Hospital Anxiety and Depression Scale (HADS)
- 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.
Body Function – Subcategory: Mental Function.
Number of Items:
- 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.
- 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.
- 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).
Versions of the scale are available in English, Arabic, Dutch, French, German, Hebrew, Swedish, Italian, and Spanish.
No special training is required to administer or score the tool.
Freely available online at http://www.sandbachgps.nhs.uk/uploaded_files/files/ashfields/HADS.pdf
- 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.
# of studies reporting psychometric properties: 4
- Internal consistency of the Anxiety subscale of the HADS is excellent (Cronbach’s a=0.8463-0.85)
- Internal consistency of the Depression subscale of the HADS is adequate to excellent (Cronbach’s a=0.79-0.8122).
[Woolrich et al. 2006, Berry & Kennedy 2003]
- Correlation of the total HADS scale is adequate 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 adequate 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 adequate 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]
No values were reported for the responsiveness of the HADS for the SCI population.
No values were reported for the presence of floor/ceiling effects in the HADS for the SCI population.
Dr. Janice Eng, Christie Chan
Date Last Updated:
Feb 1, 2013