(to be administered by a health care professional)
Patient’s Name
Date of Assessment
To rate the severity of depression in patients who are already diagnosed as depressed, administer this
questionnaire. The higher the score, the more severe the depression.
For each item, write the correct number on the line next to the item. (Only one response per item)
1. DEPRESSED MOOD (Sadness, hopeless, helpless, worthless)
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 nonverbal
communication
2. 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
3. SUICIDE
0= Absent
1= Feels life is not worth living
2= Wishes he were dead or any thoughts of possible death to self
3= Suicidal ideas or gesture
4= Attempts at suicide (any serious attempt rates 4)
4. INSOMNIA EARLY
0= No difficulty falling asleep
1= Complains of occasional difficulty falling asleep—i.e., more than 1/2 hour
2= Complains of nightly difficulty falling asleep
5. 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)
Adapted from Hedlung and Vieweg, The Hamilton rating scale for depression, Journal of Operational Psychiatry, 1979;10(2):149-165.
6. 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
7. 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 activity; 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
4= Stopped working because of present illness
8. RETARDATION: PSYCHOMOTOR (Slowness of thought and speech; impaired ability
to concentrate; decreased motor activity)
0= Normal speech and thought
1= Slight retardation at interview
2= Obvious retardation at interview
3= Interview difficult
4= Complete stupor
9. 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
10. ANXIETY (PSYCHOLOGICAL)
0= No difficulty
1= Subjective tension and irritability
2= Worrying about minor matters
3= Apprehensive attitude apparent in face or speech
4= Fears expressed without questioning
11. ANXIETY SOMATIC: Physiological concomitants of anxiety, (i.e., effects of autonomic
overactivity, “butterflies,” indigestion, stomach cramps, belching, diarrhea, palpitations,
hyperventilation, paresthesia, sweating, flushing, tremor, headache, urinary frequency).
Avoid asking about possible medication side effects (i.e., dry mouth, constipation)
0= Absent
1= Mild
2= Moderate
3= Severe
4= Incapacitating
12. SOMATIC SYMPTOMS (GASTROINTESTINAL)
0= None
1= Loss of appetite but eating without encouragement from others. Food intake
about normal
2= Difficulty eating without urging from others. Marked reduction of appetite and
food intake
13. SOMATIC SYMPTOMS GENERAL
0= None
1= Heaviness in limbs, back or head. Backaches, headache, muscle aches. Loss of energy
and fatigability
2= Any clear-cut symptom rates 2
14. GENITAL SYMPTOMS (Symptoms such as: loss of libido; impaired sexual performance;
menstrual disturbances)
0= Absent
1= Mild
2= Severe
15. HYPOCHONDRIASIS
0= Not present
1= Self-absorption (bodily)
2= Preoccupation with health
3= Frequent complaints, requests for help, etc.
4= Hypochondriacal delusions
16. LOSS OF WEIGHT
A. When rating by history:
0= No weight loss
1= Probably weight loss associated with present illness
2= Definite (according to patient) weight loss
3= Not assessed
17. INSIGHT
0= Acknowledges being depressed and ill
1= Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need
for rest, etc.
2= Denies being ill at all
18. DIURNAL VARIATION
A. Note whether symptoms are worse in morning or evening. If NO diurnal variation, mark none
0= No variation
1= Worse in A.M.
2= Worse in P.M.
B. When present, mark the severity of the variation. Mark “None” if NO variation
0= None
1= Mild
2= Severe
© 1997 Glaxo Wellcome Inc. All rights reserved. Printed in USA. WEL056R0 February 1997
19. DEPERSONALIZATION AND DEREALIZATION (Such as: Feelings of unreality;
Nihilistic ideas)
0= Absent
1= Mild
2= Moderate
3= Severe
4= Incapacitating
20. PARANOID SYMPTOMS
0= None
1= Suspicious
2= Ideas of reference
3= Delusions of reference and persecution
21. OBSESSIONAL AND COMPULSIVE SYMPTOMS
0= Absent
1= Mild
2= Severe
Total Score ______________
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Patient’s Name
Date of Assessment
To rate the severity of depression in patients who are already diagnosed as depressed, administer this
questionnaire. The higher the score, the more severe the depression.
