Hamilton Depression Rating Scale, HDRS Test - the question form
Questions: 17 · 4 minutes
1. Depressed mood (sadness, hopelessness, helplessness, feelings of worthlessness).
0 – Absent
1 – These feelings expressed only when asked directly
2 – Expressed spontaneously in complaints
3 – Communicated nonverbally (observed): facial expression, posture, voice, tearfulness
4 – Patient expresses ONLY these feelings, both spontaneously and nonverbally
2. Feelings of guilt
Absent
Self-reproach; feels they have let others down
Ideas of guilt or ruminations over past errors or sins
Sees the current illness as punishment; delusions of guilt
Accusatory or condemning auditory hallucinations and/or threatening visual hallucinations
3. Suicidal thoughts or intentions
0 – Absent
1 – Feels life is not worth living
2 – Wishes of death or any thoughts of possible death
3 – Suicidal statements or gestures
4 – Suicide attempts (any serious attempt is rated 4)
4. Early insomnia
0 – No difficulty falling asleep
1 – Complains of occasional difficulty falling asleep (taking longer than 30 minutes)
2 – Complains of inability to fall asleep every night
5. Middle insomnia
0 - Absent
1 - Complains of restless sleep throughout the night
2 - Waking during the night; any getting out of bed is rated 2 (except to use the toilet)
6. Late insomnia
0 – Absent
1 – Early morning awakening with return to sleep
2 – Final insomnia or early morning awakening
7. Work and activities (in an inpatient setting: a rating of 3 is given if the patient is active for at least 3 hours per day (ward work or hobbies); a rating of 4 is given if the patient shows no activity at all or cannot manage even routine self-care activities without help).
0 – No difficulty
1 – Thoughts and feelings of inadequacy; fatigue and weakness related to activity (work or hobbies)
2 – Loss of interest in activity (work or hobbies), marked—either reported directly or indirectly through apathy and indecisiveness (feeling that extra effort is needed to start work or be active)
3 – Decrease in actual time spent in activity, or reduced productivity
4 – Stopped working because of the current illness
8. Psychomotor retardation (slowness of thought and speech; reduced ability to concentrate; decreased motor activity).
0 – Normal speech and thought
1 – Mild retardation during the interview
2 – Definite retardation during the interview
3 – Marked difficulty in conducting the interview
4 – Complete stupor
9. Agitation
0 – Absent
1 – Restlessness
2 – Fidgety hand movements; playing with hair, etc.
3 – Pacing; cannot sit still
4 – Constant hand-wringing; nail biting; hair pulling; lip biting
10. Psychic anxiety
0 – Absent
1 – Subjective tension and irritability
2 – Worrying over minor matters
3 – Anxiety apparent in facial expression and speech
4 – Fear expressed without questioning
11. Somatic anxiety (physiological symptoms of anxiety such as dry mouth, gastrointestinal upset, palpitations, headaches, shortness of breath, urinary frequency, sweating).
0 – Absent
1 – Mild
2 – Moderate
3 – Severe
4 – Very severe
12. Gastrointestinal somatic symptoms
0 – Absent
1 – Loss of appetite but eats without needing much encouragement; heaviness in the abdomen
2 – Eats only with persistent encouragement; requires laxatives or medication for gastrointestinal symptoms
13. General somatic symptoms
0 – Absent
1 – Heaviness in the limbs, back, or head; backache, headache, muscle aches; loss of energy or fatigue
2 – Any clearly pronounced symptoms
14. Genital symptoms
0 – Absent
1 – Mild – loss of libido
2 – Severe – menstrual disturbances
15. Hypochondriasis
0 – Absent
1 – Self-absorption (somatic)
2 – Excessive concern with health
3 – Frequent complaints, requests for help, etc.
4 – Hypochondriacal delusions
16. Weight loss (by history), if weekly weight change is present and currently recorded.
0 – No weight loss / Less than 0.5 kg per week
1 – Probable weight loss associated with the current illness / More than 0.5 kg per week
2 – Definite (by patient report) weight loss / More than 1 kg per week
17. Insight into illness
Awareness of being depressed or having some illness
Awareness of being unwell, but attributing it to poor diet, climate, overwork, a viral infection, need for rest, etc.
Complete lack of awareness of illness