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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Arnold, V. K., Feifel, D., Earl, C. Q., Yang, R., & Adler, L. A. (2014) · Journal of Attention Disorders · doi:10.1177/1087054712441969 · Cited by 48
Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial
Savage, K. M., Stough, C. K. K., Byrne, G. J., Scholey, A. B., Bousman, C., Murphy, J., MacDonald, P., Suo, C., Hughes, M. E., Thomas, S. D. M., et al. (2015) · Trials · doi:10.1186/s13063-015-0986-5 · Cited by 43
“0 [46]), and is sensitive to change [47, 48].”
Background
Day Hospital Treatment for Anorexia Nervosa: A 12‐Month Follow‐up Study
Daga, G. A., Marzola, E., Bacco, C. D., Buzzichelli, S., Brustolin, A., Campisi, S., Amianto, F., Migliaretti, G., & Fassino, S. (2015) · European Eating Disorders Review · doi:10.1002/erv.2369 · Cited by 40
Objective detection of chronic stress using physiological parameters
Abdi, R. M. A., Alhitary, A. E., Abdulhay, E., & Al‐Bashir, A. K. (2018) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-018-1854-8 · Cited by 44
Psychological Functioning of Women Taking Illicit Drugs during Pregnancy and the Growth and Development of Their Offspring in Early Childhood
Serino, D., Peterson, B. S., & Rosen, T. S. (2018) · Journal of Dual Diagnosis · doi:10.1080/15504263.2018.1468946 · Cited by 40
Therapeutic Efficacy of Specific Serotonin Reuptake Inhibitors (SSRIs) in Dysthymia
Ravindran, A. V., Bialik, R. J., & Lapierre, Y. D. (1994) · The Canadian Journal of Psychiatry · doi:10.1177/070674379403900106 · Cited by 40
“Although the Hamilton scales have reasonable reliability and validity (18,19), they have been criticized for not being able to measure anxious and depressive symptoms independently.”
Background
Rebound of affective symptoms following acute cessation of deep brain stimulation in obsessive-compulsive disorder
Ooms, P., Blankers, M., Figee, M., Mantione, M., van den Munckhof, P., Schuurman, P. R., & Denys, D. (2014) · Brain Stimulation · doi:10.1016/j.brs.2014.06.009 · Cited by 35
The many faces of anxiety-neurobiological correlates of anxiety phenotypes
Andreescu, C., Mennin, D. S., Tudorascu, D., Sheu, L. K., Walker, S. E., Banihashemi, L., & Aizenstein, H. J. (2015) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2015.08.013 · Cited by 42
“While largely used as a measure of global anxiety (Clark and Donovan, 1994), the HARS has been criticized for its lack of specificity especially with regard to the somatic symptoms (Maier et al., 1988).”
Background
A trial of buspirone for anxiety in Parkinson's disease: Safety and tolerability
Schneider, R. B., Auinger, P., Tarolli, C. G., Iourinets, J., Gil-Díaz, M. C., & Richard, I. H. (2020) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2020.10.020 · Cited by 39
“Among those randomized to buspirone who completed the study (n = 12), 75% were considered responders according to our pre-specified HAM-A criteria and 42% reported at least minimal improvement on the PGI-I.”
BackgroundInfluential
Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: a real-world experience
Silvestro, M., Tessitore, A., Orologio, I., Micco, R. D., Tartaglione, L., Trojsi, F., Tedeschi, G., & Russo, A. (2022) · The Journal of Headache and Pain · doi:10.1186/s10194-022-01436-6 · Cited by 40
The Role of Muscarinic Receptors in the Pathophysiology of Mood Disorders:A Potential Noveltreatment?
