HAM-A Test — Hamilton Anxiety Rating Scale (14-Item Clinical Anxiety Assessment)
The Hamilton Anxiety Rating Scale — the clinician-administered anxiety severity standard since 1959. 14 items, 8 minutes, instant score bands. Free in the Mindtalk app.
Important safety information
The HAM-A includes a question about thoughts of self-harm (question 9). If you have had any such thoughts recently, please reach out for support before or instead of taking this assessment — you do not need to take a test to deserve help.
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The 14 HAM-A items
The scale asks you to rate each anxiety symptom's severity over the past week on a 0-4 scale:
0 = Not present · 1 = Mild · 2 = Moderate · 3 = Severe · 4 = Very severe
The 14 items are grouped into two clusters:
Psychic anxiety (items 1-6, 14):
- Anxious mood — worries, anticipation of the worst
- Tension — feelings of tension, fatigability, startle, easily moved to tears
- Fears — of the dark, strangers, being alone, animals, traffic, crowds
- Insomnia — difficulty falling asleep, disturbed sleep, unsatisfying sleep and fatigue on waking, nightmares
- Intellectual — difficulty concentrating, poor memory
- Depressed mood — loss of interest, lack of pleasure in hobbies, depression, early waking, mood variation
- Behaviour at interview — fidgeting, restlessness, hand tremor, furrowed brow, strained face, sighing, pale face
Somatic anxiety (items 7-13): 7. Muscular — muscle aches, muscle stiffness, teeth grinding, unsteady voice 8. Sensory — tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, prickling sensation 9. Cardiovascular — tachycardia, palpitations, chest pain, throbbing of vessels, fainting feelings 10. Respiratory — pressure or constriction in chest, choking feelings, sighing, dyspnoea 11. Gastrointestinal — difficulty swallowing, gas, abdominal pain, burning sensations, fullness, nausea, vomiting, borborygmi, looseness of bowels, weight loss, constipation 12. Genitourinary — frequency of urination, urgency of urination, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence 13. Autonomic — dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair
Total ranges 0-56.
HAM-A severity band table
| Score | Severity (Matza cuts) | What it means | Suggested next step |
|---|---|---|---|
| 0-7 | No / minimal anxiety | Typical for everyday life | Continue self-monitoring |
| 8-14 | Mild anxiety | Symptoms present but not majorly impairing | Lifestyle, therapy if persistent; retake in 2-4 weeks |
| 15-23 | Moderate anxiety | Symptoms causing clear impairment | Clinical evaluation; CBT often indicated |
| 24-30 | Severe anxiety | Significant impairment across areas | Clinical evaluation this week; consider combined therapy + medication |
| 31+ | Very severe | Major impairment, often disabling | Urgent clinical evaluation |
How the HAM-A was developed
The HAM-A was developed by Max Hamilton (creator of the HAM-D as well) at the University of Leeds in 1959. It was the first standardised clinician-rated anxiety severity scale, designed for use in the emerging RCT era of anxiety pharmacotherapy. The 14-item structure with psychic + somatic clusters emerged from Hamilton's factor analysis of clinical anxiety presentations and has remained essentially unchanged.
The HAM-A has been used in every major anxiolytic drug trial since the 1960s — benzodiazepines, buspirone, SSRIs (paroxetine, sertraline, escitalopram, vilazodone), SNRIs (venlafaxine, duloxetine), and pregabalin. When you read that "drug X reduced anxiety by Y%" in a psychiatric paper, HAM-A is almost always the measure.
Validation studies have replicated the two-factor structure across US, European, Indian, and East-Asian populations. The Matza et al. 2010 severity cut-offs (used in the Mindtalk app) are the most widely referenced standardisation.
HAM-A vs other anxiety scales
| Test | Items | Time | Administered by | Best for |
|---|---|---|---|---|
| HAM-A | 14 | 8 min | Clinician (self-admin adapted) | Severity + medication response tracking |
| GAD-7 | 7 | 2 min | Self-report | Screening + primary-care monitoring |
| STAI | 40 | 8 min | Self-report | State vs trait anxiety split |
| BAI | 21 | 5 min | Self-report | Somatic-heavy anxiety severity |
| DASS-21 (Anxiety) | 7 | 2 min | Self-report | Combined with depression + stress |
Use HAM-A when you need a clinician-quality severity score. Use GAD-7 for screening. Use STAI when you need to separate current-state from long-standing-trait anxiety.
When to act on your HAM-A result
- 0-7: No action. Retake if new stressors arise.
- 8-14 (mild): Behavioural activation, sleep hygiene, mindfulness. The CBT Thought Record and Progressive Muscle Relaxation are evidence-based. Retake in 2-4 weeks.
- 15-23 (moderate): Clinical evaluation. CBT is first-line; SSRI may be added if symptoms persist. Book a Mindtalk psychiatrist or psychologist.
