Cited by 1,044Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingPsychological Testing and Assessment

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The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders

Maier, Wolfgang, Buller, Raimund, Philipp, Michael, Heuser, Isabella·1988·Journal of Affective Disorders

DOI 10.1016/0165-0327(88)90072-9

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Abstract

The Hamilton Anxiety Scale (HAM-A) was tested for reliability and validity in two different samples, one sample (n = 97) defined by anxiety disorders, the other sample (n = 101) defined by depressive disorders. The reliability and the concurrent validity of the HAM-A and its subscales proved to be sufficient. Internal validity tested by latent structure analysis was insufficient. The major problems with the HAM-A are that (1) anxiolytic and antidepressant effects cannot be clearly distinguished; (2) the subscale of somatic anxiety is strongly related to somatic side effects. The applicability of the HAM-A in anxiolytic treatment studies is therefore limited. More specific anxiety scales are needed.

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Naik, R. R., Sotnikov, S., Diepold, R. P., Iurato, S., Markt, P. O., Bultmann, A., Brehm, N., Mattheus, T., Lutz, B., Erhardt, A., et al. (2017) · Translational Psychiatry · doi:10.1038/s41398-017-0025-2 · Cited by 111
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Brydges, C. R., Fiehn, O., Mayberg, H. S., Schreiber, H. L., Dehkordi, S. M., Bhattacharyya, S., Cha, J., Choi, K. S., Craighead, W. E., Krishnan, R. R., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-99845-1 · Cited by 104
Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults
Van Leeuwen, E., van Driel, M. L., Horowitz, M. A., Kendrick, T., Donald, M., De Sutter, A. I., Robertson, L., & Christiaens, T. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013495.pub2 · Cited by 90
Clinical correlates of resilience factors in geriatric depression
Laird, K. T., Lavretsky, H., Paholpak, P., Vlasova, R. M., Roman, M., St. Cyr, N., & Siddarth, P. (2019) · International Psychogeriatrics · doi:10.1017/s1041610217002873 · Cited by 93
“MMSE = Mini-Mental State Exam; GDS = Geriatric Depression Scale; HAM-D = Hamilton Depression Rating Scale; HAM-A = Hamilton Anxiety Rating Scale; AES = Apathy Evaluation Scale; QLES = Quality of Life Enjoyment and Satisfaction Questionnaire; CIRS = Cumulative Illness Rating Scale for Geriatrics.”
Method
Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study
Espay, A. J., Maloney, T., Vannest, J. J., Norris, M. M., Eliassen, J. C., Neefus, E., Allendorfer, J. B., Lang, A. E., & Szaflarski, J. P. (2017) · NeuroImage Clinical · doi:10.1016/j.nicl.2017.10.020 · Cited by 94
“In addition, we administered the 17item HAM-D (Williams, 1988) to assess depressed mood and vegetative and cognitive symptoms of depression; and the 14-item HAM-A (Maier et al., 1988), to evaluate for psychic and somatic anxiety.”
Influential
Opipramol for the treatment of somatoform disorders results from a placebo-controlled trial
Volz, H., Möller, H., Reimann, I. W., & Stoll, K.-D. (2000) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(00)00074-2 · Cited by 93
Maternal Anxiety and Breastfeeding: Findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) Study
Adedinsewo, D. A., Fleming, A. S., Steiner, M., Meaney, M. J., Girard, A. W., & on behalf of the MAVAN team (2014) · Journal of Human Lactation · doi:10.1177/0890334413504244 · Cited by 90
“The HAM-A, in use since 1959, assesses the severity, response to treatment, and/or remission of anxiety symptoms and has been shown to have a high reliability, validity, and sensitivity to change.(31-34) The STAI is a self-report scale that consists of 2 components (State and Trait) that measure different domains of a…”
Method
The cytokine profile of women with severe anxiety and depression during pregnancy
Leff, P., Mancilla‐Herrera, I., Flores‐Ramos, M., Takashima, M. F. S., Coronel, F., Cruz-Fuentes, C. S., Molina, A., Hernández-Ruiz, J., Silva-Aguilera, F. S., Farfán-Labonne, B. E., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2087-6 · Cited by 90
“Both instruments have been validated in the local language [36, 37] and have been demonstrated to be reliable, specific, and sensitive [38].”
Background
Emotion Regulatory Brain Function and SSRI Treatment in PTSD: Neural Correlates and Predictors of Change
MacNamara, A., Rabinak, C. A., Kennedy, A. E., Fitzgerald, D. A., Liberzon, I., Stein, M. B., & Phan, K. L. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.190 · Cited by 90
Relief of irritable bowel syndrome by fecal microbiota transplantation is associated with changes in diversity and composition of the gut microbiota
Huang, H. L., Chen, H. T., Luo, Q. L., Xu, H. M., He, J., Li, Y. Q., Zhou, Y. L., Yao, F., Nie, Y. Q., & Zhou, Y. J. (2019) · Journal of Digestive Diseases · doi:10.1111/1751-2980.12756 · Cited by 89
