Structured Interview Guide For The Hamilton Depression Rating Scale (SIGH-D)
Structured Interview Guide For The Hamilton Depression Rating Scale (SIGH-D)
Structured Interview Guide For The Hamilton Depression Rating Scale (SIGH-D)
This interview guide is based on the Hamilton Depression Rating Scale (Hamilton, Max: A rating scale for depression.
J Neurol Neurosurg Psychiat 23:56-61, 1960). The anchor point descriptions, with very minor modifications, have been taken
from the ECDEU Assessment Manual (Guy, William, ECDEU Assessment Manual for Psychopharmacology, Revised 1976,
DHEW Publication No. (ADM) 76-338). A reliability study of the SIGH-D has been reported (Williams JBW: A structured
interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry 45:742-747, 1988).
Copyright ©1988, 1992, 1996. All rights reserved. Permission is granted for reproduction for use by researchers and clinicians.
For correspondence: Dr. Williams, New York State Psychiatric Institute, Unit 60, 1051 Riverside Drive,
New York, New York 10032
INSTRUCTIONS TO INTERVIEWERS:
The first question for each item (in bold print) should be asked exactly as written. Follow-up questions are provided
for further exploration or additional clarification of symptoms. The specified questions should be asked until you
have enough information to rate the item confidently. You may also have to add your own follow-up questions to
obtain necessary information. If the answer to a specified question is already known, it is sufficient to confirm the
information with the subject (e.g., "You said that...), make the rating, and continue. The final score for each item
should reflect an assessment and balancing of the severity and frequency of the symptom.
Note that patients with chronic symptoms may not be able to identify a period of normalcy or may report that
"depressed" is their usual state. However, depression should not be rated as "normal" (i.e., a rating of "0") in these
cases.
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STRUCTURED INTERVIEW GUIDE FOR THE HAMILTON DEPRESSION SCALE (SIGH-D)* and
INVENTORY OF DEPRESSIVE SYMPTOMATOLOGY (IDS-C)
(SIGHD-IDS)
Instruments Combined by Kenneth A. Kobak, Janet B.W. Williams, and A. John Rush
OVERVIEW: I’d like to ask you some questions about the past week. How have you been feeling since
last (DAY OF WEEK)? IF OUTPATIENT: Have you been working? IF NOT: Why not?
What’s your mood been like this past week (compared to when you feel OK)?
Have you been feeling down or depressed? Sad? Hopeless? Helpless? Worthless?
- IF YES: Can you describe what this feeling has been like for you? How bad is the feeling?
How have you been feeling about the future? (optimistic/pessimistic) Do you feel better with
encouragement/reassurance from others? Do you feel things will get better, improve, work out?
IF DEPRESSED: In the past week, when something good, even small things have happened, did your
mood brighten up? How long did this brightened mood last? Were there things that occurred that should have
brightened your mood but did not?
In the last week, how often have you felt (OWN EQUIVALENT)? Every day? All day?
IF SCORED 1-4 ABOVE, ASK: How long have you been feeling this way?
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In the past week, have you noticed your depressed mood feeling worse at any particular time of the day-
such as in the morning or evening? (IF YES), is this related to any particular event(s)? How much worse do you
feel-a little bit or a lot? Even on weekends?
If response is 1, 2 or 3:
9A. Is mood typically worse in MORNING,
AFTERNOON, or NIGHT (CIRCLE ONE)
Have you experienced grief or loss in your life, like the death of a close friend or relative (or pet, lost an
important job)? Do you remember how you felt? How is the sad or down mood you have experienced this week
similar to how you felt then? (IF NO), How is it different?
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Have you been putting yourself down this past week, feeling you’ve done things wrong, or let others
down? IF YES: What have your thoughts been? Has this been more than is normal for you?
Have you been feeling guilty about anything that you’ve done or not done? What about things that happened a
long time ago?
Have you thought that you’ve brought (THIS DEPRESSION) on yourself in some way?
(Have you been hearing voices or seeing visions in the last week? IF YES: Tell me about them.)
This past week, have you had thoughts that life is not worth living? What about thinking you’d be better
off dead or wishing you were dead? Have you had thoughts of hurting or killing yourself?
How often do these thoughts come? How long do they stay? Have you thought of a plan in the last week?
Have you done anything to try to hurt yourself or taken any steps toward ending your life?
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Now let’s talk about your sleep. What were your usual hours of going to sleep and waking up, before this
began?
When have you been falling asleep and waking up over the past week?
Have you had any trouble falling asleep at the beginning of the night? (Right after you go to bed, how long
has it been taking you to fall asleep?)
How many nights this week have you had trouble falling asleep?
During the past week, have you been waking up in the middle of the night? IF YES: Do you get out of bed?
What do you do? (Only go to the bathroom?)
When you get back in bed, are you able to fall right back asleep?
