The Psychiatric Evaluation and Evidence-Based Rating Scales

Hamilton Depression Rating Scale

According to Carlat (2017) three objectives of a psychiatric interview write-up include thoroughness, time efficiency, and readability. A psychiatric interview should take no longer than 10 to 15 minutes to write, utilize free text space to provide a narrative and be no longer than two pages to satisfy time efficiency and readability (Carlat, 2017). Important aspects of a psychiatric interview write-up include all components of a history and physical with additional sections about past psychiatric history, substance use, mental status examination, and DSM-V diagnoses.

I was assigned the Hamilton Depression Rating Scale (HAM-D) created by Max Hamilton in 1960. Major depressive disorder is one the most diagnosed psychiatric conditions worldwide (Primo de Carvalho Alves, et al., 2017). The HAM-D is considered the gold standard in assessing depression severity and is comprised of 21 items with 17 scored questions including depressed mood, feelings of guilt, thoughts or suicide attempts, insomnia, among other categories (Rohan, et al., 2016). The overall score is calculated based on each of the 17 scored categories. Fifty points is the highest possible score calculating to very severe depression. It is appropriate to use the HAM-D if any of the measured categories are assessed during the psychiatric interview, if the patient has a history of depression, or verbalize current feelings of depression. Use of the HAM-D assessment tool has been thoroughly studied and should be administered prior to treatment, during treatment, and after treatment to calculate any change in depression scoring (Rohan, et al., 2016). The psychiatric mental health nurse practitioner should complete this assessment in 10 to 15 minutes during the psychiatric interview (American Psychological Association, 2020). Results from the HAM-D can show an improvement in depression symptoms when compared to the assessment prior to treatment.


Carlat, D. (2017). The Psychiatric Interview (4th ed.). Wolters Kluwer.

Depression Assessment Instruments. (2020). American Psychological Association.

Primo de Carvalho Alves, L., Pio de Almeida Fleck, M., Boni, A., & Sica da Rocha, N. (2017). The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome. PLOS ONE, 12(1), e0170000.

Rohan, K. J., Rough, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Roberts, L. M., & Vacek, P. M. (2016). A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, Rater training, and outcome accuracy with data on its application in a clinical trial. Journal of Affective Disorders, 200, 111–118.


Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.
By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Thanks for sharing your post, I am familiar with the “The Hamilton Depression Rating Scale (HAM-D) “I know it is an assessment tool used to determine the severity of depression in a client before and even during treatment. It is better to use this assessment tool before initiating treatment for a depressed client in other to assess the severity of depression, and after treatment is started,providers will normally reassess with the same assessment tool,  in a month (4 weeks ) to see if the client’s depression symptoms are reduced or not. It is evidence based that the HAM-D has adequate internal reliability, but some of the items on the scale poorly contribute to the measurement of depression severity (Rohan, Rough, & Vacek, 2016).  Poor interrater and retest reliability has also been proven (Rohan et al., 2016).  The main criticism related to the scale is “construct validity, since it may represent a multidimensional measure due to its inclusion of symptoms beyond the core symptoms of depression” (Da Silva, Reche, Lima, Fleck, Capp, & Shansis, 2018).  It is important to keep in mind that “The HAM-D” only measures the severity of depression, and does not determine a depressive disorder (Olden, Rosenfeld, & Breitbart, 2009).


Da Silva, A., Reche, M., Lima, A., Fleck, M., Capp, E. & Shansis, F. (2018). Assessment of the Psychometric Properties of the 17-and6-item Hamilton Depression Rating Scales in Major Depressive Disorder, Bipolar Depression and Bipolar Depression with Mixed Features. Journal of Psychiatric Research. Retrieved from Walden Library database.


Rohan, K.J., Rough, J.N., & Vacek, P.M. (2016). A Protocol for the Hamilton Rating Scale for Depression: Item Scoring Rules, Rater Training, and Outcome Accuracy with Data on its Application in a Clinical Trial. Journal of Affective Disorders. Retrieved from

Olden, M., Rosenfeld, B., & Breitbart, W. (2009). Measuring Depression at the End of Life: Is the Hamilton Depression Rating Scale a Valid Instrument? Department of Health and Human Services. Retrieved from

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