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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Kim, K., Hwang, H., Bae, S., Kim, S. M., & Han, D. H. (2024) · Journal of Medical Internet Research · doi:10.2196/51428 · Cited by 8
“The HAM-A was developed by Hamilton in 1969 [20].”
Widespread reductions in cortical thickness following ketamine abuse
Tang, J.-S., Wu, Q.-X., Qi, C., Xie, A., Liu, J., Sun, Y.-K., Yuan, T.-F., Chen, W., Liu, T.-Q., Hao, W., et al. (2024) · Journal of Psychiatry & Neuroscience · doi:10.1503/jpn.230111 · Cited by 7
Psychometric properties of the 23-Item Clinician Administered Dissociative States Scale (CADSS) in a psychological trauma population
Bremner, J. D., Williamson, D., & Vaccarino, V. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.050 · Cited by 8
A nomogram for predicting non-suicide self-injury in youth depression patients: a longitudinal analysis
Li, Y., Ma, Y., Sun, B., Rosenheck, R. A., Zhang, J., & He, H. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02603-7 · Cited by 8
“The HAMA-14 contains two primary fac - tors: somatic anxiety and psychic anxiety [ 17].”
Effects of Ketamine vs. Midazolam in Adolescent Treatment Resistant Depression
Macejova, A., Kovacova, V., Tonhajzerová, I., Višňovcová, Z., Ferencová, N., Mlyncekova, Z., Kukucka, T., & Ondrejka, I. (2024) · Pharmaceuticals · doi:10.3390/ph17121627 · Cited by 10
“HAM-A [52] is a clinician-administered 14-item scale for rating the severity of anxiety in adults, adolescents, and children with proven reliability, validity, and sensitivity [57].”
Circadian rhythm modulation in heart rate variability as potential biomarkers for major depressive disorder: A machine learning approach
Xia, Y., Zhang, H., Wang, Z., Song, Y., Shi, K., Fan, J., & Yang, Y. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.03.002 · Cited by 8
LSD microdosing in major depressive disorder: results from an open-label trial
Daldegan‐Bueno, D., Donegan, C. J., Sumner, R. L., Forsyth, A., Evans, W., Alshakhouri, M., Reynolds, L., Ponton, R., Smith, T., Roop, P. S., et al. (2025) · Neuropharmacology · doi:10.1016/j.neuropharm.2025.110762 · Cited by 9
Relation among Psychopathological Symptoms, Neuropsychological Domains, and Functional Disability in Subacute Poststroke Rehabilitation
Buono, V. L., Bonanno, L., Palmeri, R., Corallo, F., Parisi, S., Trinchera, A., Sessa, E., Pollicino, P., Galletti, B., Bramanti, P., et al. (2018) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2017.12.033 · Cited by 8
Prevalence of Anxiety and Depression among COVID-19 Patients Admitted to Tertiary Care Hospital
Kumar, P., Chaudhary, R., Chhabra, S., & Bhalla, J. K. (2021) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_377_20 · Cited by 8
Childhood adversity modulation of central autonomic network components during cognitive regulation of emotion in major depressive disorder and borderline personality disorder.
Wainsztein, A., Castro, M. N., Goldberg, X., Camacho-Téllez, V., Vulcano, M., Abulafia, C., Ladrón‐de‐Guevara, S., Cardoner, N., Nemeroff, C. B., Menchón, J. M., et al. (2021) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2021.111394 · Cited by 8
Clinical, behavioral, and electrophysiological profiles along a continuum of suicide risk: evidence from an implicit association task
Lamontagne, S. J., Gilbert, J. R., Zabala, P. K., Waldman, L. R., Zarate, C. A., & Ballard, E. D. (2023) · Psychological Medicine · doi:10.1017/s0033291723003331 · Cited by 8
Existential concerns in psychopathology: a transdiagnostic network analysis existential concerns in psychopathology
Chavez‐Baldini, U., Verweij, K. J. H., Bergamin, J., Luigjes, J., Mocking, R. J. T., Denys, D. A. J. P., Nieman, D. H., & Vulink, N. C. C. (2024) · Cogent Mental Health · doi:10.1080/28324765.2024.2313869 · Cited by 12
“The HAM-A demonstrates satisfactory interrater reliability and concurrent validity (Maier et al., 1988).”
Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial
Bhagavan, C., Glue, P., Evans, W., Reynolds, L., Turner, T., King, C., Russell, B. R., Morunga, E., Mills, J. L., Layton, G., et al. (2024) · Trials · doi:10.1186/s13063-024-08174-x · Cited by 10
“Interrater reliability of the HAM-A has been shown to be consistent and the scale has demonstrated satisfactory correlation coefficients indicating sufficient sensitivity to change [75].”