Jeon, W. J., Dean, B., Scarr, E., & Gibbons, A. S. (2015) · Current Neuropharmacology · doi:10.2174/1570159x13666150612230045 · Cited by 38
Somatic symptoms in treatment‐naïve Hispanic and non‐Hispanic patients with major depression
Dunlop, B. W., Still, S., LoParo, D., Aponte‐Rivera, V., Johnson, B. N., Schneider, R. L., Nemeroff, C. B., Mayberg, H. S., & Craighead, W. E. (2019) · Depression and Anxiety · doi:10.1002/da.22984 · Cited by 43
Cognitive Networks Disarrangement in Patients With Migraine Predicts Cutaneous Allodynia
Russo, A., Silvestro, M., Trojsi, F., Bisecco, A., Micco, R. D., Caiazzo, G., Nardo, F. D., Esposito, F., Tessitore, A., & Tedeschi, G. (2020) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13860 · Cited by 40
Prevalence and risk factors for depression and anxiety among outpatient migraineurs in mainland China
Yong, N., Hu, H., Fan, X., Li, X., Li, R., Qu, Y., Wang, Y., Tan, G., Chen, L., & Zhou, J. (2012) · The Journal of Headache and Pain · doi:10.1007/s10194-012-0442-9 · Cited by 38
“These scales represent professional assessment scales that have a better validity and reliability [24, 25, 32].”
Background
A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders
Rollman, B. L., Belnap, B. H., Reynolds, C. F., Schulberg, H. C., & Shear, M. K. (2003) · General Hospital Psychiatry · doi:10.1016/s0163-8343(03)00004-5 · Cited by 38
“They must also be experiencing at least a moderate level of anxiety symptomatology (Hamilton Rating Scale-Anxiety (HRS-A) [16] 14 if GAD and Panic Disorder Severity Scale (PDSS) [17] 7 if PD); have no history of bipolar disorder or active substance abuse; and not be in active treatment with a mental health specialist…”
Background
Efficacy and safety of balovaptan for socialisation and communication difficulties in autistic adults in North America and Europe: a phase 3, randomised, placebo-controlled trial
Jacob, S., Veenstra-VanderWeele, J., Murphy, D., McCracken, J., Smith, J., Sanders, K., Meyenberg, C., Wiese, T., Deol-Bhullar, G., Wandel, C., et al. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00429-6 · Cited by 38
The Key Determinants to Quality of Life in Parkinson’s Disease Patients: Results from the Parkinson’s Disease Biomarker Program (PDBP)
He, L., Lee, E.-Y., Sterling, N. W., Kong, L., Lewis, M. M., Du, G., Eslinger, P. J., & Huang, X. (2016) · Journal of Parkinson s Disease · doi:10.3233/jpd-160851 · Cited by 37
“HAM- ESS: Epworth Sleepiness Scale; HAM-A: Hamilton Anxiety Rating Scale; HAM-D: Hamilton Depression Rating Scale; MoCA: Montreal Cognitive Assessment; SEAS: Schwab and England ADL scale; PDQ 39SI: Parkinson’s Disease Questionnaire summary index; ADL: Activities of Daily Life; UPDRS: Unified Parkinson’s Disease Rating…”
MethodInfluential
Brief Behavioral Therapy and Bupropion for Sleep and Fatigue in Young Adults With Crohn’s Disease: An Exploratory Open Trial Study
Hashash, J. G., Knisely, M. R., Germain, A., McAuliff, K., Strassburger, M., Vachon, A., Binion, D. G., Regueiro, M., Wallace, M., & Szigethy, E. (2022) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.09.047 · Cited by 37
Looming Maladaptive Style as a Moderator of Risk Factors for Anxiety
Adler, A., & Strunk, D. R. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9221-y · Cited by 36
“It has also shown adequate reliability (a = .83 in Beck et al. 1988) and validity (Maier et al. 1988).”
Background
Is the DSM-5 Anxious Distress Specifier Interview a valid measure of anxiety in patients with generalized anxiety disorder: A comparison to the Hamilton Anxiety Scale
Zimmerman, M. A., Thompson, J. S., Diehl, J. M., Balling, C. E., & Kiefer, R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112859 · Cited by 36
Quantifying depressive symptomatology: inter-rater reliability and inter-item correlations
Kørner, A., Nielsen, B. M., Eschen, F. T., Møller‐Madsen, S., Stender, A. K., Christensen, E. M., Aggernaes, H., Kastrup, M. C., & Larsen, J. K. (1990) · Journal of Affective Disorders · doi:10.1016/0165-0327(90)90128-u · Cited by 36
Cancer pain and anxiety
Thielking, P. D. (2003) · Current Pain and Headache Reports · doi:10.1007/s11916-003-0045-x · Cited by 36
“There is a subscale for somatic anxiety; therefore, somatic complaints unrelated to anxiety can cause scoring problems [ 24 ].”
