DATE:           TIME (24hr): 

1. Depressed Mood
[]   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 non-verbal communication.

2. 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 activities; 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. In hospital rate 3 if patient does not spend at least three hours a day in activities (hospital job or hobbies) exclusive of ward chores.
[]   4 = Stopped working because of present illness. In hospital, rate 4 if patient engages in no activities except ward chores, or if patient fails to perform ward chores unassisted.

3. Social Withdrawal
[]   0 = Interacts with other people as usual.
[]   1 = Less interested in socializing with others but continues to do so.
[]   2 = Interacting less with other people in social (optional) situations.
[]   3 = Interacting less with other people in work or family situations (i.e. where this is necessary).
[]   4 = Marked withdrawal from others in family or work situations.

4. Genital Symptoms
[]   0 = Absent.
[]   1 = Mild.
[]   2 = Severe.

5. Somatic Symptoms - GI
[]   0 = None.
[]   1 = Loss of appetite but eating without staff
encouragement. Heavy feelings in abdomen.
[]   2 = Difficulty eating without staff urging. Requests or requires laxatives or medication for bowels or medication for G.I. symptoms.

6. Loss of Weight
[]   0 = No weight loss.
[]   1 = Probable weight loss associated with present illness.
[]   2 = Definite (according to patient) weight loss.

7. Weight Gain
[]   0 = No weight gain.
[]   1 = Probable weight gain due to current depression.
[]   2 = Definite (according to patient) weight gain due to depression.

8. Appetite Increase
[]   0 = No increase in appetite.
[]   1 = Wants to eat a little more than usual.
[]   2 = Wants to eat somewhat more than normal.
[]   3 = Wants to eat much more than usual.

9. Increased Eating
[]   0 = Is not eating more than usual.
[]   1 = Is eating a little more than usual.
[]   2 = Is eating somewhat more than usual.
[]   3 = Is eating much more than normal.

10. Carbohydrate Craving
[]   0 = No change in food preference or consumption.
[]   1 = Craving or eating more carbohydrates (starches or sugars) than before.
[]   2 = Craving or eating much more carbohydrates than before.
[]   3 = Irresistible craving or eating of sweets or starches.

11. Insomnia - Early
[]   0 = No difficulty falling asleep.
[]   1 = Complains or occasional difficulty falling asleep - i.e., more than 1/2 hour.
[]   2 = Complains of nightly difficulty falling asleep.

12. 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).

13. 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.

14. Hypersomnia
0 = No increase in sleep length.
[]   1 = At least 1 hour increase in sleep length.
[]   2 = 2+ hour increase.
[]   3 = 3+ hour increase.
[]   4 = 4+ hour increase.

15. 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.

16. Fatigability
[]   0 = Does not feel more fatigued than usual.
[]   1 = Feels more fatigued than usual but this has not impaired function significantly; less frequent than in (2).
[]   2 = More fatigued than usual; at least one hour a day; at least three days a week.
[]   3 = Fatigued much of the time most days.
[]   4 = Fatigued almost all the time.

17. 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.

18. Suicide
[]   0 = Absent.
[]   1 = Feels life is not worth living.
[]   2 = Wishes he were dead or any thoughts of possible death to self.
[]   3 = Suicide ideas or gestures.
[]   4 = Attempts at suicide (any serious attempt rates 4).

19. Anxiety - Psychic
[]   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.

20. Anxiety - Somatic
[]   0 = Absent.
[]   1 = Mild.
[]   2 = Moderate.
[]   3 = Severe.
[]   4 = Incapacitating.

21. Hypochondriasis
[]   0 = Not present
[]   1 = Self-absorption (bodily).
[]   2 = Preoccupation with health.
[]   3 = Frequent complaints, requests for help, etc.
[]   4 = Hypochondriacal delusions.

22. Insight
[]   0 = Acknowledges being depressed and ill.
[]   1 = Acknowledges illness but attributes cause to bad food, climate, over work, virus, need for rest, etc.
[]   2 = Denies being ill at all.

23. Motor Retardation
[]   0 = Normal speech and thought.
[]   1 = Slight retardation at interview.
[]   2 = Obvious retardation at interview.
[]   3 = Interview difficult.
[]   4 = Complete stupor.

24. 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.

(HDR  maximum score = 15)

0   -     4    normal, depending on age, education, complaints
5   -     8    mild
8   -   11    moderate
12 -  15    severe

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