Background
White matter alterations and their associations with biomarkers and behavior in subjective cognitive decline individuals: a fixel-based analysis
Wei, Y., Kung, Y., Lin, C., Chen, C., Lin, C., Tseng, R.-Y., Chen, Y.-L., Huang, W., Chen, P., Chong, S. T., et al. (2024) · Behavioral and Brain Functions · doi:10.1186/s12993-024-00238-x · Cited by 10
“We also used the Hospital Anxiety and Depression Scale (HADS) to evaluate the degree of anxiety (HADS-A) and depression (HADS-D) [58], as well as Hamilton Anxiety Rating Scale (Ham-A) and Hamilton Depression Rating Scale (Ham-D) [59, 60].”
Method
Algorithm-Based Modular Psychotherapy Alleviates Brain Inflammation in Generalized Anxiety Disorder
Kéri, S., Kancsev, A., & Kelemen, O. (2024) · Life · doi:10.3390/life14070887 · Cited by 8
“Anxiety symptoms were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) [65] and the Generalized Anxiety Disorder 7-item scale (GAD-7) [66].”
BackgroundMethod
Alpha oscillation mediates the interaction between suicide risk and symptom severity in Major Depressive Disorder
Zhang, H., Liu, X., Su, Z., Wang, Y., Chen, B., Zhang, Z., Wang, B., Zhou, J. L., Zhang, L., & Zhao, X. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1429019 · Cited by 8
Effect of Cognitive Behavioral Treatment Program on Anxiety and Self-Esteem among Secondary School Students
Mohamed, S. M. (2017) · American Journal of Nursing Science · doi:10.11648/j.ajns.20170603.17 · Cited by 7
Magnetic Resonance Image Texture Analysis of the Periaqueductal Gray Matter in Episodic Migraine Patients without T2-Visible Lesions
Chen, Z., Chen, X., Liu, M., Liu, S., Yu, S., & Ma, L. (2018) · Korean Journal of Radiology · doi:10.3348/kjr.2018.19.1.85 · Cited by 8
An Examination of Factor Structure of the Hamilton Anxiety Rating Scale in a Non-Clinical Persian Sample
Slater, P. F., Bunting, B., Hasson, F., Al‐Smadi, A. M., Gammouh, O. S., Ashour, A. F., & Jordan, D. (2019) · International Journal of Research in Nursing · doi:10.3844/ijrnsp.2019.1.9 · Cited by 8
“Whilst several papers have reported good reliability and validity (Maier et al., 1988; Clark and Donvan, 1994; Mondolo et al., 2006; Kummer et al., 2010; Leentjens et al., 2011) with acceptable Cronbach alpha scores were reported in numerous studies (Bjelland et al., 2002; García-Campayo et al.,…”
BackgroundMethod
Effects of TIP treatment on brain network topology of frontolimbic circuit in first-episode, treatment-naïve major depressive disorder
Lv, X., Lu, F., Zhang, J., Chen, H., Zhang, L., Wang, X., Fan, Y., Fang, J., Hong, L., Wang, J., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.127 · Cited by 8
Associations between brain‐derived neurotrophic factor and cognitive impairment in panic disorder
Wang, W., Liu, Y., Luo, S., Guo, X., Luο, X., & Zhang, Y. (2020) · Brain and Behavior · doi:10.1002/brb3.1885 · Cited by 8
Effect of a self-help educational program with peer group on anxiety of mothers of children with cancer: A clinical trial study
Gholamian, A., Bahrami, M., Sherbafchi, M. R., & Namnabati, M. (2021) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1494_20 · Cited by 8
Assessment of mental health issues among geriatric population during COVID19 pandemic, Indian perspective
Kumar, V., Klanidhi, K. B., Chakrawarty, A., Singh, J., Priti, P., Chatterjee, P., & Dey, A. B. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102897 · Cited by 8
Predictors of Return to Work for People with Anxiety or Depression Participating in a Randomized Trial Investigating the Effect of a Supported Employment Intervention
Hellström, L. C., Christensen, T. N., Bojesen, A. B., & Eplov, L. F. (2022) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-022-10046-7 · Cited by 8
“The Hamilton Anxiety six-item Scale (HAM-A6) [33, 35] was used to measure core symptoms of anxiety, also on a 5-point Likert scale (0 equals not present and 4 equals very severe).”
Method
The Potential Impact of Age on Gut Microbiota in Patients with Major Depressive Disorder: A Secondary Analysis of the Prospective Observational Study
Miyaho, K., Sanada, K., Kurokawa, S., Tanaka, A., Tachibana, T., Ishii, C., Noda, Y., Nakajima, S., Fukuda, S., Mimura, M., et al. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12111827 · Cited by 12
“The HAM-A is a scale for measuring the severity of anxiety, consisting of 14 items, each rated on a scale of 0 (not present) to 4 (severe), with a total score ranging from 0 to 56 [14].”
