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Anxiety is a normal human emotion that we all experience from time to time. It is a feeling of unease, such as worry or fear, that can be mild or severe. Anxiety becomes a problem when it is persistent and interferes with your daily life. It can lead to physical and emotional symptoms that can affect your work, relationships, and overall quality of life.Anxiety disorders are the most common mental health disorders in the United States, affecting about 40 million adults each year. Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Generalized anxiety disorder is characterized by excessive worry about everyday things, such as work, finances, or health, that lasts for at least six months. Panic disorder involves sudden and unexpected panic attacks that can cause intense fear and physical symptoms, such as a racing heart, sweating, and shortness of breath. Social anxiety disorder is an intense fear of social situations, such as public speaking or socializing with others. Specific phobias are intense fears of specific objects or situations, such as heights, flying, or spiders. OCD is a disorder characterized by unwanted thoughts or obsessions that lead to repetitive behaviors or compulsions. PTSD is a disorder that can develop after a traumatic event and is characterized by symptoms such as intrusive thoughts, nightmares, and avoidance of reminders of the trauma.If you are experiencing anxiety symptoms, it is important to check it because untreated anxiety disorders can have serious consequences.

Chronic anxiety can lead to physical health problems, such as high blood pressure, heart disease, and digestive problems. It can also increase the risk of developing depression, substance abuse, and other mental health disorders.

Anxiety can also impact your daily life in many ways. It can interfere with your ability to perform well at work or school, affect your relationships with others, and make it difficult to enjoy your hobbies and activities. Anxiety can cause physical symptoms, such as headaches, muscle tension, and stomach problems, that can interfere with your ability to function normally.

If you are experiencing anxiety symptoms, it is important to seek help. Treatment for anxiety disorders can include therapy, medication, or a combination of both. Cognitive-behavioral therapy (CBT) is a common form of therapy used to treat anxiety disorders. It involves identifying and changing negative thought patterns and behaviors that contribute to anxiety. Medications, such as selective serotonin reuptake inhibitors (SSRIs), can also be effective in treating anxiety disorders.There are also many self-help strategies that can be helpful in managing anxiety symptoms. These include practicing relaxation techniques, such as deep breathing and progressive muscle relaxation, getting regular exercise, eating a healthy diet, and avoiding alcohol and drugs.

Select one of the following to test your anxiety .

Hamilton Anxiety Scale (HAM-A)

GAD-7 Test

HAM-A meter

Hamilton Anxiety Scale (HAM-A)

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About HAM-A | Interpreting your score

The HAM-A evaluates the presence and degree of severity of a range of anxiety symptoms in order to provide a patient status that varies from mild to very severe anxiety.

The scale, created by Hamilton in 1959, is addressed to adult and pediatric patients, takes less than 15 minutes and is clinician rated.

It can be used for an initial assessment or to monitor changes in the anxious symptoms the patient experiences over time.

The three major domains are mental status, cognitive and physical condition. The following table introduces the items in the scale and a description of the symptoms they refer to:

HAM-A items	Symptoms
Anxious mood	Refers to worries, fearful anticipation, irritability and pessimism.
Tension	Feelings of restlessness, fatigability, startle response or trembling.
Fears of different kinds	Presence of phobias, such as fear of dark, strangers, small spaces, isolation.
Insomnia	Difficulty falling asleep, lack of sleep, nightmares, sleep walking.
Intellectual response	Poor concentration, poor memory
Depressed mood	Complete lack or loss of interest in activities previously enjoyed.
Somatic muscular response	Pains and aches, stiffness, twitching, stiffness, grinding of teeth and increased muscular tone.
Somatic sensory response	Weakness, tinnitus, vision flashes and blurring, distorted temperature perception.
Cardiovascular symptoms	Palpitations, tachycardia, chest pain, throbbing of vessels.
Respiratory symptoms	Choking sensation, chest pain or pressure, dyspnea, sighing.
Gastrointestinal symptoms	Nausea, abdominal pain, burning sensation, vomiting, constipation, weight loss.
Genitourinary symptoms	Urinary frequency and urgency, frigidity, dysmenorrhea, impotence.
Autonomic symptoms	Headaches, dry mouth, sweating, pallor.
Interview behaviour	The patient shows restlessness, increased respiration or hand tremors.

