[HRSD Hamilton Depression Scale]
Hamilton Depression Scale is the most commonly used scale in clinical evaluation of depression compiled by Hamilton in 1960, and has been revised several times since then. There are 24 versions of17,21. Now, 24 versions have been released.
Adaptation range
Suitable for adults with depressive symptoms.
Reliability and validity test
If (1) Reliability: Evaluators are trained, they can expect a high degree of consistency. Hamilton himself reported that the reliability of 70 patients with depression was 0.90. Shanghai Mental Health Center conducted a joint examination on 46 patients with depression, bipolar disorder and anxiety. The consistency between the two evaluators is quite good: the reliability coefficient of the total score evaluation is 0.99; The reliability coefficient of each single symptom score is 0.78-0.98; P values are all less than 0.0 1, and the China Psychiatric Scale 14 unit cooperation group and each cooperation group have a good consistency, with the reliability coefficient of the total score of 0.88-0.99 and the P value less than 0.0 1.
(2) Validity: The total score of HRSD can better reflect the severity of the disease. Foreign reports show that the correlation coefficient with GAS is r0.84, and domestic reports show that the empirical authenticity coefficient reflecting the severity of clinical symptoms is 0.92. HRSD can also measure the therapeutic effect well. Shanghai Mental Health Center analyzed the changes of total score and clinical efficacy of 58 patients with depression before and after treatment, showing a positive correlation, r = 0.26 (P0.05). If factor analysis is used to analyze the curative effect, it can also accurately reflect the changes of each target symptom group.
Application mode
The joint inspection of HRSD should be conducted by two trained assessors. Generally speaking, talk and observation are used. After the inspection, the two judges scored independently. If it is necessary to compare the depressive symptoms and illness changes before and after treatment, evaluate the situation at that time or one week before the group; After 2-6 weeks of treatment, they were evaluated and compared again. Most projects in HRSD adopt a five-level scoring method, with scores of 0-4: (0) None, (1) Mild, (2) Moderate, (3) Severe and (4) Severe. A few items were rated as 0-2 and 3 grades: (0) none, (1) mild to moderate, and (2) severe. The following describes the specific scoring criteria for each project name.
Matters needing attention
(1) Item 9 and Item 1 1 of HRSD were evaluated according to patient observation; The rest items are scored according to the patient's own oral narrative; However, the project 1 requires both. In addition, in items 7 and 22, it is still necessary to collect data of patients' families or ward staff; For item 16, it is best to evaluate it according to the weight record, or according to the patient's chief complaint and the information provided by family members or ward staff.
(2) Some versions only have 2 1 item, that is, 22-24 items are less than 24 items, and the seventh item is a three-level scoring method, with 0-2 points. Now a five-level scoring method of 0-4 points is adopted.
(3) There are only 17 items in some versions, that is, there are no 18-24 items.
(4) The evaluation will take about (15-20) minutes. This mainly depends on the severity and cooperation of people's illness; If the patient is seriously delayed, the time will be longer.
Result interpretation
(1) Boundary value: According to Davis JM, the total score is over 35, which may be severe depression; More than 20 points may be mild or moderate depression; If the score is less than 8, but there are no depressive symptoms, the scores of the 17 version are 24, 17 and 7 respectively.
(2) Total score: it is a very important information, which can better reflect the severity of the disease, that is, the lighter the disease, the lower the total score; The more serious the illness, the higher the total score. The total score of HRSD of 1 15 inpatients with depression (version 17) is 28. 457.4438+06 (x standard deviation). ), indicating that the research object is a group of patients with severe depression, which is convenient for analogy and repeated research results. At the same time, the change of the total score can evaluate the evolution of the disease, such as the depressive symptoms of the above-mentioned 1 15 patients with depression. After 4 weeks of treatment, the total HRSD score (version 17) decreased to 12.688.75, indicating that the patient's condition has made obvious progress. In addition, this result is consistent with clinical experience and impression.
(3) Factor score: HRSD can be divided into seven factor structures: (1) anxiety/somatization, which consists of mental anxiety, somatic anxiety, gastrointestinal symptoms, hypochondriasis and insight; (2) weight, that is, weight loss; (3) Cognitive impairment consists of six items: self-guilt, suicide, anxiety, disintegration of personality or reality, paranoid symptoms and obsessive-compulsive symptoms. (4) daily variation; Only one day and one night changes; (5) stunting, including depression, work and interest, stunting and sexual symptoms; (6) Sleep disorder, which consists of difficulty in falling asleep, lack of sleep and early awakening; (7) Despair consists of three items, namely, sense of diminished ability, sense of despair and sense of inferiority. This can reflect the actual characteristics of the patient's condition more simply and clearly, and better reflect the treatment effect of the target symptom group.
Application value
HRSD is a classic quantitative scale for depression, which has been used for a long time and has been recognized. The method is simple, the standard is clear and easy to master. It can be used to evaluate the depressive symptoms of depression, bipolar disorder, anxiety and other diseases, especially for depression. But this scale can't distinguish between depression and anxiety, because the total score of both has a similar increase.
Theoretical significance
In depression scale, HRSD is one of the criteria. If we want to develop a new depression scale, we usually need to test its parallel validity with HRSD scale. HRSD factor analysis can reflect the psychopathological characteristics of patients with depression.
Hamilton Depression Scale (HRSD)