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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 Templates, pick HAM-A, 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 server rejects sent_async delivery — the picker has no “send to client” path.

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How Rivet scores it

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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)

TotalBand
<17Mild
18-24Mild-to-moderate
25-30Moderate-to-severe
≥31Severe

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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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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.

HAM-D

The Hamilton Depression Rating Scale. Most often paired with HAM-A in mixed depression/anxiety presentations.

Clinician-administered overview

Why these six measures don’t ship to clients, and how solo fill works.