Scale content.
1. Depressed mood
(1) Only complained when asked.
(2) Expressed spontaneously during the interview.
(3) The mood can be revealed without words by expression, posture, voice or desire to cry.
(4) The patient’s spontaneous speech and nonverbal expressions (expressions, gestures) are almost exclusively expressions of this emotion.
2.Guilt feeling
(1) Blaming oneself and feeling that one has implicated others.
(2) Believing that he or she has committed a sin or repeatedly thinking about past faults and mistakes.
(3) Believing that the current illness is a punishment for one’s mistakes, or having delusions of guilt.
(4) Guilty delusions accompanied by accusatory or threatening hallucinations.
3.Suicide
(1) Feeling that there is no point in living.
(2) wishing they were dead, or often thinking about something related to death.
(3) negative perceptions (suicidal thoughts).
(4) Suicidal behavior.
4.Difficulty in falling asleep Initial insomnia
(1) Complains of difficulty in falling asleep, unable to fall asleep even after half an hour of going to bed. (Pay attention to the patient’s usual time to fall asleep).
(2) Complaint of difficulty in falling asleep every night.
5.Insomnia in the middle of the sleep
(1) shallow sleep with many nightmares
(2) Waking up in the middle of the night (before 12 o’clock at night) (excluding going to the toilet).
6.Early awakening Final sleep
(1) Have woken up early, 1h earlier than usual, but can fall back to sleep (usual habits should be excluded)
(2) Unable to fall back to sleep after early awakening.
7.Work and interest
(1) Complains only when asked questions.
(2) Spontaneous direct or indirect expression of loss of interest in activities, work or study, such as feeling listless, indecisive, unable to persist or force oneself to work or activities.
(3) Reduced or less productive activity time, with inpatients participating in ward work or recreation for less than 3 h per day.
(4) stop working because of the current disease, the resident is unable to complete the daily things in the ward without participating in any activity or without the help of others (note that you cannot score 4 points for any hospitalization).
8.Blocking Refers to slow thoughts and speech, difficulty concentrating, and reduced initiative
(1) Mild blockage found in the mental examination.
(2) Significant blockage found in mental examination.
(3) difficulty in conducting mental examination.
(4) Complete inability to answer questions (mute).
9.Excitement
(1) Some distraction during the examination.
(2) Significantly distracted or with many small movements.
(3) inability to sit still during the examination had stood up.
(4) rubbing hands, biting fingers, pulling hair, biting lips.
10.Psychotic anxiety
(1) Complaining when asked.
(2) Spontaneous expression.
(3) Expression and speech showing obvious apprehension.
(4) Apparent panic.
11.Somatic anxiety Physical symptoms of anxiety, including: dry mouth, bloating, diarrhea, hiccups, colic, palpitations, headache, hyperventilation and sighing, as well as frequent urination and sweating
(1) Mild.
(2) Moderate, with definite symptoms as described above.
(3) Severe, with severe symptoms as described above that interfere with life or require management.
(4) Seriously affects life and activities.
12.Gastrointestinal symptoms
(1) Loss of appetite, but eat on their own without encouragement.
(2) Need to be urged or requested by others to eat and need to apply laxatives or digestive aids.
13.Systemic symptoms
(1) Heavy feeling in the limbs, back or neck, back pain, headache, muscle pain, general weakness or fatigue.
(2) Symptoms are obvious.
14.Sexual symptoms: Decreased sexual desire, menstrual disorders, etc.
(1) mild.
(2) severe.
(3) Not sure, or the item is not suitable for the evaluated person (not counted in the total score).
15.Suspiciousness
(1) Excessive concern about the body.
(2) Recurrent consideration of health problems.
(3) Having paranoid delusions.
(4) Paranoid delusions with hallucinations.
16.Weight loss
(1) Assessment according to medical history: (1) the patient complains of possible weight loss; (2) the patient is sure of weight loss.
(2) Assessment according to weight record: ① weight loss of more than 0.5kg in 1 week; ② weight loss of more than 1kg in 1 week.
17.Self-awareness
(1) Knowing that he/she is sick and showing depression.
(2) Knowing that you are sick, but blaming poor food, environmental problems, overwork, viral infection or the need for rest.
(3) Completely denies having an illness.
Assessment method.
A 5-point scale of 0 to 4 was used for most items of HAMD. The criteria for each level are: (0) none; (1) mild; (2) moderate; (3) severe; (4) very severe. A few items were graded using a 3-point scale from 0 to 2, and the criteria for each grade were: (0) none; (1) mild to moderate; (2) severe.
Result determination.
(1) Total score over 24 was classified as severe depression, over 17 as mild or moderate depression, and less than 7 as no depressive symptoms.
(2) Factor score: HAMD can be categorized into 7 types of factor structure: (1) anxiety somatization: consisting of 5 items such as psychotic anxiety, somatic anxiety, gastrointestinal symptoms, suspicion and self-knowledge (i.e., items 10, 11, 12, 15 and 17); (2) weight: i.e., one weight loss (item 16); (3) cognitive impairment: consisting of self-guilt, suicidality, and agitation (items 2, 3 and 9); (4) blocking: consisting of depressed mood, work and interest, blocking and sexual symptoms, etc. 4 items (1, 7, 8, 14); ⑤ sleep disturbance: consists of difficulty in falling asleep, poor sleep and early awakening, etc. 3 items (4~6).
Factor analysis not only specifically reflects the characteristics of the patient’s condition, but also reflects the clinical outcomes of the target symptom clusters.