indicate very severe depression (Hamilton,

1960).

Development

HAM-D was developed by Max Hamilton as a method to differentiate depression and to provide

a measure for the progress made during therapy. However, Hamilton warned that the scale

should not be used as a diagnostic tool (Berrios & Bulbena, 1990). The scale was originally

published in 1960 and was subsequently revised in 1966, 1967, 1969, and 1980.

Psychometric properties

In patients with multiple sclerosis, HAM-D showed good convergent validity with respect to

neuropsychiatric inventory (NPI) subdomain of depression (r rho = .85) and good divergent

validity with respect to remaining NPI subdomains (r rho < .30). It was also found to have good

internal consistency (Cronbach's alpha = 0.8) (Raimo, 2015).

Application

According to Hamilton, the scale is used to differentiate depression from mixed presentation

and can also be used to assess the effectiveness of and the progress made in therapy (Hamilton,

1960). The scale should not be used as a diagnostic tool, however.

 References

Berrios, G.E., & Bulbena, A. (1990). The Hamilton Depression Scale and the Numerical

Description of the Symptoms of Depression. In Bech, P., & Coppen, A. (Eds.), The

Hamilton Scales, Heidelberg: Springer, pp. 80–92

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and

Psychiatry, 23(1), 56-62.

Raimo, S., Trojano, L., Spitaleri, D., Petretta, V., Grossi, D., & Santangelo, G. (2015). Psychometric

properties of the Hamilton Depression Rating Scale in multiple sclerosis. Quality of life

research : an international journal of quality of life aspects of treatment, care and

rehabilitation, 24(8), 1973–1980. https://doi.org/10.1007/s11136-015-0940-8

 Proforma of the client

Name- SS

Age- 21

Gender- Female

Education- Completed BTech in chemical engineering

Presenting concerns- Self-doubts, feelings of guilt, disappointment with self, sense of

helplessness

Test administered- Hamilton Depression Rating Scale

Purpose of testing- To assess the level of depression of the client

Behavioural observations-

● Appearance and grooming- Properly dressed and groomed. Hair combed.

● Psychomotor activity- Normal and no signs of tics or mannerisms. No psychomotor

agitation or retardation was observed.

● Speech- Client's speech was spontaneous, coherent, had proper intonations, and was

rich in content. She could answer the questions posed, and could elaborate her

responses when requested to do so.

● Eye contact- The client made appropriate eye contact throughout the sessions

Test results

The client had the following scores on the 17 symptoms-

1. Depressed mood- 1

2. Feelings of guilt- 2

3. Suicide- 0
 4. Insomnia- initial- 1

5. Insomnia- middle- 1

6. Insomnia- delayed- 1

7. Work and interests- 1

8. Retardation- 0

9. Agitation- 1

10. Anxiety- psychic- 1

11. Anxiety- somatic- 0

12. Gastrointestinal somatic symptoms - 1

13. General somatic symptoms- 1

14. Genetic symptoms- 0

15. Hypochondriasis- 0

16. Weight loss- 1

17. Insight- 0

The final score for the client on the scale was 12.

Test interpretation

The score of 12 indicates that the client has mild depression.

Impression and recommendation

The client has been in therapy for quite some time now and the improvement is visible in the

form of a low test score. The therapist and the client would need to work further to consolidate

the gains made in therapy.