The HAM-A is a 14-item scale a clinician rates in an interview to measure how severe anxiety is. Each item scores 0 to 4, for a total from 0 to 56, split into psychic and somatic anxiety. See what each score means, how to read the two subscores and track change, and record the rating with the free template. The official form comes from its publisher.
HAM-A result template
FreeHAMILTON ANXIETY RATING Rating date: [Date] Patient: [Name or record number, age] Rater: [Name, role, and HAM-A training] Interview: [Unstructured or SIGH-A guide; in person or video; minutes taken] Period rated: [Past week, or the period your protocol sets] Condition tracked: [Generalized anxiety disorder, panic disorder, health anxiety, mixed anxiety and depression, or other] ITEM RATINGS Items 1 to 14: [Each rating 0 to 4, in order] Rated 3 or 4: [Symptom areas rated severe or very severe] TOTALS HAM-A total: [0 to 56] Severity band: [Mild 0-17, mild to moderate 18-24, moderate to severe 25-30, or severe 31-56; name the set if different] Psychic subscore: [Items 1 to 6 and 14, out of 28] Somatic subscore: [Items 7 to 13, out of 28] SINCE BASELINE Baseline rating: [Date, total, subscores, and who rated it] Change: [Points and percent; response at a 50% fall, remission at 7 or less] Same rater and method: [Yes, or what changed] CONTEXT Physical causes checked: [Thyroid, heart, lungs, caffeine, alcohol, stimulants, side effects of current medicines] Mood and safety: [Depression rating or screen, suicide risk] Patient's account: [Self-report scores such as the GAD-7, and what the patient says has changed] DECISION Treatment: [Continue, raise dose, switch, add therapy, or step down] Referral: [Psychology, psychiatry, medical workup, or none] Next HAM-A: [Date or weeks from now, same rater if possible] Rated by: [Clinician name, credentials]
Use it for
A trained clinician rates the HAM-A from an interview of about 15 to 20 minutes. The patient doesn’t fill it in.
Avoid: Handing the form to the patient to fill in. It’s built for a rater, and a self-rated total can’t be compared with one from an interview.
Each of the 14 items is rated 0 to 4 for how severe that symptom area has been. The items add up to a total from 0 to 56.
Avoid: Rating an item from a one-word answer. Ask a follow-up question, and an example, before choosing between 2 and 3.
The band shows how severe the anxiety is now. It doesn’t say which anxiety disorder the patient has; the diagnosis comes from the full assessment.
Avoid: Using the HAM-A as a screen. It was built to rate severity once anxiety is known; for a quick screen, the GAD-7 is the usual tool.
The psychic items cover worry, tension, fears, sleep, concentration, low mood, and how the patient seems in the interview. The somatic items cover muscles, the senses, heart, breathing, gut, urinary and sexual symptoms, and signs such as sweating or flushing.
Avoid: Counting side effects as anxiety. Nausea from an SSRI or sweating on venlafaxine raises the somatic items while the anxiety improves.
Rate it at baseline and at each treatment review, often every 4 to 6 weeks in a clinic, to see whether treatment is working.
Each one follows the recording template. Use them to judge how much to write.
Specialty anxiety clinic, 12-week review, rated in person by her psychiatrist with the SIGH-A guide
Items 1 to 14: 2, 2, 0, 1, 2, 1, 2, 0, 1, 0, 1, 0, 1, 1. Nothing rated 3 or 4 today; worry, tension, and sleep were all 3 at baseline.
HAM-A 14, mild on the common bands. Psychic 9, somatic 5.
Baseline 26 on August 17, moderate to severe: psychic 15, somatic 11, same rater and guide. Down 12 points, 46%: a partial response, just short of the 50% mark and well above remission.
39-year-old woman who runs a bakery, diagnosed with generalized anxiety disorder in August. Venlafaxine XR 75 mg for 12 weeks; blood pressure 124/78. Sleeping 6 to 7 hours now. Still worries most days about cash flow and her son’s asthma, with neck and shoulder tension by evening. GAD-7 15 at baseline, 8 today. PHQ-9 6, item 9 at 0. Thyroid tests normal in August; one coffee a day.
Venlafaxine XR raised to 150 mg, with a blood pressure check in 2 weeks. Referred to the clinic psychologist for 12 sessions of CBT for generalized anxiety, with relaxation training for the tension. Next HAM-A in 6 weeks with the same rater and guide; the aim is 7 or less.