Background
Neuropsychiatric Function Improvement in Pediatric Patients with Phenylketonuria
Grant, M., Jurecki, E. R., McCandless, S. E., Stahl, S. M., Bilder, D. A., Sanchez‐Valle, A., & Dimmock, D. (2023) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2023.113526 · Cited by 8
Cortico–subcortical spatiotemporal dynamics in Parkinson’s disease can be modulated by transcranial alternating current stimulation
Liu, T., Yan, Z., Han, Z., Zhang, J., Fang, B., & Yan, T. (2023) · Brain Science Advances · doi:10.26599/bsa.2023.9050009 · Cited by 8
“Motor, emotional, and cognitive functions were assessed with the following scales: UPDRS-I, UPDRS-II, UPDRS-III, UPDRS-IV, TUG, Berg, MoCA, MMSE, HAMA, and HAMD.”
MethodInfluential
Neuro‐11: a new questionnaire for the assessment of somatic symptom disorder in general hospitals
Zeng, S., Yu, Y., Lu, S., Zhang, S., Su, X., Dang, G., Liu, Y., Cai, Z., Chen, S., He, Y., et al. (2023) · General Psychiatry · doi:10.1136/gpsych-2023-101082 · Cited by 8
Short-Term and Long-Term Impact of COVID-19 on Quality of Life and Psychological Outcomes in Saudi Arabia: A Comparative Cross-Sectional Study
Althomali, O. W., Amin, J., Shaik, D. H., Alghamdi, W., Ibrahim, A. A., Hussein, H. M., & Kanwal, R. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s449152 · Cited by 8
Comparison of first episode and recurrent major depression patients in terms of cognitive function
Kaygusuz, Ç. Ç., Arısoy, Ö., Boztaş, M. H., & Sercan, M. (2013) · Dusunen Adam The Journal of Psychiatry and Neurological Sciences · doi:10.5350/dajpn2013260401 · Cited by 9
“Scores of 0-4 means no anxiety, 4-17 means mild, 18-24 means moderate and above 25 means severe anxiety (40).”
Background
Anxiety Symptoms Among Lebanese Health-care Students: Prevalence, Risk Factors, And Relationship With Vitamin D Status
伊藤, 和., & Audi, L. (2021) · Journal of Health Sciences · doi:10.17532/jhsci.2021.1191 · Cited by 8
Spatio-temporal dynamics of EEG features during sleep in major depressive disorder after treatment with escitalopram: a pilot study
Wu, L., Wang, X., Yang, Y., Dong, T.-F., Lei, L., Cheng, Q.-Q., & Li, S. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02519-x · Cited by 8
Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry
Chen, Z., Chen, X.-Y., Liu, M., Ma, L., & Yu, S. (2018) · Chinese Medical Journal · doi:10.4103/0366-6999.240807 · Cited by 8
Clinical findings of hyperechoic substantia nigra in patients with Parkinson's disease
Fan, Y.-Y., Ma, J.-J., Yang, D.-W., Li, X.-H., Liang, K.-K., She, Z., Qi, X., Shi, X., Gu, Q., Zheng, J.-H., et al. (2024) · European Journal of Neuroscience · doi:10.1111/ejn.16308 · Cited by 7
“Neuropsychiatric symptoms were assessed with the 14-item Hamilton Anxiety Rating Scale (HAMA) and the 17-item Hamilton Depression Rating Scale (HAMD) (Leentjens et al., 2000; Maier et al., 1988).”
Method
Circuit-based neuromodulation enhances delayed recall in amnestic mild cognitive impairment
Ma, J., Wu, J., Xing, X., Xue, X., Xiang, Y., Zhen, X., Li, J., Lu, J., Zhang, J.-P., Zheng, M., et al. (2024) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2023-333152 · Cited by 9
Shoden promotes Relief from stress and anxiety: A randomized, double-blind, placebo-controlled study on healthy subjects with high stress levels
Mishra, D. N., & Kumar, M. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e36885 · Cited by 14
“A total score of 17 or less indicates mild anxiety severity, 18 to 24 indicates mild to moderate anxiety severity, and 25 to 30 indicates moderate to severe anxiety severity [22].”
Background
Identifying latent subtypes of symptom trajectories in major depressive disorder patients and their predictors
Meng, F., Ou, W., Zhao, X., Wang, M., Lu, X., Dong, Q., Zhang, L., Sun, J., Guo, H., Zhao, F., et al. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01883-z · Cited by 7
“The severity of anxiety was assessed by the Hamilton Anxiety Rating Scale (HAMA) [34] with scores ranging from 0 to 56 points.”
Effects of Music Therapy in the Context of Positive Emotions, Engagement, Relationships, Meaning and Accomplishment (PERMA) on Negative Emotions in Patients with Mild-to-Moderate Depression
Shan, J., & Qi, X. (2024) · Noise and Health · doi:10.4103/nah.nah_57_24 · Cited by 7
Effects of Music Therapy Combined with Hospice Care on the Quality of Life and Negative Emotions of Elderly Patients with Advanced Breast Cancer
Wu, L., Zhou, F., Cheng, Y., Lv, W., Shi, W., & Xu, X. (2025) · Noise and Health · doi:10.4103/nah.nah_124_24 · Cited by 7
“[15,16] The medication compliance of the patients was compared and divided into three levels.”

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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