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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Method
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Chen, Z., Chen, X., Chen, Z., Liu, M., He, H., Ma, L., & Yu, S. (2017) · The Journal of Headache and Pain · doi:10.1186/s10194-017-0820-4 · Cited by 14
“However, significant increased HAMA and HAMD scores and decreased MoCA score were identified in MOH compared with NC (P 0.05).”
MethodInfluential
Trajectories of Return to Work Among People on Sick Leave with Mood or Anxiety Disorders: Secondary Analysis from a Randomized Controlled Trial
Hellström, L. C., Madsen, T., Nordentoft, M., Bech, P., & Eplov, L. F. (2017) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-017-9750-x · Cited by 14
“Level of symptoms was measured by the Hamilton Depression Scale (HAM-D6) [32, 33], and the Hamilton Anxiety Scale (HAM-A6) [33, 34]; and level of functioning by The Global Assessment of Functioning (GAF-F) [35] all assessed at baseline interview.”
Method
Bipolar subtypes and their clinical correlates in a sample of 391 bipolar individuals
Serafini, G., Gonda, X., Aguglia, A., Amerio, A., Santi, F., Pompili, M., & Amore, M. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112528 · Cited by 18
Prediction of Antidepressant Treatment Outcome Using Event-Related Potential in Patients with Major Depressive Disorder
Lee, H. S., Baik, S. Y., Kim, Y.-W., Kim, J.-Y., & Lee, S. (2020) · Diagnostics · doi:10.3390/diagnostics10050276 · Cited by 14
“, anxiety-related physical complaints) anxiety [69].”
Lactate‐induced anxiety after imipramine and diazepam treatment
Pohl, R. B., Balon, R., Berchou, R. C., & Lycaki, H. (1994) · Anxiety · doi:10.1002/anxi.3070010204 · Cited by 14
Effects of Sleep Reactivity on Sleep Macro-Structure, Orderliness, and Cortisol After Stress: A Preliminary Study in Healthy Young Adults
Feng, Y.-Z., Chen, J., Hu, Z., Liu, G.-X., Zhou, Y.-S., Zhang, P., Su, A.-X., Yang, S., Zhang, Y., Wei, R., et al. (2023) · Nature and Science of Sleep · doi:10.2147/nss.s415464 · Cited by 16
“HAMA-14 < 7 indicates that the participants have no anxiety symptoms.(39)”
Background
Structural changes in the retina and serum HMGB1 levels are associated with decreased cognitive function in patients with Parkinson's disease
Liang, K., Li, X., Guo, Q., Ma, J., Yang, H., Fan, Y., Yang, D., Shi, X., She, Z., Qi, X., et al. (2023) · Neurobiology of Disease · doi:10.1016/j.nbd.2023.106379 · Cited by 13
“Neuropsychiatric symptoms were assessed with the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and the 17-item Hamilton Depression Rating Scale (HAMD-17)(Leentjens et al., 2000; Maier et al., 1988 symptoms were assessed in the “ ON ” state by the same experienced neurologist.”
