HAM-A — Hamilton Anxiety Rating Scale

The HAM-A is the dominant anxiety severity rating in clinical trials. You fill it about the client after a structured interview. The client never sees the form. It’s frequently paired with the HAM-D in mixed depression-and-anxiety presentations, and is the standard outcome scale in SSRI, SNRI, and buspirone trials.

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What it measures

Fourteen items split into two subscales:

• Psychic anxiety (items 1-7): anxious mood, tension, fears, insomnia, cognitive symptoms, depressed mood, somatic muscular tension
• Somatic anxiety (items 8-14): sensory symptoms, cardiovascular, respiratory, gastrointestinal, genitourinary, autonomic, behavior at interview

Each item scores 0-4 (Not present / Mild / Moderate / Severe / Very severe — incapacitating). Total range is 0-56.

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When to use it

• Anxiety disorder severity tracking — GAD, panic disorder, PTSD-comorbid anxiety
• Benzodiazepine taper monitoring
• Treatment-response measurement in SSRI, SNRI, and buspirone trials
• Mixed depression-and-anxiety presentations, paired with HAM-D

For routine therapy monitoring, the GAD-7 self-report is usually the right tool — it’s shorter, the client engages with the score, and the psychometrics hold up. The HAM-A earns its cost when you need rater anchors: trial protocols, complex presentations, or contexts where self-report is unreliable.

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How you fill it

Solo fill. Open HAM-A from the templates picker and tap New response. The renderer walks you through each item with the SIGH-A (Shear et al. 2001) anchor language in the answer options. Typical administration time is 15-25 minutes. The form never goes to the client. The picker has no “Send to client” option for this measure.

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Scoring and severity cutoffs

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Total + subscales

• Total: sum of all 14 items, 0-56
• Psychic anxiety subscale: sum of items 1-7, 0-28
• Somatic anxiety subscale: sum of items 8-14, 0-28

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Severity bands (Maier et al. 1988)

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Clinical change thresholds

• Response: ≥50% reduction in total from baseline
• Remission: total ≤7 sustained

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Rater training

The Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A, Shear et al. 2001) provides standardized probe questions. Inter-rater reliability with trained raters typically ranges ICC 0.74-0.96.

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What we render vs. the source

Verbatim Hamilton 1959 items with the SIGH-A anchor descriptors in the answer options. Item 7 (“somatic muscular”) and item 8 (“somatic sensory”) may seem misaligned to the psychic/somatic subscale split — that’s the canonical Hamilton 1959 split per Maier 1988, and Rivet surfaces it as the standard subscale division.

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Known limitations

• The 0-4 scale doesn’t distinguish well between items rated for frequency vs. intensity vs. duration. Clinical judgment for borderline ratings.
• Items 12 (genitourinary) and 13 (autonomic) overlap substantially with depression symptoms. The scale doesn’t differentiate well between anxious depression and pure anxiety — pair with HAM-D for disambiguation.
• Item 14 (behavior at interview) is the only direct-observation item. The others rely on patient report.

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HAM-A vs GAD-7 and the BAI

The HAM-A is rated by you during a structured interview; the GAD-7 is filled in by the client. That difference drives everything else. The HAM-A gives you fourteen items split into psychic and somatic anxiety and is the scale treatment trials report, which makes it the better fit for tracking response to a medication change or a benzodiazepine taper. The GAD-7 takes two minutes, can go out ahead of a session, and is what a referrer recognises. It also costs your time rather than the client’s, and reliable scoring depends on rater familiarity — the structured interview guide exists for exactly that reason. Against the BAI: the Beck Anxiety Inventory is the self-report scale most often set beside the HAM-A in the literature. It is licensed by Pearson and paid for per use, so Rivet doesn’t include it. If you want a self-report anxiety measure here, the GAD-7 is the one to use.

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Is it free to use?

Yes — it is public domain. Hamilton, 1959.

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Citations

• Hamilton, M. (1959). “The assessment of anxiety states by rating.” British Journal of Medical Psychology, 32(1): 50-55. Public domain.
• Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). “The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders.” Journal of Affective Disorders, 14(1): 61-68.
• Shear, M. K., Vander Bilt, J., Rucci, P., et al. (2001). “Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A).” Depression and Anxiety, 13(4): 166-178.

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