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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“HAMA is widely used in clinical practice and research studies, with a Cronbach’s α of 0.86 (Maier et al., 1988).”
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“…and anxiety symptoms was measured using the positive and negative syndrome scale (PANSS), the 24-item Hamilton depression rating scale (HDRS), and the 14-item Hamilton anxiety rating scale (HARS) (Kay, Fiszbein, & Opler, 1987; Maier, Buller, Philipp, & Heuser, 1988; Williams, 1988), respectively.”
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“…anxiety scale (sas) were used to evaluate treatment efficacy. haMa, with its 14 items, is a validated tool for objective anxiety symptom assessment (Maier et al., 1988). sas’s 20 items provide a subjective weekly anxiety measure (David et al., 2020), tracking treatment progress from the patient’s…”
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“This is also observed through MCID, which, according to the literature, indicates clinically significant improvements [36,39–41].”
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“27,28 It contains 14 items, divided into mental anxiety and somatic anxiety.”
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“In addition, we also used the Hamilton Anxiety Rating Scale (HAMA), [20] the Self-rating Anxiety Scale (SAS), [21] and the Self-rating Depression Scale (SDS) [22] to further evaluate the psychological status of all patients.”
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“Moreover, the commonly accepted TRD definition often overlooks critical clinical factors, such as psychiatric and somatic comorbidities, which are highly prevalent in TRD populations [83% and 70%, respectively, in a recent study (82)].”
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“HAMA (0–56): Scores ≥ 7 indicate anxiety symptoms, with severity correlating with score level [20].”
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“Anxiety symptoms were evaluated with the Generalized Anxiety Disorder-7 (GAD-7) [33] and the Hamilton Anxiety Scale (HAMA) [34].”
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“The Inclusion criteria for patients were as follows: (1) CID group: meet the diagnostic guidelines of the third edition of the International Classification of Sleep Disorders, 3 At the same time, meet the following requirements: ① Duration suffered from insomnia > 6 months; ② 18–60 years old; ③ Receiving education ≥ 9…”
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“Outcome measures for diagnosing anxiety, depression and comorbidities assessed included the 24-item Hamilton Depression Rating Scale (HAMD-24) [28, 29] and the 14-item Hamilton Anxiety Scale (HAMA-14) [30, 31].”
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“Four instruments were used: a Sociodemographic Questionnaire, the World Health Organization Quality of Life-BREF (WHOQOL-BREF) (31), the Hamilton Anxiety Rating Scale (HAMA) (32), and the 17-item Hamilton Depression Rating Scale (HAMD-17) (33), to assess quality of life (QOL), anxiety, and depression in both groups.”
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“Also, anxiety symptoms did not significantly change, as measured through the Hamilton Anxiety Rating Scale (HAM-A; Maier et al., 1988; Kim et al., 2024).”
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“The HAMA consists of 14 items, with a total score ranging from 0 to 56, which eﬀectively reﬂects the severity of anxiety symptoms.”
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“22 BAI is a 21-item self-report questionnaire focusing on the severity of anxiety symptoms, particularly somatic manifestations.”
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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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