Vitamin D supplementation improves anxiety but not depression symptoms in patients with vitamin D deficiency
Zhu, C., Zhang, Y., Wang, T., Lin, Y., Yu, J., Xia, Q., Zhu, P., & Zhu, D. (2020) · Brain and Behavior · doi:10.1002/brb3.1760 · Cited by 92
EMOTIONAL AVAILABILITY IN MOTHER-CHILD INTERACTION: THE EFFECTS OF MATERNAL DEPRESSION IN REMISSION AND ADDITIONAL HISTORY OF CHILDHOOD ABUSE
Kluczniok, D., Boedeker, K., Fuchs, A., Attar, C. H., Fydrich, T., Fuehrer, D., Dittrich, K., Reck, C., Winter, S., Heinz, A., et al. (2015) · Depression and Anxiety · doi:10.1002/da.22462 · Cited by 87
“[63] The HAMD has good concurrent validity with other depression severity assessment scales.[64] Maternal History of Childhood Abuse.”
Background
Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials
Chawla, N., Anothaisintawee, T., Charoenrungrueangchai, K., Thaipisuttikul, P., McKay, G. J., Attia, J., & Thakkinstian, A. (2022) · BMJ · doi:10.1136/bmj-2021-066084 · Cited by 96
Combining computerized home-based treatments for generalized anxiety disorder: an attention modification program and cognitive behavioral therapy
Amir, N., & Taylor, C. T. (2012) · Behavior Therapy · doi:10.1016/j.beth.2010.12.008 · Cited by 76
Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial
Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F., Segura Garcia, C., De Fazio, P., & Fiorillo, A. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00266-7 · Cited by 81
A randomized double-blind placebo-controlled study of tropisetron in the treatment of outpatients with generalized anxiety disorder
Lecrubier, Y., Puech, A. J., Azcona, A., Bailey, P., & Lataste, X. (1993) · Psychopharmacology · doi:10.1007/bf02247373 · Cited by 81
“Studies in patients with panic disorder or depression (Maier et al. 1988; Bech et al. 1992) using the Rasch model (Rasch 1960) have shown that the Hamilton total score and the two subscale total scores are not homogeneous.”
Method
Quality of life in women with endometriosis: a narrative overview
Rosa, V. L. L., FRANCISCIS, P. D., Barra, F., Schiattarella, A., Török, P., Shah, M., Karaman, E., Cerentini, T. M., Guardo, F. D., Gullo, G., et al. (2020) · Minerva Medica · doi:10.23736/s0026-4806.19.06298-0 · Cited by 82
Disrupted functional connectivity of periaqueductal gray subregions in episodic migraine
Chen, Z., Chen, X., Liu, M., Liu, S., Ma, L., & Yu, S. (2017) · The Journal of Headache and Pain · doi:10.1186/s10194-017-0747-9 · Cited by 79
“The anxiety, depression, and cognitive function of all the participants were evaluated with the Hamilton Anxiety Scale (HAMA) [13], the Hamilton Depression Scale (HAMD) [14], and the Montreal Cognitive Assessment (MoCA) Beijing Version (http://www.mocatest.org).”
MethodInfluential
Bupropion for attention deficit hyperactivity disorder (ADHD) in adults.
Verbeeck, W., Bekkering, G., den Noortgate, W. V., & Kramers, C. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009504.pub2 · Cited by 73
Long-term outcome following selective serotonin reuptake inhibitor induced neonatal abstinence syndrome
Klinger, G., Frankenthal, D., Merlob, P., Diamond, G. W., Sirota, L., Levinson-Castiel, R., Linder, N., Stahl, B., & Inbar, D. (2011) · Journal of Perinatology · doi:10.1038/jp.2010.211 · Cited by 77
St John's wort extract (LI 160) in somatoform disorders: results of a placebo-controlled trial
Volz, H., Murck, H., Kasper, S. F., & Möller, H. (2002) · Psychopharmacology · doi:10.1007/s00213-002-1171-6 · Cited by 77
“1985; Van Riezen and Segal 1998) and (ii) these scales are reliable and valid (Maier et al. 1988; AMDP and CIPS, 1996).”
BackgroundMethod
The Hamilton Scales and the Hopkins Symptom Checklist (SCL–90): A Cross-National Validity Study in Patients with Panic Disorders
Bech, P., Allerup, P., Maier, W., Albus, M., Lavori, P., & Ayuso, J. L. (1992) · British Journal of Psychiatry · doi:10.1192/bjp.160.2.206 · Cited by 75
Self-citation
Factors that impact health-related quality of life in neuromyelitis optica spectrum disorder: anxiety, disability, fatigue and depression
Shi, Z., Chen, H., Lian, Z., Liu, J., Feng, H., & Zhou, H. (2016) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2016.02.011 · Cited by 77
“A score of less than 7 indicates no anxiety, 7–14 indicates mild anxiety, 15–21 indicates moderate anxiety, 22–29 indicates obvious anxiety, and above 29 indicates severe anxiety (Maier et al., 1988).”
Background
Development and validation of a computer-administered version of the Hamilton Rating Scale.
Kobak, K. A., Reynolds, W. M., & Greist, J. H. (1993) · Psychological Assessment · doi:10.1037/1040-3590.5.4.487 · Cited by 76
Psychiatric disorders in multiple sclerosis
Sparaco, M., Lavorgna, L., & Bonavita, S. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09426-6 · Cited by 79
