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The HAM-D6 through the lens of grief: Clinical considerations for administering the six-item Hamilton Depression Rating Scale in the context of bereavement

Published online by Cambridge University Press:  25 October 2023

Maya Goldman Open the ORCID record for Maya Goldman [Opens in a new window] ,
Stephanie Napolitano ,
Kailey E. Roberts Open the ORCID record for Kailey E. Roberts [Opens in a new window]  and
Wendy G. Lichtenthal Open the ORCID record for Wendy G. Lichtenthal [Opens in a new window]
Maya Goldman
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Stephanie Napolitano
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Kailey E. Roberts
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA Clinical Psychology, Yeshiva University Ferkauf Graduate School of Psychology, Bronx, NY, USA
Wendy G. Lichtenthal*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
*
Corresponding author: Wendy G. Lichtenthal; Email: wendylichtenthal@miami.edu
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Abstract

Objectives

Diagnosing mental health challenges in bereavement is controversial; however, regardless of one’s position on this matter, assessments of bereaved individuals continue to occur in clinical and research contexts. It is critical for evaluations to account for contextual factors that are unique to bereavement. This paper summarizes considerations for diagnosing depression in bereaved individuals, focusing on use of the six-item Hamilton Depression Rating Scale (HAM-D6).

Methods

Following a literature review of the Hamilton Depression Rating Scale (HAM-D) and various versions, we summarized decision rules we used in scoring the HAM-D6 in a study of parents bereaved by cancer. We expanded on existing scoring guidelines for each of the HAM-D6 items, including depressed mood, work and activities, general somatic symptoms, guilt, psychic anxiety, and psychomotor retardation, and illustrated clinical distinctions and probes for assessors to consider through case examples from our research with bereaved parents.

Results

Considerations for assessing depressive symptoms and behavior changes in the context of bereavement were summarized. Symptoms that may be diagnostic of depression in some populations may reflect other factors in the bereaved, such as a change in priorities, social expectations surrounding grief, or avoidance of grief activators. Nuanced factors are important for assessors to consider when administering the HAM-D6 to bereaved individuals.

Significance of results

Our sharing of these considerations is not intended to promote diagnosis of depression in bereavement but to highlight the unique contextual factors that distinguish symptoms of depression from common experiences of grievers when applying an assessment tool such as the HAM-D6. While validated measures can be constraining, they can have clinical utility; they may increase standardization in research, help clinicians communicate with each other, advance the field more generally to understand the varying struggles bereaved individuals experience, and systemically facilitate access to services via managed care.

Keywords

Depressiongriefbereavementdiagnostic assessmentHamilton Depression Rating Scale
Type
Review Article
Information
Palliative & Supportive Care , Volume 21 , Issue 6 , December 2023 , pp. 1079 - 1084
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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