HAM-A

Measure anxiety severity. Widely used in clinical trials and for monitoring treatment response. Clinician-administered (not self-report).

Indication

Measure anxiety severity. Widely used in clinical trials and for monitoring treatment response. Clinician-administered (not self-report).

Criteria

id: anxious_mood; label: Anxious mood (worries, fearful anticipation, irritability); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: tension; label: Tension (fatigability, startle, trembling, restlessness); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: fears; label: Fears (of dark, strangers, being alone, animals, crowds); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: insomnia; label: Insomnia (difficulty falling/staying asleep, nightmares); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: intellectual; label: Intellectual (difficulty concentrating, poor memory); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: depressed_mood; label: Depressed mood (loss of interest, anhedonia, early waking); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: somatic_muscular; label: Somatic muscular (aches, twitching, stiffness, bruxism); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: somatic_sensory; label: Somatic sensory (tinnitus, blurred vision, flushes, weakness); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: cardiovascular; label: Cardiovascular (tachycardia, palpitations, chest pain, fainting); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: respiratory; label: Respiratory (chest constriction, choking, sighing, dyspnea); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: gastrointestinal; label: Gastrointestinal (dysphagia, pain, nausea, looseness, constipation); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: genitourinary; label: Genitourinary (frequency, urgency, amenorrhea, loss of libido); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: autonomic; label: Autonomic (dry mouth, flushing, sweating, tension headache); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe
id: behavior; label: Behavior at interview (fidgeting, tremor, strained face, sighing); type: options; options: value: 0; label: 0 — Not present; value: 1; label: 1 — Mild; value: 2; label: 2 — Moderate; value: 3; label: 3 — Severe; value: 4; label: 4 — Very severe

Interpretation

function(score) { if (score <= 7) return { risk: score + '/56', tier: 'Minimal / no anxiety', action: 'Below clinical threshold. Routine follow-up.', color: 'green' }; if (score <= 14) return { risk: score + '/56', tier: 'Mild anxiety', action: 'Consider psychotherapy; reassess. GAD-7 preferred for screening.', color: 'green' }; if (score <= 23) return { risk: score + '/56', tier: 'Moderate anxiety', action: 'Treatment indicated \u2014 psychotherapy and/or SSRI/SNRI.', color: 'yellow' }; if (score <= 30) return { risk: score + '/56', tier: 'Moderate-severe anxiety', action: 'Active treatment. Combine pharmacotherapy and psychotherapy.', color: 'red' }; return { risk: score + '/56', tier: 'Severe anxiety', action: 'Significant impairment. Optimize pharmacotherapy; close follow-up.', color: 'red' }; }

Clinical pearls

HAM-A is clinician-administered — GAD-7 is preferred for screening
Used in clinical trials as a primary outcome measure
Somatic symptoms (items 7–13) may overlap with medical conditions — consider medical workup
Serial HAM-A tracks treatment response more sensitively than categorical diagnosis

Source and review

Hamilton M. Br J Med Psychol 1959. Last reviewed: 2025-01-01