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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“Comprised of 14 items, it encompasses a diverse array of anxiety manifestations, spanning from physiological to cognitive domains [46].”
Background
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Gao, N., Wu, L., Liu, X., Lin, Z., Liu, Z., Liang, J., & Wang, W. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e30417 · Cited by 3
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“Anxiety was diagnosed using a HAMA scale score of > 14 points [11].”
Method
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Pérez-Machı́n, R., Vega-Morales, T., Elvira-Aranda, C., Rico, L. L., Gomis-Gomis, M. J., & López-Ríos, L. (2025) · Pharmaceuticals · doi:10.3390/ph18020278 · Cited by 3
“The HAM-A is a widely recognized psychometric scale for evaluating anxiety, consisting of 14 items that measure the severity of both psychic and somatic anxiety symptoms [63].”
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Developments in application of optogenetics in pain and anxiety: a literature review
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Shea, A. L. A., García, M. V., Cadavid, A. O., Vélez, R. C., Díaz, M. M., & Fernández, T. B. (2011) · Atención Primaria · doi:10.1016/j.aprim.2010.05.014 · Cited by 3
Four-dimensional structure underlying scales for depression anxiety and retardation: emergence of trapped anger and scale improvements
Goekoop, J. G., de Beurs, E., & Zitman, F. G. (2006) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2006.09.001 · Cited by 3
“Recently, the insufficiency of the HAMD has extensively been discussed [5], and more or less similar shortcomings of the other scales have been reported [6-10].”
Background
Endometriosis: Impact on Patient Quality of Life
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Executive Dysfunction Correlated With 2-Year Treatment Response in Patients With Late-Life Undifferentiated Somatoform Disorders
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Anxiety and genetic polymorphisms in catechol-O-methyltransferase (COMT) and serotonin transportation gene (5HTT) are associated with benign migratory glossitis
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Giner, J., Enguix, S. C., García, J. B., Cercós, C. L., Baldomero, E. B., & Ibáñez, E. (2004) · Actas Españolas de Psiquiatría · Cited by 3
Assessment of Anxiety using Hamilton Anxiety Scale in Augmented Reality Head Mounted Display User: A Study ProtocolPreprint
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“Since no other accurate scale is available, the HAM-A is widely used for these reasons (6).”
Background
Hamilton Anxiety Rating Scale
Yang, Z. (2020) · Springer eBooks · doi:10.1007/978-3-319-69892-2_825-1 · Cited by 3
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“Hamilton Anxiety Rating Scale (HAM-A)—clinician-administered, 14-item scale assessing anxiety severity, scored 0–4 per item [18].”
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“Although some items overlap, including depressive mood, somatic anxiety, gastrointestinal symptoms, and insomnia, which may blur the distinction between anxiety and depression (163).”
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“In the case of HAM-A scores, the findings were similar: no significant main effect of the group ( p = 0.8), a significant main effect of the treatment intervention ( F (1,84) = 83.28, p 0.001, η 2 = 0.10), and no significant two-way interaction ( p = 0.8).”
Influential
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Dynamics of Anxiety, Depression, and Sleep Quality Following COVID-19 Hospitalization in Romania
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“A score of 0–4 indicates absence of anxiety, 5–10 indicates mild anxiety, 11–16 indicates moderate anxiety, and 17 or higher indicates severe anxiety [38–40].”
Fatigue as a moderator in symptom networks of insomnia, anxiety, and depression: insights from moderated network analysis
Xing, H., Ma, X., Meng, F., & Li, Z. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1644015 · Cited by 2
“The higher the score, the more severe the degree of anxiety (34).”
Comparative effects of intermittent theta-burst stimulation and sequential bilateral rTMS on depression and emotion regulation in major depressive disorder: a randomized controlled trial
Pu, L., Li, Y., Deng, Z., Deng, C., Hu, A., Wu, J., Chen, Z., Yao, D., Yan, H., & Yan, G. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1756383 · Cited by 2
Depressive Symptoms, Anxiety, Insomnia, and Sexual Quality of Life in Patients with Chronic Obstructive Pulmonary Disease from the Podlaskie Voivodeship, Poland: A Cross-Sectional Pilot Study
Bojarska, K., Orzechowska, M., Grochowski, M., Skiepko, R., & Cybulski, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15072769 · Cited by 2
“The reliability of the HAM-A in international studies is rather high (Cronbach’s alpha between 0.77 and 0.90) [25].”
Influential
Prevalence of Generalized Anxiety Disorder in Patients with Rheumatoid Arthritis and Its Relationship with Disease Activity
Ahmed, A. B., Radwan, A. M. A., & Baddary, H. (2016) · The Egyptian Journal of Hospital Medicine · doi:10.12816/0033778 · Cited by 2
“Despite this, the reported levels of interrater reliability for the scale appear to be acceptable; also it covers many of the features of GAD and can be helpful also in assessing its severity (30)”
Background

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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