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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“The Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) were used to evaluate the severity of anxiety and depres - sive symptoms, respectively (Maier et al. 1988 ; Frank et al. 1991).”
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“HAM-A has shown good psychometric properties, including adequate interrater reliability (Clark and Donovan, 1994; Maier et al., 1988), internal consistency (Clark and Donovan, 1994), and convergent validity (Beck et al., 1988).”
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“The Hamilton Anxiety Rat - ing Scale-14 (HAMA-14) was performed to measure anxiety symptoms(Maier et al. 1988).”
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“These included depression (evaluated using the Patient Health Questionnaire-9, PHQ-9) [23], anxiety (measured with the Hamilton Anxiety Scale, HAMA) [24], hypomania (Hypomania Checklist-32, HCL-32) [25], mania (Mood Disorder Questionnaire, MDQ; and Young Mania Rating Scale, YMRS) [26, 27],…”
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“The Hamilton anxiety scale (HAM-A), [15] The Hamilton rating scale for depression (HAM-D), [16] brief psychiatric rating scale (BRPS) [17] and young Mania rating scale (YMRS) [18] were applied accordingly depending on the psychiatric symptoms.”
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“The Hamilton Anxiety Scale (HAMA) [28] was used to assess anxiety.”
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“Cette échelle a de bonnes caractéristiques psychométriques (217).”
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Dudek, D., Chrobak, A. A., Podkowa, K., Krupa, A. J., Gorostowicz, A., Jaeschke, R. R., Juryk, A., & Siwek, M. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1739359
“…which captures both psychic and somatic symptoms of anxiety; and sleep disturbances, assessed via the AIS, a self-report tool evaluating sleep quality and insomnia symptoms (Hamilton, 1959; Maier et al., 1988; Snaith et al., 1995; Soldatos et al., 2003; Mateen et al., 2017; Trøstheim et al., 2020).”
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“The Hamilton Anxiety Rating Scale (HAMA) is a widely recognised and standardised assessment tool utilised to evaluate the severity of anxiety symptoms [50].”
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Zhang, X., Wang, Z., Sun, M., Bao, Q., Chen, Z., Liu, Y., Wang, Z., Ye, F., Yang, Z., Du, X., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0346717
“…will be measured using the word recall and word recognition improvement tasks of ADAS-Cog scales at the12 th , 24 th , 36 th , 48 th , and 60 th weeks; (3) The emotional disorders will be measured using the HAMD and HAMA scales [36,37] at the 12 th , 24 th , 36 th , 48 th , and 60 th weeks.”
A multidimensional astrocytic framework links serum biomarkers to depression subtypes cognition and sleep EEG
Ma, Z.-J., Zou, T., Zhou, Y.-S., Li, X., Hu, Z., Liu, G.-X., Xia, L., & Chen, G.-H. (2026) · Discover Mental Health · doi:10.1007/s44192-026-00467-8 · Cited by 1
“The severity of anxiety symptoms was assessed using the 14 item-Hamilton Anxiety Scale (HAMA-14), which includes a set of symptoms [26].”
Effects of light therapy on depression, anxiety and sleep quality in mental disorders: A systematic review and meta-analysis
Wang, X., Jiang, W., & Yuan, Y. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.04.014
Temporal Changes in Affective Symptoms, Headache Burden, and Quality of Life Following rTMS Treatment in Migraine: A Longitudinal Study
Zgarbură, R., Pavel, A. N., Parlițeanu, O.-A., Sabri, J., & Tudose, C. (2026) · Healthcare · doi:10.3390/healthcare14091242
“Cronbach’s alpha for HAMA at baseline was 0.642, slightly lower than reported in the literature [33].”
Influential
Impact of Noise Levels of the Dialysis Machine Alarm on Patient Anxiety
Bera, B., & Hemanth, P. (2026) · Hemodialysis International · doi:10.1111/hdi.70080
“HAM-A score of 8–14 indicates mild anxiety, 15–23 indicates moderate anxiety, ≥ 24 indicates severe anxiety, and Scores ≤ 7 indicate minimal or no anxiety [15].”

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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