Anxiety scales

Hamilton Anxiety Rating Scale (HAM-A)

Main reference: Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology 32:50–55, 1959.

Type: Clinician-rated symptom scale.

Main indications: Designed to quantify the severity of anxiety symptoms and to assess the response to therapeutic interventions.

Rating performed by: Trained health professional.

Time period covered by scale: Usually past week.

Time required to complete rating: 10–15 minutes.

Remarks: Consists of 14 items (anxious mood, tension, fears, insomnia, intellectual impairment, depressed mood, somatic muscular complaints, somatic sensory complaints, cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, genitourinary symptoms, autonomic symptoms, patient's behaviour at interview), each defined by a series of symptoms. Each item is scored on a scale of 0 (not present) to 4.

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Hopkins Symptom Checklist (SCL-90)

Main reference: Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacological Bulletin 9:13–28, 1973.

Type: Self-rated symptom scale.

Main indications: Designed to rate psychiatric symptoms, either in screening or to measure change over time. May be used in a wide range of clinical and community settings.

Rating performed by:  Patient.

Time period covered by scale:  Past week.

Time required to complete rating:  20 minutes.

Remarks:  Consists of 90 items, of which 83 relate to nine subscales (somatisation, obsessive–compulsive symptoms, interpersonal sensitivity, depression, anxiety, anger or hostility, phobic anxiety, paranoid ideation, and psychotic symptoms). The remaining seven items assess disturbances of sleep or appetite.

Raw scores are subjected to arithmetical analysis to arrive at the final score. Contains no normative information, and so the revised version (SCL-90-R) is more commonly used in published psychometric research. This generates three global indices (global severity; positive symptom distress, and positive symptom total score) as well as nine symptom subscales. Requires a reading age of about 12. A twenty-five item version is also available.

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Hospital Anxiety Depression Scale (HAD)

Main reference: Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67:361–370, 1983.

Type: Self-administered rating scale of symptoms and functioning.

Main indications: Designed to assess the presence and severity of anxiety and depression in patients in non-psychiatric hospital settings. It may also be used in primary care or in the community.

Rating performed by: The patient.

Time period covered by scale: The past few days.

Time required to complete rating: 5–10 minutes.

Remarks: Can used by patients in either an in-patient or an out-patient setting. Anxiety and depression are assessed as separate components, each with seven items that are rated from 0 (no problem) to 3; scores are totalled for each component. A score of <7 in a component is taken as a normal result; a score of 8–10 indicates mild symptoms; 11–14 indicates moderate symptoms; and 15 or more indicates severe symptoms. The scores for the two components can also be added together to give a composite anxiety–depression score.