Hospital Anxiety and Depression Scale (HADS)

Download Clinical Summary PDF

Tool Description

  • Assesses anxiety and depression in a non-psychiatric population.
  • Has 2 subscales: Depression and Anxiety, both with 7 items.
  • Other than physically ill individuals, the HADS is also used with community samples/populations.

ICF Domain:

Body Function – Subcategory: Mental Function.

Number of Items:

14

Brief Instructions for Administration & Scoring

Administration:

  • Self-report format
  • Responses are based on the relative frequency of symptoms over the past week, using a four point Likert scale ranging from 0 (not at all) to 3 (very often indeed)
  • Can be completed in around 5 minutes.

Equipment: None

Scoring:

  • Responses are summed to provide separate scores for anxiety and depression symptomology; each of anxiety or depression scale have a score range of 0-21.

Interpretability

MCID: not established for SCI
SEM: not established for SCI
MDC: not established for SCI

  • Higher scores indicating greater likelihood of depression or anxiety.
  • A cut-off point of 8/21 for the Anxiety subscale gave a specificity of 0.78 and sensitivity of 0.9; a cut-off point of 8/21 for the Depression subscale gave a specificity of 0.79 and a sensitivity of 0.83.
  • No normative data for the SCI population has been established
  • Published data is available to compare results for individuals with SCI (see interpretability section of Study Details sheet).

Languages:

Versions of the scale are available in English, Arabic, Dutch, French, German, Hebrew, Swedish, Italian, and Spanish.

Training Required:

No special training is required to administer or score the tool.

Availability:

The HADS can be licensed at http://www.gl-assessment.co.uk/products/hospital-anxiety-and-depression-scale-0

Digital version is no longer available; Paper version only.

Clinical Considerations

  • It is unclear if the few somatic items influence the reliability and validity of this measure with an SCI population. Further research is needed to confirm psychometric properties within this population.
  • The HADS should only be used as a screening instrument. It is one of two instruments with an anxiety specific scale that has had its measurement properties evaluated for the SCI population.

Measurement Property Summary

# of studies reporting psychometric properties: 9

Reliability:

  • Internal consistency of the Anxiety subscale of the HADS is High (Cronbach’s a=0.8463-0.85)
  • Internal consistency of the Depression subscale of the HADS is High (Cronbach’s a=0.79-0.8122).

[Woolrich et al. 2006, Berry & Kennedy 2003]

Validity:

  • Correlation of the total HADS scale is Moderate with the:
    • Life Satisfaction Questionnaire (Pearson’s r=-0.585)
    • Sexual Adjustment Scale (Pearson’s r=-0.49)
    • Emotional Quality of the Relationship scale (-0.38).
  • Correlation of the Anxiety subscale of the HADS is Moderate with the:
    • Spinal Cord Lesion Coping Strategies – Acceptance subscale (Pearson’s r=-0.45)
    • Spinal Cord Lesion Coping Strategies - Fighting Spirit subscale (Pearson’s r=-0.40)
  • Correlation of the Depression subscale of the HADS is Moderate with the:
    •  Spinal Cord Lesion Coping Strategies – Acceptance subscale (Pearson’s r=-0.58)
    •  Spinal Cord Lesion Coping Strategies –Fighting Spirit subscale (Pearson’s r=-0.49).

[Woolrich et al. 2006, Berry & Kennedy 2003, Elfstrom et al. 2007, Kreuter et al. 1996]

Responsiveness:

No values were reported for the responsiveness of the HADS for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the HADS for the SCI population.

Reviewer

Dr. Vanessa Noonan, John Zhu, Jeremy Mak

Date Last Updated:

Dec 1, 2016

Download the measure

Download Worksheet:
The HADS can be licensed online at http://www.gl-assessment.co.uk/products/hospital-anxiety-and-depression-scale-0The HADS can be licensed online at http://www.svri.org/sites/default/files/attachments/2016-01-13/HADS.pdf

Video

n/a

Scoring

  • Higher scores indicating greater likelihood of depression or anxiety.

Equipment Needed

HADS:

Berry C, Kennedy P. A psychometric analysis of the Needs Assessment Checklist (NAC). Spinal Cord, 2002; 41: 490-501.
http://www.ncbi.nlm.nih.gov/pubmed/12934089

Ebrahimzadeh MH, Soltani-moghaddas SH, Birjandinejad A, Omidi-kashani F, Bozorgnia S. Quality of life among veterans with chronic spinal cord injury and related variables. Arch Trauma Res. 2014;3(2):e17917.
http://www.ncbi.nlm.nih.gov/pubmed/25147777

Elfstrom ML, Kennedy P, Lude P, Taylor N. Condition-related coping strategies in persons with spinal cord injury: a cross-national validation of the Spinal Cord Lesion-related Coping Strategies Questionnaire in four community samples. Spinal Cord, 2007; 45: 420-428.
http://www.ncbi.nlm.nih.gov/pubmed/17179976

Kreuter M, Sullivan M, Siosteen A. Sexual adjustment and quality of relationships in spinal paraplegia: A controlled study. Arch Phys Med Rehabil 1996;77:541-548.
http://www.ncbi.nlm.nih.gov/pubmed/8831469

Middleton JW, Tate RL, Geraghty TJ. Self-Efficacy and Spinal Cord Injury: Psychometric Properties of a New Scale. Rehabil Psychol. 2003; 48(4):281-288
http://dx.doi.org/10.1037/0090-5550.48.4.281

Munce SE, Straus SE, Fehlings MG, et al. Impact of psychological characteristics in self-management in individuals with traumatic spinal cord injury. Spinal Cord. 2016;54(1):29-33.
http://www.ncbi.nlm.nih.gov/pubmed/26055818

Menon N, Gupta A, Khanna M, Taly AB, Thennarasu K. Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery. J Spinal Cord Med. 2016.
http://www.ncbi.nlm.nih.gov/pubmed/25582227

Paker N, Bugdayci D, Midik M, Celik B, Kesiktas N. Reliability of the Turkish version of the hospital anxiety and depression scale in the people with traumatic spinal cord injury. NeuroRehabilitation. 2013;33(2):337-41.
http://www.ncbi.nlm.nih.gov/pubmed/23949046

Snaith RP. The Hospital Anxiety And Depression Scale. Health and Quality of Life Outcomes, 2003; 1: 29.
http://www.ncbi.nlm.nih.gov/pubmed/12914662

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.
http://www.ncbi.nlm.nih.gov/pubmed/17129897

Zigmond AS, Snaith RP. The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
http://www.ncbi.nlm.nih.gov/pubmed/6880820