REVIEW ARTICLE
DEPRESSION IN PRIMARY CARE
PART 1: SCREENING AND DIAGNOSIS
Appendix 1: Hamilton Depression Rating Scale
Reproduced from: Hamilton M. Hamiton Depression Rating Scale (HDRS). J Neuro Neurosurg Psychiatry. 1960;23:56-62
Patient Name: _____________________ Date: (dd/mm/yy) ___ / ___ /____ Rater: ____________________________
1. Depressed Mood
0. Absent
1. These feeling states indicated only on questioning.
2. These feeling states spontaneously reported verbally.
3. Communicates feeling states non-verbally, i.e. through facial expression,
posture, voice, and tendency to weep.
4. Patient reports virtually only these feeling states in his spontaneous verbal
and non-verbal communication.
2. Work and Activities
0. No difficulty
1. Thoughts and feelings of incapacity, fatigue or weakness related to activities;
work or hobbies.
2. Loss of interest in activities; hobbies or work-either directly reported by
patient, or indirect in listlessness, indecision and vacillation (feels he has to
push self to work or activities).
3. Decrease in actual time spent in activities or decrease in productivity. In
hospital rate 3 if patient does not spend at least three hours a day in activities
(hospital job or hobbies) exclusive of ward chores.
4. Stopped working because of present illness. In hospital rate 4 if patient
engages in no activities except ward chores, or if patient fails to perform ward
chores unassisted.
3. Genital Symptoms
0. Absent.
1. Mild.
2. Severe.
4. Somatic Symptoms – GI
0. None.
1. Loss of appetite but eating without staff encouragement. Heavy feelings in the
abdomen.
2. Difficulty eating without staff urging. Requests or requires laxatives or
medication for bowels or medication for GI symptoms.
5. Loss of Weight
0. No weight loss.
1. Probable weight loss associated with present illness.
2. Definite (according to patient) weight loss.
6. Insomnia – Early
0. No difficulty falling asleep.
1. Complains of occasional difficulty falling asleep, i.e. more than ½ hour.
2. Complains of nightly difficulty falling asleep.
7. Insomnia – Middle
0. No difficulty.
1. Patient complains of being restless and disturbed during the night.
2. Waking during the night – any getting out of bed rates 2 (except for purposes
of voiding).
8. Insomnia – Late
0. No difficulty.
1. Waking in early hours of the morning but goes back to sleep.
2. Unable to fall asleep again if he gets out of bed.
9. Somatic Symptoms
0. None.
1. Heaviness in limbs, back or head. Backaches, headache, muscle aches. Loss
of energy and fatigability.
2. Any clear-cut symptoms rates 2.
10. Feelings of Guilt
0. Absent.
1. Self reproach, feels he has let people down.
2. Ideas of guilt or rumination over past errors or sinful deeds.
3. Present illness is a punishment. Delusions of guilt.
4. Hears accusatory or denunciatory voices and/or experiences threatening
visual hallucinations.
11. Suicide
0. Absent.
1. Feels life is not worth living.
2. Wishes he were dead or any thoughts of possible death to self.
3. Suicide ideas or gestures.
4. Attempts at suicide.
12. Anxiety – Psychic
0. No difficulty.
1. Subjective tension and irritability.
2. Worrying about minor matters.
3. Apprehensive attitude apparent in face or speech.
13. Anxiety - Somatic
0. Absent
1. Mild.
2. Moderate.
3. Severe.
4. Incapacitating.
14. Hypochondriasis
0. Not present.
1. Self-absorption (bodily).
2. Preoccupation with health.
3. Frequent complaints, requests for help, etc.
4. Hypochondriacal delusions.
15. Insight
0. Acknowledges being depressed and ill.
1. Acknowledges illness but attributes cause to bad food, climate, over work,
virus, need for rest, etc.
2. Denies being ill at all.
16. Motor Retardation
0. Normal speech and thought.
1. Slight retardation at interview.
2. Obvious retardation at interview.
3. Interview difficult
4. Complete stupor.
17. Agitation
0. None
1. Fidgetiness.
2. Playing with hands, hair, etc
3. Moving about can’t sit still.
4. Hand wringing, nail biting, hair pulling, biting of lips.
17-item HDRS TOTAL: __ __
Score of 0-7: within normal or in clinical remission
Score of 20 or above: at least moderate severity and usually required medication.
P/s: Please cover the score and the interpretation when administer this questionnaire.