HAM-D: Hamilton Depression Rating Scale

Overview

The HAM-D is a clinician-rated scale for depression symptom severity. The 17-item version described here produces a total from 0 to 52. Published forms and score bands differ, so record the edition and scoring convention used.

Why the exact edition matters

A result is incomplete without its edition.

Hamilton's original depression rating scale was published in 1960. Later forms changed the number of items, interview guidance, response anchors, optional branches, and score interpretation. The name "HAM-D-17" therefore does not identify every detail needed for reproducible administration.

This page describes a 17-item form with a past-week instruction and a 0 to 52 total. Other versions use different items, branches, or recall periods.

Because those details change interpretation, record the form, interview method, recall interval, rater training, and scoring convention with any result. Do not compare totals from unidentified editions as though they were interchangeable.

How HAM-D scoring works

The questions use a mix of 0 to 4 and 0 to 2 ratings. The 17 values add to these display bands:

These labels were not part of the original Hamilton paper (1960), and later publications use different boundaries. The lowest band should not be relabeled as remission without a protocol that defines remission and assesses the person more broadly.

A total describes the sum of the current ratings. It does not diagnose major depressive disorder, establish functional recovery, select treatment, or explain why a score changed.

What the scale covers

The current form rates mood, guilt, sleep, work and interests, movement, anxiety, physical symptoms, weight, and insight. Some ratings rely on what the patient reports. Others depend on clinician observation and judgment.

This mixture is one reason rater training matters. Sleep, appetite, energy, anxiety, and physical complaints can reflect depression, medical conditions, medication effects, or more than one cause. The total does not separate those explanations.

Administration and reliability

The HAM-D is clinician-administered, not a patient self-report questionnaire. Use the same specified interview method and trained rating process when comparing results over time.

Williams developed a structured interview guide because agreement on individual items with less structured administration was often only fair or poor. Williams (1988) found that added interview guidance improved agreement. That finding supports standardized administration; it does not prove that every modern HAM-D form produces the same result.

In one primary-care study, a specified semistructured 17-item protocol produced an intraclass correlation of 0.95 among 42 patients with paired ratings. Morriss et al. (2008) applies to that protocol and sample, not to every edition or interview.

Item 3 and safety

Any nonzero response on Item 3 needs direct safety follow-up. The item score does not establish current suicide risk, intent, or required level of care.

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Clinicians should follow their organization's direct suicide-risk assessment and emergency protocol regardless of the total. A manual or imported total-only result cannot show the Item 3 response. Its safety status is therefore unknown.

The wording and response anchors for Item 3 vary across HAM-D forms. Use the selected edition's exact anchors and do not infer the item response from a total-only record.

When the HAM-D is useful

The HAM-D can document clinician-rated symptom severity in a specialist or research protocol that names an exact form and administration method. Repeated ratings can describe symptom change when the same edition, recall period, rater process, and scoring convention are maintained.

The scale should not replace a diagnostic interview or a broader review of functioning and safety. It also should not be used as a self-screen. A self-report tool such as the PHQ-9 collects different information and is not an interchangeable shorter HAM-D.

Interpreting change

Research studies often define response or remission for their own protocols. Those conventions vary and should not be imported into an individual result without naming the source, population, edition, and purpose.

The total cannot show what changed. A lower total means the rated items summed to less under the same scoring method, but it does not identify the cause or show whether important symptoms and functional problems remain. Review the item pattern, functioning, adverse effects, safety, and clinical course.

For a plain-language walkthrough, read what your HAM-D score means.

Important limits

• The 0 to 52 range and display bands apply to the 17-item version described here.
• The HAM-D is a clinician rating, not a diagnostic interview or self-report screen.
• Interview structure and rater training affect reliability.
• Total-only results cannot recover Item 3 safety information.
• Score bands do not prescribe treatment, level of care, response, or remission.