- 24-30 (severe): Clinical evaluation this week. Combined CBT + medication often indicated. Consider the 90-day Anxiety Loop Breaker programme.
- 31+ (very severe): Urgent clinical evaluation. Full assessment for anxiety subtype, comorbidities, and functional impairment.
- High somatic + low psychic pattern: Rule out cardiac, thyroid, and vestibular causes. HAM-A cannot distinguish somatic anxiety from underlying medical causes.
After the HAM-A
- Track over time. Retake every 2-4 weeks during treatment. The psychic and somatic clusters often respond at different rates.
- Pair with self-report. Use GAD-7 for weekly self-monitoring alongside HAM-A for monthly clinician review.
- Assess comorbid depression. Anxiety and depression co-occur in ~60% of cases. Take the PHQ-9 alongside.
- Structured programme. The 90-day Anxiety Loop Breaker is calibrated for HAM-A scores in the 15-25 range.
- Book a specialist. Mindtalk's psychiatrists and psychologists treat anxiety presentations across Bangalore, Hyderabad, Mysore, and online for anywhere in India.
How to take the HAM-A
- 1
Open the HAM-A in the Mindtalk app
Tap "Take the HAM-A" to open the self-administered adaptation. You will need a free Mindtalk account — sign-in takes under a minute.
- 2
Answer the 14 items
Rate each of the 14 anxiety symptoms on a 0-4 severity scale over the past week. The app groups items into psychic and somatic clusters so you can see which drives your score.
- 3
Get your total, sub-cluster split, and severity band
Receive a total 0-56 score, psychic vs somatic split, severity band, and a personalised next-step recommendation. High somatic scores route to consideration of medical rule-outs; high psychic scores route to psychotherapy planning.
Frequently Asked Questions
- How accurate is the HAM-A?
- The HAM-A has been the primary anxiety severity measure in psychiatric research and clinical practice for over 65 years. Inter-rater reliability is excellent when clinicians are trained (intraclass correlations 0.74-0.96 across studies). It has demonstrated sensitivity to medication response in every major SSRI, SNRI, benzodiazepine, and buspirone RCT for anxiety since the 1970s. Its main limitation is that it was designed for clinician administration — self-administered adaptations preserve the band structure but under-detect subtle presentations that a trained clinician would probe.
- HAM-A vs GAD-7 — when to use which?
- The GAD-7 is a self-report screener designed for primary care — 7 items, 2 minutes, focused specifically on generalized anxiety. The HAM-A is a clinician-administered severity measure across all anxiety subtypes — 14 items, 8 minutes, richer coverage of somatic symptoms. Rule of thumb: use GAD-7 for screening and quick treatment monitoring; use HAM-A when you need a formal severity score, when tracking medication response, or when generalized anxiety and panic overlap.
- What are the HAM-A severity bands?
- Standard bands are: 0-17 = mild anxiety, 18-24 = moderate anxiety, 25-30 = severe anxiety, above 30 = very severe. Different studies use slightly different cut-offs; the most-cited Matza et al. 2010 reference cuts are 0-7 no/minimal, 8-14 mild, 15-23 moderate, 24+ severe. The Mindtalk app uses the Matza cuts and displays both.
- Why does the HAM-A include somatic items?
- Because anxiety is not only mental — physical symptoms (racing heart, sweating, GI upset, muscle tension, dizziness) are a defining feature and often the reason people first seek help. Hamilton deliberately split the scale into psychic + somatic clusters so clinicians could see the balance. A high somatic + moderate psychic pattern often flags panic disorder or a medical rule-out; high psychic + low somatic often flags generalized anxiety or worry-dominant presentation.
- Is the HAM-A validated in India?
- Yes. The HAM-A has been used and validated in Indian psychiatric practice for decades, with translations into Hindi, Kannada, Tamil, and other major Indian languages. It is used routinely at NIMHANS, AIIMS, and Cadabams for anxiety severity mapping and medication response tracking.
- Should I take the HAM-A if I'm already taking a self-report scale like GAD-7?
- Only if the additional information would change treatment planning. If GAD-7 is showing clear treatment response and severity is stable, HAM-A adds little. If GAD-7 and clinical picture disagree (score says one thing, symptoms say another), if somatic symptoms are prominent, or if medication is being adjusted, HAM-A adds precision.
- How do I take the HAM-A?
- Click 'Take the HAM-A'. Complete the 14 items (6-8 minutes for the self-administered version), receive your total + psychic/somatic split + severity band, and get a personalised next-step recommendation. Free in the Mindtalk app.
Need a clinician's read on your results?
A high score is a signal, not a diagnosis. Mindtalk's psychiatrists and clinical psychologists can interpret your results and recommend next steps — same-day appointments available.