Table of Contents

HAM-A scores

Each of the items in the anxiety scale is scored based on a Likert scale from 0 to 4:

0 – symptoms not present;

1 – mild prevalence of the symptoms or feelings;

2 – moderate prevalence of the feelings or symptoms;

3 – severe display of feelings and symptoms;

4 – very severe prevalence of the symptoms.

Therefore, the final score ranges from 0 to 56. There are four categories of results:

HAM-A score	Interpretation
0 – 17	Mild anxiety
18 – 24	Mild to moderate anxiety
25 – 30	Moderate to severe anxiety
30 – 56	Very severe anxiety

About anxiety

Anxiety is a condition characterised by an inner state of turmoil, irritability and fear, which triggers a fight or flight somatic reaction of the body.

While most people experience feelings of fear or anxiety at some point in their lives, there is a limit after which these become pathologic and after which anxious feelings become a symptom of a mental disorder.

The generalized anxiety disorder (GAD) is the most common diagnosis in people with anxiety, however, there are other conditions that display similar symptoms, panic attacks or specific phobias.

Derived from :Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50 – 55.

GAD 7 meter

Generalized Anxiety Disorder (GAD 7)

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About GAD 7 | Interpreting your score

The GAD 7 is a mental health evaluation model aimed at anxiety severity. It takes the form of a questionnaire that is administered to patients in the clinical environment.

The subject is prompted to consider their behaviour in the past two weeks, by taking into account the following:

1. Feeling nervous, anxious or on edge;

2. Not being able to stop or control worrying;

3. Worrying too much about different things;

4. Trouble relaxing;

5. Being so restless that it is hard to sit still;

6. Becoming easily annoyed or irritable;

7. Feeling afraid as if something awful might happen.

Each of the 7 criteria is accompanied by a scale describing the frequency of the anxious sign, as exhibited in the 2 weeks prior to the evaluation:

■ Not at all (0 points) – with the implication that the subject has not experienced the anxious sign in the two week period;

■ Several days (1 point) – the subject has experienced the sign in some days (7 or less);

■ More than half the days (2 points) – the subject has experienced the sign for more than 7 days;

■ Nearly every day (3 points) – with the implication that the sign was experienced almost every day of the two weeks.

GAD 7 scoring interpretation

The result provided by the GAD 7 calculator is aimed at revealing whether an anxiety disorder is present and to what degree.

Each of the 7 questions can be rated from 0 to 3 on the scale introduced above. Therefore, the overall GAD 7 score ranges between 0 and 21, 0 meaning no anxiety and 21 meaning severe anxiety.

The following table introduces the scores along their interpretation and a recommendation:

GAD 7 score (points)	Interpretation	Recommendation
0 – 4	No or little anxiety	Common symptoms should continue to be monitored if there are still suspicions. Follow up GAD 7 assessment in 2 weeks.
5 – 9	Mild anxiety disorder	Patient monitoring needs to be initiated.
10 – 14	Moderate anxiety disorder	The patient should be evaluated with other quantitative and qualitative measures of psychological/ psychiatric testing.
15 – 21	Severe anxiety disorder	Treatment needs to be initiated if it hasn’t already.

About the study

The GAD 7 was created by Spitzer et al. in 2006, as the first clinical measure for assessing the generalized anxiety disorder.

The original study involved a cohort of 2,740 adult patients belonging to 15 primary care clinics in the United States.

Following the application of the questionnaire (within a week), 965 of these patients have been referred for an interview (telephone) with a mental health professional.

The GAD 7 has been validated with independent diagnoses and other measures such as functional status, disability and health care use.

The model has been found to have good reliability and a cut point for optimized sensitivity (89%) and specificity (82%) was found.

Recommended usage

The GAD 7 should be used in association with other anxiety scales, such as the Hamilton scale, especially when there are concerns about the mental health status of the patient.

The application of the questionnaire should be followed by other questions, related to other experiences and symptoms of the patient.

The questionnaire can also be used for anxiety monitoring purposes.

The anxiety screening provided by the GAD 7 scoring can be used in other mental health conditions (the specificity and sensitivity are presented for scores above 10) such as:

■ Generalized Anxiety Disorder – sensitivity 89%, specificity 82%;

■ Panic Disorder – sensitivity 72%, specificity 80%;

■ Post Traumatic Stress Disorder (PTSD) – sensitivity 66%, specificity 81%;

■ Social Phobia – sensitivity 74%, specificity 81%.

Derived from : Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.

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