Shocks, Personality, and Anxiety in Patients with an Implantable Defibrillator
van den Broek, K. C., Nyklíček, I., van der Voort, P. H., Alings, M., & Denollet, J. (2008) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2008.01099.x · Cited by 75
PREPP: postpartum depression prevention through the mother–infant dyad
Werner, E. A., Gustafsson, H., Lee, S., Feng, T., Jiang, N., Desai, P., & Monk, C. E. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0549-5 · Cited by 74
“and reliability of the HRSD and HAM-A is well established (Maier et al. 1988; Ramos-Brieva and Cordero-Villafafila 1988; Trajković et al. 2011).”
Background
Are you gonna leave me? Separation anxiety is associated with increased amygdala responsiveness and volume
Redlich, R., Grotegerd, D., Opel, N., Kaufmann, C., Zwitserlood, P., Kugel, H., Heindel, W., Donges, U.-S., Suslow, T., Arolt, V., et al. (2015) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsu055 · Cited by 73
Psychometric Properties of the SAS, BAI, and S-AI in Chinese University Students
Pang, Z., Tu, D., & Cai, Y. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00093 · Cited by 73
A randomized controlled trial of ecological momentary intervention plus brief group therapy for generalized anxiety disorder.
Newman, M. G., Przeworski, A., Consoli, A. J., & Taylor, C. B. (2014) · Psychotherapy · doi:10.1037/a0032519 · Cited by 71
“HARS scores show strong convergent (Beck & Steer, 1991; Maier, Buller, Philipp, & Heuser, 1988) and discriminant validity (Kobak et al., 1993).”
Background
Fifty Years with the Hamilton Scales for Anxiety and Depression
Bech, P. (2009) · Psychotherapy and Psychosomatics · doi:10.1159/000214441 · Cited by 71
“However, in clinical trials on anxiety disorders the HAM-A is still the most frequently used outcome scale. When used for the assessment of response in clinical trials, the total score as well as the factor scores are traditionally employed. In a mixed population of patients with panic disorder and major depression Ma…”
Method
Rating scales for mood disorders: Applicability, Consistency and construct validity
Bech, P. (1988) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1988.tb08567.x · Cited by 71
Dysfunction in emotion processing underlies functional (psychogenic) dystonia
Espay, A. J., Maloney, T., Vannest, J., Norris, M. M., Eliassen, J. C., Neefus, E., Allendorfer, J. B., Chen, R., & Szaflarski, J. P. (2018) · Movement Disorders · doi:10.1002/mds.27217 · Cited by 69
Evidence for Chronically Altered Serotonin Function in the Cerebral Cortex of Female 3,4-Methylenedioxymethamphetamine Polydrug Users
Watkins, T. J. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.156 · Cited by 69
Analysis of hair cortisol level in first-episodic and recurrent female patients with depression compared to healthy controls
Wei, J., Sun, G., Zhao, L., Yang, X., Liu, X., Lin, D., Li, T., & Ma, X. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.023 · Cited by 74
Depressive symptom differences in hospitalized, medically ill, depressed psychiatric inpatients and nonmedical controls.
Clark, D. A., Cook, A., & Snow, D. (1998) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.107.1.38 · Cited by 71
Gait, balance, mobility and muscle strength in people with anxiety compared to healthy individuals
Feldman, R., Schreiber, S., Pick, C. G., & Been, E. (2019) · Human Movement Science · doi:10.1016/j.humov.2019.102513 · Cited by 74
Participation Restriction, Not Fear of Falling, Predicts Actual Balance and Mobility Abilities in Rural Community-Dwelling Older Adults
Allison, L. K., Painter, J. A., Emory, A., Whitehurst, P., & Raby, A. (2012) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0b013e3182493d20 · Cited by 67
Anatomical and functional connectivity in the default mode network of post‐traumatic stress disorder patients after civilian and military‐related trauma
Reuveni, I., Bonne, O. B., Giesser, R., Shragai, T., Lazarovits, G., Isserles, M., Schreiber, S., Bick, A. S., & Levin, N. (2015) · Human Brain Mapping · doi:10.1002/hbm.23051 · Cited by 70
“Analysis of the z-scores shows that the effect is driven by negative CAPS, Clinician Administered PTSD Scale; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Rating Scale.”
MethodInfluential
Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke
Wang, J., Li, F., Xiao, L., Peng, F., Sun, W., Li, M., Liu, D., Jiang, Y., Guo, R., Li, H., et al. (2018) · Neurology · doi:10.1212/wnl.0000000000006534 · Cited by 63
Anxiety Symptoms Questionnaire (ASQ): development and validation
Baker, A. W., Simon, N. M., Keshaviah, A. P., Farabaugh, A. H., Deckersbach, T., Worthington, J. J., Hoge, E. A., D, M. F. M., & Pollack, M. H. (2019) · General Psychiatry · doi:10.1136/gpsych-2019-100144 · Cited by 72
“8 Alternatives to the HAMA-A include self-report measures of anxiety, the most commonly used being the Beck Anxiety Inventory (BAI).”
Method