How many nights this week have you had that kind of trouble?
(IF NO INSOMNIA) Has your sleep been restless or disturbed some nights?
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What time have you been waking up in the morning for the last time, this past week?
IF EARLY: Is that with an alarm clock, or do you just wake up yourself? What time do you usually wake up (that is,
when you feel well)?
How many mornings this past week have you awakened early?
How many hours on average have you been sleeping in a 24-hour period in the past week, including naps? Is that
a normal amount for you? What is the longest you've slept in a 24-hour period last week?
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How have you been spending your time this past week (when not at work)?
Have you felt interested in doing (THOSE THINGS), or do you feel you have to push yourself to do them?
How would you describe your level of interest and motivation to complete daily activities?
Have you stopped doing anything you used to do? (What about hobbies?) IF YES: Why?
About how many hours a day do you spend doing things that interest you?
Have you had any fun this past week? (IF NO), Has there been anything you enjoyed (meal, movie, spending
time with friends)? (IF YES), was the enjoyment you experienced at a normal level for you?
IF WORKING (IN OR OUT OF THE HOME): Have you been able to get as much (work) done as you usually do?
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How has your concentration been in the past week? Were you able to focus on what you were doing (like
reading or watching TV)? Did you notice that minor decisions were more difficult to make than usual (what to
wear, eat, watch on TV)?
Have you felt slowed down in your thinking, speaking, or movement in the past week? Have others
commented on this?
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Have you noticed feeling restless or fidgety in the past week? Have you found yourself unable to stay seated
or needing to move around?
Have you been feeling especially tense or irritable this past week? IF YES: Is this more than is normal for
you?
Have you been unusually argumentative or impatient? Have you found yourself becoming angry with others for
little apparent reason? More so than normal for you? How much of the time in this past week?
Have you been feeling especially anxious, nervous or on edge in the past week? How much of the time?
Have you been worrying a lot about little things, things you don’t ordinarily worry about?
IF YES: Like what, for example?
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Have you suddenly felt intensely frightened, anxious or extremely uncomfortable? Extremely panicky for no
apparent reason? Has this occurred in the past 7 days? When did it last occur? What happened?
Are there situations or things that you persistently dislike or avoid because they make you anxious? Any
phobias? Have you noticed this avoidance increasing in the past week?
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Tell me if you’ve had any of the following physical symptoms in the past week. (READ LIST)
NOTE: DO NOT RATE SYMPTOMS THAT ARE CLEARLY RELATED TO A DOCUMENTED PHYSICAL
CONDITION.
28. Gastrointestinal:
0 - Has no change in usual bowel habits
1 - Has intermittent constipation and/or diarrhea that is
mild
2 - Has diarrhea and/or constipation most of the time
that does not impair functioning
3 - Has intermittent presence of constipation and/or
diarrhea that requires treatment or causes
functional impairment
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How has your appetite been this past week? What about compared to your usual appetite?
IF LESS: How much less?
Have you had to force yourself to eat?
Have other people had to urge you to eat? (Have you skipped meals?)
Have you found yourself eating more than usual? Every day? Have you noticed you eat more at meals? Have you
noticed you are snacking or eating more in between meals? Have you felt driven to eat? Have you had eating
binges?
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IF LOW ENERGY: Have you felt tired? (How much of the time? How bad has it been?)
This week, have you had any aches or pains? (What about backaches, headaches, or muscle aches?)
During the past week, have you had feelings of being weighted down, like you had lead weights on your
arms and legs? How many days? How much of the time? Do these symptoms interfere with your day-to-day
activities?
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Sometimes, along with depression or anxiety, people might lose interest in sex. This week, how has your
interest in sex been? (I’m not asking about actual sexual activity, but about your interest in sex.)
Has there been any change in your interest in sex (from when you were feeling OK)?
IF YES: Is this unusual for you, compared to when you feel well? (Is it a little less or a lot less?)
In the last week, how much have your thoughts been focused on your physical health or how your body is
working (compared to your normal thinking)? (Have you worried a lot about being or becoming physically ill?
Have you really been preoccupied with this?)
Have you found yourself asking for help with things you could really do yourself?
IF YES: Like what, for example? How often has that happened?
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Have you lost any weight since this (DEPRESSION) began? IF YES: Did you lose any weight this last week?
(Was it because of feeling depressed or down?) How much did you lose?
IF NOT SURE: Do you think your clothes are any looser on you?
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Have you felt easily rejected, slighted or criticized by others? How often has this occurred? How do you
respond when that happens - angry, down, etc.? (Probe severity of reaction) How does this impact upon
your ability to relate with others socially or complete work tasks?
IF YOU SCORED 1, 2, 3 OR 4 ON THE SUICIDE ITEM (HAMD ITEM 3 OR IDS ITEM 18), BE SURE TO
ADMINISTER THE C-SSRS.
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