Background
Prevalence of depression and anxiety among drug resistant tuberculosis: A study in North India
Srinivasan, G., Chaturvedi, D., Verma, D., Pal, H., Khatoon, H., Yadav, D., Sahil, A. P., Gautam, D., & Deepak, D. (2021) · Indian Journal of Tuberculosis · doi:10.1016/j.ijtb.2021.04.010 · Cited by 37
Anxiety level among students of different college and universities in India during lock down in connection to the COVID-19 pandemic
Biswas, S., & Biswas, A. (2021) · Journal of Public Health · doi:10.1007/s10389-020-01431-8 · Cited by 35
Noninvasive Cervical Vagal Nerve Stimulation Alters Brain Activity During Traumatic Stress in Individuals With Posttraumatic Stress Disorder
Wittbrodt, M. T., Gurel, N. Z., Nye, J. A., Shandhi, M. M. H., Gazi, A. H., Shah, A. J., Pearce, B. D., Murrah, N. V., Ko, Y., Shallenberger, L. H., et al. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000987 · Cited by 34
“Participants also completed the PTSD Checklist (30), Beck Depression Inventory (31), ClinicianAdministered Dissociative States Scale (32), Hamilton Anxiety Scale (33), Early Childhood Trauma—”
Treatment of Panic Disorder in Older Adults: A Pilot Study Comparison of Alprazolam, Imipramine, and Placebo
Sheikh, J. I., & Swales, P. J. (1999) · The International Journal of Psychiatry in Medicine · doi:10.2190/kqej-mqjr-vk3d-f3hv · Cited by 35
“The HAM-A has become an established measure for anxiety severity, change, and outcome in clinical trials [25].”
Method
Psychometric properties of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype questionnaire in Chinese patients with mood disorders
Du, Y., Hu, J., Huang, T., Lai, J., Ng, C. H., Zhang, W., Li, C., Xu, Z.-Y., Zhou, H., Ruan, L., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.117 · Cited by 35
Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression
Laird, K. T., Siddarth, P., Krause, B., Kilpatrick, L. A., Milillo, M. M., Silvan, Y. A., Narr, K. L., & Lavretsky, H. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.05.066 · Cited by 34
The association between suicidality and serotonergic dysfunction in depressed patients
Kim, D.-H., & Park, Y. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.051 · Cited by 34
Effect of using gamification of “Kahoot!” as a learning method on stress symptoms, anxiety symptoms, self-efficacy, and academic achievement among university students
alsswey, A., & Malak, M. Z. (2024) · Learning and Motivation · doi:10.1016/j.lmot.2024.101993 · Cited by 33
Connectivity between the anterior insula and dorsolateral prefrontal cortex links early symptom improvement to treatment response
Yuan, H., Zhu, X. L., Tang, W., Cai, Y., Shi, S., & Luo, Q. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.09.041 · Cited by 31
Psychometric Properties of the Reconstructed Hamilton Depression and Anxiety Scales
Porter, E., Chambless, D. L., McCarthy, K. S., DeRubeis, R. J., Sharpless, B. A., Barrett, M. S., Milrod, B. L., Hollon, S. D., & Barber, J. P. (2017) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000666 · Cited by 34
“…researchers have questioned the content validity of these scales: HRSD items capture many symptoms thought to be characteristic of anxiety but not depression, and HARS items capture symptoms thought to be characteristic of depression but not anxiety (Bagby et al., 2004; Maier et al., 1988).”
Background
Psychosocial interventions for stimulant use disorder
Minozzi, S., Saulle, R., Amato, L., Traccis, F., & Agabio, R. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011866.pub3 · Cited by 32
The effect of a single yoga class on interoceptive accuracy in patients affected by anorexia nervosa and in healthy controls: a pilot study
Demartini, B., Goeta, D., Marchetti, M., Bertelli, S., Anselmetti, S., Cocchi, A., Ischia, M., & Gambini, O. (2020) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-020-00950-3 · Cited by 35
Digital Interventions for Generalized Anxiety Disorder (GAD): Systematic Review and Network Meta-Analysis
Saramago, P., Gega, L., Marshall, D. C., Nikolaidis, G. F., Janković, D., Melton, H., Dawson, S., Churchill, R. C., & Bojke, L. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.726222 · Cited by 33
“The Hamilton Anxiety Scale (HAM-A) (74) used in a recent NMA on medication for GAD (7), only appeared once in the included RCTs (Appendix F2).”