For each item, write the correct number on the line next to the item. (Only one response per item)
1. DEPRESSED MOOD (Sadness, hopeless, helpless, worthless)
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 nonverbal
communication
2. 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
3. SUICIDE
0= Absent
1= Feels life is not worth living
2= Wishes he were dead or any thoughts of possible death to self
3= Suicidal ideas or gesture
4= Attempts at suicide (any serious attempt rates 4)
4. INSOMNIA EARLY
0= No difficulty falling asleep
1= Complains of occasional difficulty falling asleep—i.e., more than 1/2 hour
2= Complains of nightly difficulty falling asleep
5. 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)
Adapted from Hedlung and Vieweg, The Hamilton rating scale for depression, Journal of Operational Psychiatry, 1979;10(2):149-165.
6. 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
7. 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 activity; 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
4= Stopped working because of present illness
8. RETARDATION: PSYCHOMOTOR (Slowness of thought and speech; impaired ability
to concentrate; decreased motor activity)
0= Normal speech and thought
1= Slight retardation at interview
2= Obvious retardation at interview
3= Interview difficult
4= Complete stupor
9. 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
10. ANXIETY (PSYCHOLOGICAL)
0= No difficulty
1= Subjective tension and irritability
2= Worrying about minor matters
3= Apprehensive attitude apparent in face or speech
4= Fears expressed without questioning
11. ANXIETY SOMATIC: Physiological concomitants of anxiety, (i.e., effects of autonomic
overactivity, “butterflies,” indigestion, stomach cramps, belching, diarrhea, palpitations,
hyperventilation, paresthesia, sweating, flushing, tremor, headache, urinary frequency).
Avoid asking about possible medication side effects (i.e., dry mouth, constipation)
0= Absent
1= Mild
2= Moderate
3= Severe
4= Incapacitating
12. SOMATIC SYMPTOMS (GASTROINTESTINAL)
0= None
1= Loss of appetite but eating without encouragement from others. Food intake
about normal
2= Difficulty eating without urging from others. Marked reduction of appetite and
food intake
13. SOMATIC SYMPTOMS GENERAL
0= None
1= Heaviness in limbs, back or head. Backaches, headache, muscle aches. Loss of energy
and fatigability
2= Any clear-cut symptom rates 2
14. GENITAL SYMPTOMS (Symptoms such as: loss of libido; impaired sexual performance;
menstrual disturbances)
0= Absent
1= Mild
2= Severe
15. HYPOCHONDRIASIS
0= Not present
1= Self-absorption (bodily)
2= Preoccupation with health
3= Frequent complaints, requests for help, etc.
4= Hypochondriacal delusions
16. LOSS OF WEIGHT
A. When rating by history:
0= No weight loss
1= Probably weight loss associated with present illness
2= Definite (according to patient) weight loss
3= Not assessed
17. INSIGHT
0= Acknowledges being depressed and ill
1= Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need
for rest, etc.
2= Denies being ill at all
18. DIURNAL VARIATION
A. Note whether symptoms are worse in morning or evening. If NO diurnal variation, mark none
0= No variation
1= Worse in A.M.
2= Worse in P.M.
B. When present, mark the severity of the variation. Mark “None” if NO variation
0= None
1= Mild
2= Severe
© 1997 Glaxo Wellcome Inc. All rights reserved. Printed in USA. WEL056R0 February 1997
19. DEPERSONALIZATION AND DEREALIZATION (Such as: Feelings of unreality;
Nihilistic ideas)
0= Absent
1= Mild
2= Moderate
3= Severe
4= Incapacitating
20. PARANOID SYMPTOMS
0= None
1= Suspicious
2= Ideas of reference
3= Delusions of reference and persecution
21. OBSESSIONAL AND COMPULSIVE SYMPTOMS
0= Absent
1= Mild
2= Severe
Total Score ______________
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