Method
Assessment and factors affecting quality of life among patients with Wilson’s disease
Zhan, T., Guan, Y., Sun, C.-J., Wang, L., Wang, Y., & Li, X. (2024) · Scientific Reports · doi:10.1038/s41598-024-59377-w · Cited by 13
Evaluation of low vagally-mediated heart rate variability as an early marker of depression risk
Watanabe, D. K., Jarczok, M. N., Williams, D. P., Koenig, J., & Thayer, J. F. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.051 · Cited by 16
The Screen-ICD trial. Screening for anxiety and cognitive therapy intervention for patients with implanted cardioverter defibrillator (ICD): a randomised controlled trial protocol
Berg, S. K., Herning, M., Svendsen, J. H., Christensen, A. V., & Thygesen, L. C. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-013186 · Cited by 13
Cognitive dynamics of intertemporal choice in gambling disorder
Calluso, C., Pettorruso, M., Tosoni, A., Carenti, M. L., Cannito, L., Martinotti, G., Giannantonio, M. D., & Committeri, G. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106463 · Cited by 17
Are All Anxieties Created Equal? Stress-related Networks and Anxiety Phenotypes in Old Age
Kolobaric, A., Karim, H. T., Banihashemi, L., Mizuno, A. N., Aizenstein, H. J., & Andreescu, C. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2021.12.007 · Cited by 13
Humanoid Robot Use in Cognitive Rehabilitation of Patients with Severe Brain Injury: A Pilot Study
Corallo, F., Maresca, G., Formica, C., Bonanno, L., Bramanti, A., Parasporo, N., Giambò, F. M., Cola, M. C. D., & Buono, V. L. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11102940 · Cited by 13
“Legend: SIB: Severe Impairment Battery; LCF = Level of Cognitive Functioning Scale; MMSE = Mini Mental State Examination; HAM-A = Hamilton Rating Scale for anxiety; BDI-II = Beck Depression Inventory; FIM = Functional Independence Measure scale; EQ-5D = EuroQol-5D; AIC = Akaike’s Information criteria; BIC = Bayesian i…”
MethodInfluential
The effect of IPS-modified, an early intervention for people with mood and anxiety disorders: study protocol for a randomised clinical superiority trial
Hellström, L. C., Bech, P., Nordentoft, M., Lindschou, J., & Eplov, L. F. (2013) · Trials · doi:10.1186/1745-6215-14-442 · Cited by 13
“Secondary outcomes are: 1) number of days of competitive employment or education; 2) level of symptoms assessed by the Hamilton Depression Scale (HAM-D6) [39,40]; 3) level of symptoms assessed by the Hamilton Anxiety Scale (HAM-A6) [39,41]; 4) level of functioning assessed by The Global Assessment of Functioning (GAF)…”
MethodInfluential
Gambling disorder and obsessive–compulsive personality disorder: A frequent but understudied comorbidity
Medeiros, G. C., & Grant, J. E. (2018) · Journal of Behavioral Addictions · doi:10.1556/2006.7.2018.50 · Cited by 14
“%: relative values; n: absolute values; SD: standard deviation; p: statistical significance; χ(2): Pearson’s χ(2) test; t: Student’s t-test; HAM-D: Hamilton Depression Rating Scale (Williams, 1988); HAM-A: Hamilton Anxiety Scale (Maier et al., 1988).”
Feasibility and pilot efficacy testing of integrated yoga and Shirodhara (Ayurvedic oil-dripping) intervention on clinical symptoms, cognitive functions and sleep quality of adults with anxiety disorder
Bhargav, P. H., Hegde, D., Bhargav, H., Babu, H., Varsha, K., & Nagarathna, R. (2020) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_44_19 · Cited by 13
“This pilot study revealed that adding Shirodhara to integrated yoga program was feasible in patients with ADs.”
BackgroundMethodInfluential
Perinatal depression prevention through the mother-infant dyad: The role of maternal childhood maltreatment
Berry, O. O., Babineau, V., Lee, S., Feng, T., Scorza, P., Werner, E. A., & Monk, C. E. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.068 · Cited by 15
“The validity and reliability of the HRSD and HRSA are well established (Maier et al., 1988; Ramos-Brieva and Cordero-Villafafila, 1988; Trajković et al., 2011).”
Fluphenazine (oral) versus atypical antipsychotics for schizophrenia
Sampford, J., Sampson, S. J., Li, B. G., Zhao, S., Xia, J., & Furtado, V. A. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010832.pub2 · Cited by 14
Cost-effectiveness of escitalopram for generalized anxiety disorder in Canada
Iskedjian, M., Walker, J. H., Bereza, B. G., Mellédo, J. L., & Einarson, T. R. (2008) · Current Medical Research and Opinion · doi:10.1185/030079908x297277 · Cited by 13
Comparison of Body, Auricular, and Abdominal Acupuncture Treatments for Insomnia Differentiated as Internal Harassment of Phlegm-Heat Syndrome: An Orthogonal Design
Jiao, Y., Han, Y., Li, X., Fang, Y., Liu, Z., Zhou, W., Zhou, J., Wu, Z., Yang, J.-H., Li, S., et al. (2015) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2015/578972 · Cited by 13
“The therapeutic effects were evaluated by comparing the Pittsburgh sleep quality index (PSQI), Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores of patients before treatment, after one course of treatment, and after two courses of treatment as well as one month after treatment.”
