This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
A classic scale for anxiety
The Hamilton Anxiety Rating Scale (HAM-A or HARS) was published by the British psychiatrist Max Hamilton in 1959. It remains one of the most widely used measures of anxiety severity in clinical trials and practice. It is rated by a clinician after an interview, rather than filled in by the patient.
The 14 items
Each is rated from 0, not present, to 4, very severe:
- Anxious mood
- Tension
- Fears
- Insomnia
- Intellectual: concentration and memory
- Depressed mood
- Somatic, muscular
- Somatic, sensory
- Cardiovascular symptoms
- Respiratory symptoms
- Gastrointestinal symptoms
- Genitourinary symptoms
- Autonomic symptoms
- Behavior at the interview
The total ranges from 0 to 56. Items 1 to 6 and 14 form the psychic anxiety subscore, items 7 to 13 the somatic anxiety subscore.
Interpreting the score
A commonly used set of bands, proposed by Matza and colleagues in 2010, is:
- 0 to 7: no or minimal anxiety
- 8 to 14: mild anxiety
- 15 to 23: moderate anxiety
- 24 or more: severe anxiety
Many trials require a score of 18 to 20 or more for inclusion, and a fall of 50% from baseline is often used to define a response to treatment.
Example
A patient with moderate anxious mood and tension, and mild symptoms across most other items, scores 14, mild anxiety, with a psychic subscore of 9 and a somatic subscore of 5.
Limits
The HAM-A gives a lot of weight to physical symptoms, which can also come from medical illnesses or medications. It does not distinguish between anxiety disorders such as generalized anxiety, panic or social anxiety. For self-assessment, use the GAD-7 questionnaire, and talk to a doctor or mental health professional if anxiety interferes with your daily life.