Hamilton Depression Rating Scale (HAMD-21)

1. Scale Overview

The Hamilton Depression Rating Scale (HAMD) is an internationally used tool for assessing depressive symptoms, developed by the British psychiatrist Max Hamilton in 1960. This version has 21 items (the first 17 are scored, and the last 4 are used to assist clinical information), covering emotional, cognitive, physical, and other multidimensional assessments; for more than half a century it has remained one of the most widely used tools in the field of depressive symptom assessment.

This scale is in the public domain and can be used for clinical assessment, research, and personal reference. Through standardized items, it quantitatively assesses the severity of depressive symptoms, providing a reference for the early screening, symptom monitoring, and treatment evaluation of depression.

2. Scale Structure and Scoring Method

This scale has 21 items in total, covering the following symptom dimensions:

• Emotional symptoms: depressed mood, guilt, suicidal ideation, hopelessness, and feelings of inferiority
• Sleep disturbance: difficulty falling asleep, light sleep, and early awakening
• Activity and cognition: reduced work and interest, retardation (slowed thinking/speech/movement), agitation, and a sense of reduced ability
• Anxiety symptoms: psychic anxiety and somatic anxiety
• Somatic Symptoms: gastrointestinal symptoms, general symptoms, sexual symptoms, and weight loss
• Other: hypochondriasis, insight, diurnal variation, depersonalization, paranoid symptoms, and obsessive-compulsive symptoms

Scoring notes: the first 17 items are counted in the total score (on a 0-2 or 0-4 scale), with a total score range of 0-52. The higher the score, the more severe the depressive symptoms. Items 18-21 (diurnal variation, depersonalization, paranoid symptoms, and obsessive-compulsive symptoms) are not counted in the total score and are used to assist clinical observation.

3. Scoring Rules for Each Dimension

This test has 21 questions, scored by level according to symptom severity:

• Items on a 0-2 scale (items 4, 5, 6, 12, 13, 14, and 16): 0 points = none; 1 point = mild/questionable; 2 points = obvious/severe
• Items on a 0-4 scale (the other 14 items): 0 points = none; 1 point = mild; 2 points = moderate; 3 points = severe; 4 points = extremely severe
• Total score range: 0-52 points (the higher the score, the more severe the symptoms)

4. Result Interpretation Criteria

• 0-7 points: no depressive symptoms; mood is good
• 8-13 points: mild depressive symptoms; it is advisable to pay attention to mood changes
• 14-18 points: moderate depressive symptoms; seeking professional help is recommended
• 19-22 points: severe depressive symptoms; seeing a doctor is strongly recommended
• ≥23 points: extremely severe depressive symptoms; emergency professional intervention is needed

5. Applicable Scenarios

The Hamilton Depression Rating Scale is suitable for the following scenarios:

• People who show depressed mood and reduced interest and want to understand their own depressive state
• Assessment of symptom severity and monitoring of treatment effects in patients with depression
• Standardized measurement in mental health screening and clinical research
• Assessment of depressive symptoms in psychiatric outpatients and inpatients

6. Usage Notes

• Please base your choices onthe past week's actual feelings
• Results are affected by your current emotional state; it is advisable to consider long-term patterns for a comprehensive judgment
• Diagnosis of depression requires a professional doctor to make a comprehensive assessment based on symptom duration (at least 2 weeks)
• If you have suicidal thoughts or behavior, please immediately call a psychological crisis intervention hotline or go to a hospital
• This assessment result is for reference only and cannot replace a professional medical diagnosis

7. Core Symptoms of Depression

Before taking a depression self-test, understanding the core symptoms of depression helps you complete the test more accurately:

• Persistent low mood, loss of interest in everything, and anhedonia
• Noticeably reduced energy, easy fatigue, and feeling weak after even slight activity
• Sleep disturbance: there may be insomnia (difficulty falling asleep, early awakening) or excessive sleepiness
• Changes in appetite and weight: reduced appetite and weight loss, or increased appetite and weight gain
• Impaired cognitive function: difficulty concentrating, slowed thinking, and reduced memory
• Self-blame and guilt, excessive guilt, and hopelessness about the future
• Possible suicidal thoughts or suicidal behavior

If one or more of the above symptoms persist in your daily life, it is advisable to assess yourself with a professional tool and seek professional help promptly. Early detection and early intervention are key to improving the prognosis of depression.