BackgroundInfluential
Lower Fractional Anisotropy in the Gray Matter of Amygdala-Hippocampus-Nucleus Accumbens Circuit in Methamphetamine Users: an In Vivo Diffusion Tensor Imaging Study
Li, Y., Zhou, W., Dong, H., Shen, W., Zhang, J., Feng, L., & Zhang, L. (2017) · Neurotoxicity Research · doi:10.1007/s12640-017-9828-4 · Cited by 13
Altered local gyrification index and corresponding functional connectivity in female depressed adolescents with suicide attempts and non-suicidal self-injury
Yang, L., Wang, S., Ji, Y., Gao, X.-S., Guo, Z., Zhou, Z., Yang, Y., Xia, Y., Huang, H., Li, J., et al. (2025) · Psychoradiology · doi:10.1093/psyrad/kkaf023 · Cited by 12
“…and anxiety in depressed adolescents over the past week were assessed using the Hamilton Rating Scale for Depression (HAMD-17) (Cronbach’s alpha: 0.85) (M, 1960 ; Seemuller et al., 2023 ) and the Hamilton Rating Scale for Anxiety (HAMA-14) (Cronbach’s alpha: 0.74) (M, 1959 ; Maier et al ., 1988 ).”
Influential
Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial
Parewa, M., Burman, A. S., Brahma, A., Rutten, L., Sadhukhan, S., Misra, P., Gupta, B., Saklani, N. K., Michael, J., Basu, A., et al. (2021) · Complementary Medicine Research · doi:10.1159/000514524 · Cited by 14
Reduced T cell immunity in unmedicated, comorbidity-free obsessive-compulsive disorder: An immunophenotyping study
Subbanna, M., Shivakumar, V., Jose, D. A., Venkataswamy, M., Debnath, M., Ravi, V., Reddy, Y. C. J., Venkatasubramanian, G., & Narayanaswamy, J. C. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.035 · Cited by 12
Reduced interoceptive accuracy in patients with obsessive–compulsive disorder: A case-control study
Demartini, B., Nisticò, V., Ranieri, R., Scattolini, C., Fior, G., Priori, A., Gambini, O., & Ricciardi, L. (2021) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2021.05.067 · Cited by 12
Plasma IL-6 levels in unmedicated, comorbidity free obsessive-compulsive disorder
Jose, D. A., Dinakaran, D., Shivakumar, V., Subbanna, M., Reddy, Y. C. J., Venkatasubramanian, G., & Narayanaswamy, J. C. (2021) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2021.1937657 · Cited by 13
“…of clinical symptoms was assessed by the Yale-Brown ObsessiveCompulsive Scale (Y-BOCS) (Goodman et al. 1989), Clinical Global Impression (CGI) Severity and improvement (Guy 1976), Hamilton Depression Rating Scale (HDRS) (Hamilton 1960) and Hamilton Anxiety Rating Scale (HARS) (Maier et al. 1988).”
Method
Acupuncture combined with auricular acupressure for smoking cessation and its effects on tobacco dependence and smoking behavior among Hong Kong smokers: a multicenter pilot clinical study
Ho, L. F., Ho, W. K., Wong, L. L., Chiu, S. W., Tang, S. Y., Wong, C., Chan, K. S., Lam, C. L., Chen, M., Chan, K. L., et al. (2022) · Chinese Medicine · doi:10.1186/s13020-022-00649-w · Cited by 12
“HAM-A (score, 0–56) is a validated 14-item (symptom-defined elements) clinician-rated instrument for quantifying anxiety symptoms, with higher scores indicating greater symptom severity [28, 29].”
Background
Functional connectivity between the cerebellar vermis and cerebrum distinguishes early treatment response for major depressive episodes in adolescents
Wang, L., Zhao, P., Zhang, J., Zhang, R., Liu, J., Duan, J., Zhang, X., Zhu, R., & Wang, F. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.054 · Cited by 12
Translation, cultural adaptation and evaluation of the psychometric properties of the Hamilton Anxiety Scale among a sample of Portuguese adult patients with mental health disorders
Santos, E., Coelho, J. C. F., Ribeiro, I., & Sampaio, F. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05010-5 · Cited by 12
“[28] in a study in which the Hamilton Anxiety Scale was administered to two samples, the first composed of 97 patients with anxiety disorders and the second composed of 101 patients with depressive disorders.”