Authors: Maier, W., Buller, R., Philipp, M., & Heuser, I.
Affiliations: Johannes Gutenberg University Mainz (DE)
Corresponding author: Maier, Wolfgang
ORCID: Maier, Wolfgang
Buller, Raimund
Heuser, Isabella
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 1988-01
Volume: 14
Issue: 1
Pages: 61-68
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/0165-0327(88)90072-9
OpenAlex: W2021803359
Cited by: 1,044
References: 15
Citations by year: 2026: 102 · 2025: 132 · 2024: 122 · 2023: 77 · 2022: 81 · 2021: 73 · 2020: 74 · 2019: 56 · 2018: 47 · 2017: 49 · 2016: 45 · 2015: 29 · 2014: 27 · 2013: 22 · 2012: 12
FWCI: 4.75
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Keywords: Hamilton Anxiety Rating Scale, anxiety disorders, depressive disorders, psychometric validation, reliability statistics, concurrent validity, internal validity, latent structure analysis, anxiolytic treatment, antidepressant effects, sensitivity to change
MeSH terms: Agoraphobia, Alprazolam, Amitriptyline, Anxiety Disorders, Clinical Trials as Topic, Depressive Disorder, Humans, Imipramine, Panic, Psychological Tests, Psychometrics, Random Allocation

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The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders

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