Assignment 2: Critique of Assessments

Assignment 2 Your Name Subject and Section Professor’s Name Date Assignment 2 Hamilton Anxiety Rating Scale (HAM-A) General Information and the Purpose of the First Assessment The HAM-A is another assessment tool that clinicians administer, and the objective of this tool is to rate the severity of anxiety. Initially developed in 1959, it is still in use in clinical and research settings to measure the patient's rating of the severity of anxious symptoms (Hamilton, 1959; Thompson, 2015). The original version of HAM-A, which will be used in this paper, comprises 14 items that interfere with an individual's psychological and somatic aspects. Each item is scored from 0, “Not present," to 4, “Severe.” The total outcomes varied from 0 to 56, in which the outcomes of less than 17 points reflect the mild severity of the ailment, 18-24 points reflect the mild to moderate severity, and 25-30 points hint at moderate to severe anxiety (Matza et al., 2010). Nonetheless, some evocations were carried out about HAM-A, and criticisms were given stating that the HAM-A does not distinguish one outcome from the other anxiolytic versus antidepressant, somatic anxiety from somatic side effects. Nevertheless, the results are good enough to attain average reliability and validity (Matza et al., 2010; Thompson, 2015). The HAM-A takes approximately 10-15 minutes to administer and score and contains two subscales: these include psychological anxiety, which refers to psychological distress, and somatic anxiety, which is a concern with bodily symptoms. Moreover, the HAM-A does not have any copyright, and thus, it falls into the public domain (Schneider et al., 2020; Hamilton, 1959). Psychometrics of the Assessment Matza et al. (2010) state that HAM-A's reliability is sufficient, whereas the validity is also acceptable. The study also revealed that the HAM-A test correlates with the CGI-S rating clinician assessor, hence improving the criterion validity of the study. The optimal HAM-A score ranges were identified as follows: by its severity into mild, where the score ranges from 8 to 14; moderate, with a score of 15 to 23; and severe, where the score is 24 or more. These ranges presented differences in the SF-36 and HADS scores associated with anxiety levels (p < 0. 001). These results, in the cited study obtained on a sample of 144 patients with a mean baseline HAM-A score of 23.7, show that HAM-A is a valid and reliable measure that allows assessing the severity of anxiety and serves as a valuable instrument for the clinicians in the different phases of the trials and the clinical practice. Consequently, Jeong & Lee (2024) highlighted the use of Confirmatory Factor Analysis (CFA) in establishing construct validity of HAM-A among Korean university students. Testing between the models of somatic and psychic/psychological anxiety showed that the two-factor model was the most appropriate. The results indicated that the two-factor model, which separates psychic/psychological anxiety from somatic anxiety, provided the best fit for the data. The goodness-of-fit indices for this model were χ² = 168.3, df = 74, χ²/df = 2.3, CFI = 0.94, GFI = 0.97, RMSEA = 0.056 (90% CI = 0.049–0.072), and SRMR = 0.050, suggesting that this model was statistically acceptable and better than the one-factor and three-factor models tested​. Also, the coefficient alpha values for the two-factor model based on the items were estimated to be between 0. 44 and 0. 79, which revealed that the items were highly in sync with their respective factors. Moreover, a correlation coefficient of 0.52 was obtained between the two factors, confirming that the two scales measure slightly different types of anxiety, as suggested in the literature. The study also revealed high internal consistency for the scale, wherein the Cronbach's alpha coefficients of 0.90 for the total scale, 0.88 for the psychic/psychological subscale, and 0.82 for the somatic subscale, demonstrating the reliability and construct validity of the HAM-A in this population​. In addition, the internal consistency reliability of the current assessment and item analysis were computed based on Cronbach's alpha coefficients. The internal consistency reliability of the scale was determined for all 14 items, as well as for the two identified factors: psychic/psychological and somatic anxiety. This indicates that both measures of state anxiety comprised psychic/psychological and somatic anxiety. The internal reliability revealed a Cronbach's alpha coefficient equaling 0.90, indicating excellent reliability. The subscales were also highly reliable; alpha coefficients ranged from 0.88 for the psychic/psychological factor to 0.82 for the somatic factor. Furthermore, Cronbach's alpha coefficients were above 0.80 even if one item was removed, and the overall alpha was significantly unaffected by more than 0.05, excluding any item. Such consistency means that each item is essential and contributes to the measures of anxiety symptoms by the scale. Ethical and Multicultural Considerations Having reviewed the peculiarities of using the HAM-A in different cultural settings, we can discuss probable ethical and multicultural problems. It is worth noting one major ethical issue, and that is the right to self-determination, specifically regarding confidentiality, for instance, in an online assessment such as the one completed amidst the COVID-19 pandemic that targeted Korean university students. In the study being referred to, the survey was conducted discreetly, and consent was also received online, tackling the ethical issue of privacy and voluntary response​. However, they also admit that such increased anxiety because of COVID-19 might affect the participants' mental state, and so is significant when interpreting the outcomes. In addition, the ethical specifics must guarantee the participants' knowledge of the study and that their participation does not worsen their anxiety (Jeong & Lee, 2024). Additionally, translation and cross-cultural issues are related to the possibility that some or all items of the HAM-A are valid or suitable for use in different cultures. The study also confirmed that the HAM-A adaptation in the Korean language would suit Korean university students. Specifically, the Korean Version of the HAM-A translated and adapted was reliable according to the referenced study​. Elements of this process entailed the establishment of reliability of the instrument and validity within this population. This unfortunate fact is also moving in its way. Moreover, the authors of the work noted that the types of anxiety that university students might experience are not the same as those among the general population, which is why anxiety testing should be constantly validated and may be adapted for better correspondence to cultural differences. The findings of these studies should be further evidenced by similar studies conducted with other populations so that the HAM-A can be applied to different cultures without confirming the presence of cultural bias (Jeong & Lee, 2024). Therapist Decision Considering the evaluation of Maha's presenting issue, first of all, the HAM-A was chosen because of its high reliability and validity and its relevance to the state described by the patient. These worries are generalized and have led to anxiety that manifests in restlessness, rumination, and somatic complaints of muscle tension and gastrointestinal upset, which Maha has been complaining of. The HAM-A is one of the most well-known methods for the assessment of the severity of both psychiatric and somatic manifestations of anxiety, and the chosen tool will cover all these aspects of Maha's condition. Its application helps me in the clinical evaluation by supplementing the score that is based on the DSM-IV criteria and assesses the symptom severity of her anxiety. This scale wi...