MethodResultInfluential
The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: a randomized controlled trial
Feng, X., Sun, J., Wang, Z., Zhang, N., Liu, Y., Wang, Z., Wang, N., Jian, G., Cheng, D., Sheng, X., et al. (2025) · Renal Failure · doi:10.1080/0886022x.2025.2482124 · Cited by 16
“Anxiety and depression were measured with the Hamilton Anxiety Rating Scale/Hamilton Depression Rating Scale (HAMA/HAMD) [29,30].”
The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease
Bolat, M. S., Özer, İ., Çınar, Ö., Akdeniz, E., & Aşçı, R. (2017) · Renal Failure · doi:10.1080/0886022x.2017.1349678 · Cited by 12
“The first month and third month of treatment mean HARS scores were statistically decreased compared to the mean pretreatment score (p¼ .001) (Table 3).”
Influential
Subcortical Brain Abnormalities and Clinical Relevance in Patients With Hemifacial Spasm
Xu, H., Guo, C., Luo, F., Sotoodeh, R., Zhang, M., & Wang, Y. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2019.01383 · Cited by 11
Assessment of depression and anxiety in relation to quality of life in patients with vitiligo
Sayed, D. S., Abdelmaguid, E., Khalifa, H., & Salah, M. M. (2020) · Egyptian Journal of Dermatology and Venerology · doi:10.4103/ejdv.ejdv_54_19 · Cited by 12
Factors for Maintaining Abstinence at 2 and 6 Months After Alcohol Withdrawal
PAREAUD, M., Girard, M. F., & Nubukpo, P. (2021) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000522 · Cited by 12
Predicting subretinal fluid absorption with machine learning in patients with central serous chorioretinopathy
Xu, F., Xiang, Y., Wan, C., You, Q., Zhou, L., Li, C., Gong, S., Gong, Y., Li, L., Li, Z., et al. (2021) · Annals of Translational Medicine · doi:10.21037/atm-20-1519 · Cited by 12
“…chosen by clinicians, the baseline characteristics on the retina and lifestyle also exert a significant impact on SFA, including the SRF height, the central macula thickness (CMT), the double-layer sign (DLS), and the scores on the Pittsburgh Sleep Quality Index and Hamilton Anxiety Scale (19,20).”
Neuropsychiatric, neuropsychological, and neuroimaging features in isolated REM sleep behavior disorder: The importance of MCI
Vacca, M., Assogna, F., Pellicano, C., Chiaravalloti, A., Placidi, F., Izzi, F., Camedda, R., Schillaci, O., Spalletta, G., Lombardo, C., et al. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.08.018 · Cited by 12
Efficacy of cognitive behavioural therapy with medication for patients with obsessive-compulsive disorder: A multicentre randomised controlled trial in China
Meng, F., Han, H., Luo, J., Liu, J., Liu, Z., Tang, Y., Hou, X., Wei, J., Shi, L., Tang, M., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.090 · Cited by 14
Clinical characteristics of moderate–severe obsessive–compulsive disorder in children and adolescents in China
Luo, L., Feng, B., Yang, S., Zhang, N., & Qiu, S. (2020) · Journal of International Medical Research · doi:10.1177/0300060520922679 · Cited by 14
Childhood Emotional Neglect Is Associated With Low Social Support in Chinese Patients With Major Depressive Disorder
Qin, X., Wang, M., Lu, X., Sun, J., Dong, Q., Zhang, L., Liu, J., Ju, Y., Wan, P., Guo, H., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.781738 · Cited by 13
Cognitive Dysfunction in Patients With Late-Life Somatic Symptom Disorder: A Comparison According to Disease Severity
Inamura, K., Shinagawa, S., Nagata, T., Tagai, K., Nukariya, K., & Nakayama, K. (2014) · Psychosomatics · doi:10.1016/j.psym.2014.10.004 · Cited by 14
One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study.
Huddleston, C., Martin, L., Woods, K., & Dindo, L. (2018) · Military Medicine · doi:10.1093/milmed/usx090 · Cited by 11
A novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial
Sorsdahl, K., Stein, D. J., Pasche, S., Jacobs, Y., Kader, R., Odlaug, B., Richter, S., Myers, B., & Grant, J. E. (2021) · Addiction Science & Clinical Practice · doi:10.1186/s13722-020-00209-3 · Cited by 11

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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