Outpatient psychiatry consultation, referred by his family physician after a normal heart workup, rated in person
Items 1 to 14: 2, 1, 1, 1, 1, 1, 2, 2, 3, 3, 2, 0, 3, 1. Rated 3: heart, breathing, and autonomic symptoms.
HAM-A 23, mild to moderate. Psychic 8, somatic 15: the bodily items are driving the total.
First HAM-A; this rating is his baseline.
55-year-old man, a school caretaker. Since his brother’s heart attack in March he checks his pulse 20 to 30 times a day and has been to the emergency department three times with a racing heart and tight breathing. ECG, exercise stress test, 24-hour heart monitor, thyroid tests, and blood count all normal since May. No discrete panic attacks; the symptoms build while he checks. Two coffees a day, no other stimulants or new medicines. PHQ-9 7, item 9 at 0. Impression: health anxiety with prominent bodily symptoms, fitting somatic symptom disorder, moderate.
CBT for health anxiety, 12 to 16 sessions, aimed at the pulse checking and reassurance seeking. Agreed with his family physician on a visit every 4 weeks on a schedule, and no new tests without new signs. Sertraline discussed; he wants to try therapy first. Next HAM-A in 8 weeks, watching the somatic subscore; if the total hasn’t fallen by then, we’ll talk about medication again.
The HAM-A rates severity once anxiety is known, and it takes a trained rater. Screen with a short self-report such as the GAD-7, then rate with the HAM-A if you need a clinician’s measure.
Different raters, and a structured guide against a free interview, can shift the total by a few points. Note who rated it and how, and keep both the same where you can.
Heart, lung, and thyroid disease, and side effects of medicines, all raise items 7 to 13. Check for them, and record the subscores, so the total isn’t misread.
Two sets of bands are in wide use, and they disagree in the middle. A total of 24 is mild to moderate on one and severe on the other, so name the set in the note.
Vero Scribe records the HAM-A rating in your template from the visit, with the patient’s consent, or from your dictation: the total, the psychic and somatic subscores, the change since baseline, and your decision. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
A clinician rates each of the 14 items from 0 for not present to 4 for very severe, using the descriptions on the official form, then adds them. The total runs from 0 to 56. Items 1 to 6 and 14 make the psychic subscore, and items 7 to 13 the somatic subscore, each out of 28.
The bands most often quoted are 17 or less mild, 18 to 24 mild to moderate, 25 to 30 moderate to severe, and 31 or more severe. Cutoffs vary: a 2010 study in generalized anxiety disorder proposed 7 or less as none or minimal, 8 to 14 mild, 15 to 23 moderate, and 24 or more severe. State which set you use.
A fall of 50% or more from the baseline total is the usual definition of response. A total of 7 or less is the usual definition of remission, though some services use 10 or less. Compare ratings made by the same rater with the same method.
The GAD-7 is 7 questions the patient answers alone in a couple of minutes, scored 0 to 21, and it’s used to screen and track anxiety. The HAM-A is 14 items a clinician rates in an interview, scored 0 to 56, with much more on physical symptoms. It’s used mainly in specialty care and research to measure severity and change.
Max Hamilton wrote both. The depression scale, published in 1960, rates depression severity from an interview in the same way. They overlap: each has items on anxiety, sleep, and low mood, so the totals tend to rise and fall together, and many clinics rate both.
A clinician trained to rate it: a psychiatrist, psychologist, mental health nurse, or trained research rater. The interview takes about 15 to 20 minutes. The SIGH-A interview guide gives set questions for each item and helps different raters agree.
The scale was published in Hamilton’s 1959 paper, and ePROVIDE lists the copyright with The British Psychological Society, managed by Wiley. Check the terms there before you reprint it or use it in software or a study. The recording template on this page is free to copy or download.
Nine questions on the last two weeks: depression screening and severity, scored 0 to 27.
Two questions on interest and mood: a quick first screen for depression, scored 0 to 6.
Seven questions on worry and tension: anxiety screening and severity, scored 0 to 21.
Up to six questions on suicidal thoughts and behavior; the highest yes sets low, moderate, or high risk.
Twenty items on the past month: PTSD screening and symptom tracking, scored 0 to 80.
The full assessment, with rating scale scores, risk, and the plan.
Evaluations, medication reviews, and rating scales recorded for psychiatrists.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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