Hospital Anxiety and Depression Scale (HADS)

Clinical Summary

Jump to: Tool Description | Interpretability | Measurement Property Summary

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
SEM: not established
MDC: not established

  • 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:

Freely available online at http://www.sandbachgps.nhs.uk/uploaded_files/files/ashfields/HADS.pdf

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: 4

Reliability:

  • 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]

Validity:

  • 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]

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. Janice Eng, Christie Chan

Date Last Updated:

Feb 1, 2013