Method
REMOVED: Validation of the Hamilton Anxiety Rating Scale and State Trait Anxiety Inventory A and B in Arabic among the Lebanese population
Hallit, S. R., Haddad, C., Hallit, R. R., Akel, M., Obeïd, S., Haddad, G., Soufia, M., Khansa, W., Khoury, R., Kheir, N., et al. (2019) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2019.02.002 · Cited by 32
Retracted
Exercise Increases the Dynamics of Diurnal Cortisol Secretion and Executive Function in People With Amnestic Mild Cognitive Impairment
Tortosa‐Martínez, J., Clow, A., Pertegáz, N. C. I., González-Caballero, G., Abellán-Miralles, I., & Saenz, M. J. (2014) · Journal of Aging and Physical Activity · doi:10.1123/japa.2014-0006 · Cited by 32
Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders
Pruessner, L., Timm, C., Kalmar, J., Bents, H., Barnow, S., & Mander, J. (2024) · Depression and Anxiety · doi:10.1155/2024/9081139 · Cited by 37
“This approach should include a variety of emotion regulation measures (e.g., [125 – 128]) and incorporate observer-based assessments of depressive and anxiety symptoms (e.g., [129, 130]) for a more holistic understanding.”
Background
Psilocybin therapy for mood dysfunction in Parkinson’s disease: an open-label pilot trial
Bradley, E., Sakai, K., Fernandes‐Osterhold, G., Szigeti, B., Ludwig, C., Ostrem, J. L., Tanner, C. M., Bock, M., Llerena, K., Finley, P. R., et al. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02097-0 · Cited by 35
“To evaluate preliminary ef ﬁ cacy for mood dysfunction, we used the Montgomery – Åsberg Depression Rating Scale (MADRS) [62] and the Hamilton Anxiety Scale (HAM-A) [63].”
Serum BDNF Levels in Relation to Illness Severity, Suicide Attempts, and Central Serotonin Activity in Patients with Major Depressive Disorder: A Pilot Study
Park, Y.-M., Lee, B.-H., Um, T., & Kim, S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0091061 · Cited by 37
“Furthermore, the (BHS) [24], the Barratt Impulsiveness Scale (BIS) [25], the Hamilton Anxiety Scale (HAMA) [26], and the Beck Scale for Suicidal Ideation (BSS) [27] were applied.”
Method
Altered functional connectivity of the marginal division in migraine: a resting-state fMRI study
Chen, Z., Chen, X., Liu, M., Liu, S., Shu, S., Ma, L., & Yu, S. (2016) · The Journal of Headache and Pain · doi:10.1186/s10194-016-0682-1 · Cited by 31
“Additionally, we evaluated anxiety, depression, and cognitive function of all the participants by using the Hamilton Anxiety Scale (HAMA) [20], the Hamilton Depression Scale (HAMD) [21], the Chinese version of Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA) Beijing Version (www.mocat…”
MethodInfluential
Stigma and mental health among people living with HIV across the COVID-19 pandemic: a cross-sectional study
Gennaro, F. D., Papagni, R., Segala, F. V., Pellegrino, C., Panico, G. G., Frallonardo, L., Diella, L., Belati, A., Santoro, C. R., Brindicci, G., et al. (2024) · BMC Infectious Diseases · doi:10.1186/s12879-024-09315-y · Cited by 35
“This scale consists of 14 items, with scores ranging from 0 (not present) to 4 (severe anxiety), yielding a possible total score between 0 and 56 [22].”
BackgroundMethod
Silexan in generalized anxiety disorder
Kasper, S. F., Möller, H., Volz, H., Schläfke, S., & Dienel, A. (2017) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000176 · Cited by 30

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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