Description.
The Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960) is a widely used interviewer-administered measure of the depressive symptom severity. The HRSD suicide item consists of 4 ratings of suicidal behavior: 0 ("absent"), 1 ("feels life is not worth living or any thoughts of possible death to self"), 2 ("wishes he were dead"), 3 ("suicidal ideas or gestures"), or 4 ("attempts at suicide").

Reliability.
Reynolds (1991b) reported a high level of interrater reliability (r = .92) for the HRSD suicide item. The test-retest reliability for this item over a 3-day period is adequate (r = .64; Williams, 1988).

Concurrent validity.
The HRSD suicide item was found to be highly correlated with the Adult Suicide Ideation Questionnaire (Reynolds, 1991b), the Scale for Suicide Ideation (Beck et al., 1997) and the suicide item of the Beck Depression Inventory (Beck & Steer, 1988). In a sample of elderly psychiatric patients (60 years or older), the seriousness of intent of previous attempts, poor social support and the severity of depression (total HRSD score minus the suicide item) were significant predictors of suicide ideation (HRSD suicide item >0; Alexopolous, Bruce, Hull, Sirey, & Kakuma, 1999).

Predictive validity.
The predictive validity of this item was investigated in a prospective study of risk factors for suicide in psychiatric outpatients (Brown et al., 2000). These (unpublished) results indicated that patients who scored a 2 or higher on the HRSD suicide item were 4.9 times (95% CI: 2.7 - 9.0) more likely to commit suicide than patients who scored less than 2.

Summary and evaluation.
Although there is some evidence that the HRSD suicide item is associated with other measures of suicide ideation and completed suicide, this item does not measure suicide ideation or suicide attempts as proposed by O'Carroll et al. (1996).