Hospital Anxiety and Depression Scale (HADS)

Description: The HADS is a screening tool for anxiety and depression in non-psychiatric clinical populations [1]. It is thought to tap into the construct of affect [2].

Format: The scale consists of 14 items (7 each for anxiety and depression). Each item is rated on a four point scale ranging from 0 (not at all) to 3 (very often). Responses are based on the relative frequency of symptoms over the preceding week.

Scoring: Possible scores range from 0 to 21 for each subscale. An analysis of scores on the two subscales supported the differentiation of each mood state into four ranges: ‘mild cases’ (scores 8-10), ‘moderate cases’ (scores 11-15), and ‘severe cases’ (scores 16 or higher).

Administration and Burden: Interviewer-administered; Approximately 5 minutes to complete.

Psychometrics for SCI: For the SCI population, the internal consistency has been found to be excellent for the anxiety scale (α= .85), and adequate for the depression scale (α = .79) [3]. The anxiety subscale has adequate validity, whereas that of the depression scale is excellent when correlated with the Life Satisfaction Questionnaire (LSQ; r = -.42 for the anxiety scale and r = -.66 for the depression scale) [4].

Languages: The HADS has been translated into all major European languages in addition to Arabic, Hebrew, Chinese, Japanese, and Urdu.

QoL Concept: The HADS assesses presence of depression and anxiety, and is arguably a measure of Affect, which corresponds to Box E (subjective evaluations and reactions) on Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The HADS scale and its manual can be purchased at the GL Assessment website at: http://shop.gl-assessment.co.uk/home.php?cat=417.

**CLICK ON THE LISTED SECONDARY HEALTH CONDITIONS ON THE RIGHT TO READ HOW THE HADS HAS BEEN USED WITH A PARTICULAR CONDITION**

References:

1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-70.
2. Crawford JR, Henry JD. The Positive and Negative Affect Schedule (PANAS): Construct validity, measurement properties and normative data in a large non-clinical sample. Br J Clin Psych 2004;43:245-65.
3. Heinrich RK, Tate DG. Latent variable structure of the Brief Symptom Inventory in a sample of persons with spinal cord injuries. Rehabil Psychol 1996;41:131-47.
4. Woolrich RA, Kennedy P, Tasiemski T. A preliminary psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) in 963 people living with a spinal cord injury. Psychol Health Med 2006;11:80-90.