What is the Zung SAS used for?

The Zung SAS is used to screen for anxiety and gauge how severe a patient's symptoms are. Clinicians use it at intake and across follow-up visits to quantify affective and physical anxiety symptoms, support conversation about how a patient feels, and track whether symptom burden is rising or easing over time.

How many items are on the Zung SAS?

The Zung SAS has 20 items. Each asks how often a patient has experienced a specific anxiety-related symptom over a recent period, rated on a four-point scale from a little of the time to most of the time. Several positively worded items are reverse scored to reduce response bias.

How is the Zung SAS scored?

Each of the 20 items is scored 1 to 4, producing a raw total from 20 to 80. The raw score is commonly multiplied by 1.25 to yield an anxiety index from 25 to 100. Higher scores indicate greater anxiety symptom burden, with positively worded items reverse scored before totaling.

What do the Zung SAS score ranges mean?

Using the anxiety index, values below 45 fall in the normal range, 45 to 59 suggest mild to moderate anxiety, 60 to 74 suggest marked to severe anxiety, and 75 and above suggest extreme anxiety. Published analyses caution that these bands are index values, not raw scores, to avoid misclassification.

Is the Zung SAS a diagnostic test?

No. The Zung SAS is a screening and severity measure, not a diagnostic instrument. A score quantifies self-reported anxiety symptoms and guides clinical decision-making, but it does not confirm an anxiety disorder. Results should be interpreted alongside history, examination, and clinical judgment before any conclusion is reached.

Is the Zung SAS free to use?

The Zung SAS was published in 1971 and is widely available for routine clinical and research use without proprietary fees, though proper citation of the original source is expected. Because it is broadly reproduced, practices can administer it as part of standard intake and follow-up workflows.

Zung Self-Rating Anxiety Scale | Template & auto-scoring

The Zung Self-Rating Anxiety Scale (SAS) is a 20-item self-report questionnaire that measures the presence and severity of anxiety symptoms in adults. Developed by William W. K. Zung in 1971, it asks patients to rate common affective and physical symptoms of anxiety over a recent period, producing a total score that helps quantify symptom burden.

Why healthcare providers use the SAS

Quantifies anxiety severity. It converts self-reported symptoms into a numeric score so you can gauge how pronounced a patient's anxiety is.
Quick to complete. Patients finish the 20 items in about five minutes, which fits limited appointment time.
Tracks change over time. Repeat administration shows whether symptoms are rising or easing across visits.
Supports conversation. A structured score gives you a concrete starting point for discussing anxiety with a patient.
Broadly validated. Decades of use across clinical and research settings give the tool a well-documented track record.

Which settings use the SAS?

Primary care. Clinicians screen for anxiety symptoms that surface during routine or physical-complaint visits.
Mental health clinics. Therapists and psychiatrists use it at intake and to monitor progress during care.
Research studies. Investigators measure anxiety severity as an outcome across study populations.
Integrated behavioral health. Care teams fold it into broader screening alongside depression measures.

What does the SAS measure?

The SAS asks patients how often they have experienced 20 anxiety-related symptoms over a recent period. The items span affective symptoms and somatic, or physical, symptoms, with several positively worded items reverse scored to reduce response bias. The domains it covers are described below.

Affective symptoms. Feelings such as nervousness, apprehension, and a sense that something bad may happen.
Somatic symptoms. Physical signs including racing heart, trembling, dizziness, and shortness of breath.
Sleep and rest. Difficulty falling asleep and restless or disturbed sleep.
Cognitive experiences. Nightmares and feelings of being easily upset or distressed.

Scoring the SAS

Number of items: 20.
Per-item scale: each item is rated 1 to 4 (a little of the time, some of the time, good part of the time, most of the time), with positively worded items reverse scored.
Total score range: 20 to 80 as a raw score, or 25 to 100 after conversion to the anxiety index.
Score direction: higher scores indicate greater anxiety symptom burden.

The raw score is commonly converted to an anxiety index by multiplying by 1.25, producing a 25 to 100 scale. The traditional severity bands below are anxiety index values, and published analyses have documented misclassification when clinicians apply them to raw scores instead. The SAS is a screening and severity measure, not a diagnostic test, so results guide clinical decision-making and should be interpreted alongside history and examination.

Anxiety index score	Interpretation	Suggested next step
Below 45	Normal range	Routine monitoring
45 to 59	Mild to moderate anxiety	Consider further assessment
60 to 74	Marked to severe anxiety	Consider further assessment
75 to 100	Extreme anxiety	Prompt clinical evaluation

Best practices for administration

Explain the time frame. Tell patients to answer based on how they have felt over the recent period so responses are consistent.
Let patients self-complete. The tool is designed for self-report, so avoid leading or interpreting items for them.
Check for skipped items. A complete set of 20 responses is needed for an accurate total.
Re-administer consistently. Use the same instructions and interval each time so scores are comparable across visits.
Pair with clinical judgment. Use the score to open a conversation, not to replace a full assessment.

How Zentake helps with the SAS

Automatic scoring. Totals are calculated the moment a patient submits, with no hand-tallying.
Longitudinal tracking. Re-send the SAS on a schedule and view change over time.
Before the visit. Mental health practices let patients complete it from home on any device so the clinician starts informed.
HIPAA compliant. Data is encrypted and covered by a signed BAA on every plan.

References

The SAS was introduced by William W. K. Zung in "A rating instrument for anxiety disorders," published in Psychosomatics in 1971, which defined the 20-item structure, the 1 to 4 response format, and the raw and index score ranges.

Dunstan and colleagues analyzed misclassification arising from confusion between index and raw scores in Depression Research and Treatment (2018), which supports applying the traditional severity bands to converted anxiety index values.

Last updated: August 2026

Zung Self-Rating Anxiety Scale