Psychiatry Investig.  2011 Dec;8(4):312-319.

The Symptom Frequency Characteristics of the Hamilton Depression Rating Scale and Possible Symptom Clusters of Depressive Disorders in Korea: The CRESCEND Study

  • 1Department of Neuropsychiatry, Bongseng Memorial Hospital, Busan, Korea.
  • 2Department of Psychiatry, SeoDaegu Daedong Hospital, Daegu, Korea.
  • 3Department of Psychiatry, School of Medicine, the Catholic University, Seoul, Korea.
  • 4Department of Psychiatry, School of Medicine, Korea University, Seoul, Korea.
  • 5Department of Psychiatry, School of Medicine, Chonnam National University, Gwangju, Korea.
  • 6Department of Preventive Medicine, School of Medicine, the Catholic University, Seoul, Korea.
  • 7Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea.


This study analyzed the symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) to understand the characteristics of each item and to propose the possible symptoms clusters.
From psychiatric clinics of 18 Hospitals in Korea, 1,183 patients, diagnosed with major depressive disorder (psychotic or non-psychotic), dysthymia or depressive disorder not otherwise specified. according to DSM-IV criteria, participated in this study from January 2006 to August 2008. The frequencies of each item of HDRS-17 were analyzed according to sex and severity. In addition, we compared this study with a previous study performed in England by Hamilton and with two studies performed in Korea by Kim et al.
The frequencies of HDRS-17 items varied widely in this study, ranging from 95.8% in work and activities to 37.4% in loss of weight. But, depressed mood, psychic anxiety and work and activities items exhibited constant and higher frequency or rank regardless of study, the severity of depression or sex. Insomnia early, somatic gastrointestinal, genital symptoms and insight showed relatively constant but lower frequency or rank in disregard of studies or the clinical variables. Other symptoms had variable frequencies or ranks according to the variable clinical situations (culture, time, sex, severity of depression).
We propose three clusters of symptoms in depressive disorders: core symptoms cluster, an associated symptoms, and a situation-specific symptoms. We can use these possible symptom clusters of depression in simplifying diagnosis of depression, increasing diagnostic specificity in special situation and indexing disease severity.


Symptom frequency; Variation; HDRS-17; Core symptoms cluster; Associate symptoms cluster; Situation-specific symptoms cluster
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