The HADS was developed to assess anxiety and depression in a non-psychiatric population. It is meant to differentiate symptoms of depression with those of anxiety. It has also been used with community samples/populations (Snaith 2003).

Number of items: 14 (7 questions relating to anxiety; 7 questions relating to depression)

Procedure/Administration: Self-report format. Responses are based on the relative frequency of symptoms over the past week, using a four point scale ranging from 0 (not at all) to 3 (very often indeed).

How scored: Responses are summed to provide separate scores for anxiety and depression symptomology with possible scores ranging from 0 to 21 for each scale.

Interpretability: Higher scores indicate greater likelihood of depression or anxiety. Recommended cutoffs are: 8-10: mild cases, 11-15: moderate cases and 16 or above: severe cases (Zigmond & Snaith 1994).

Acceptability: It is unclear if the few somatic items influence the reliability and validity of this measure with an SCI population.

Languages: English, Arabic, Dutch, French, German, Hebrew, Swedish, Italian, and Spanish.

Usability: The HADS is easy to score and administer. It was originally developed for use with outpatients attending medical clinics. The HADS should only be used as a screening instrument.

Time to administer: 5 minutes. It is easy to administer

Time to score: Time is unknown, but burden is likely quite low.

Training required: N/a

Availability: The HADS and manual is available from http://www.nfer-nelson.co.ukor email: information@nfer-nelson.co.uk. Also, an online pdf version is available at: http://www.eardoctor.org/pdf/Hospital%20Anxiety%20and%20Depression%20Scale.pdf.

Equipment required: N/a

Summary:

• Given the co-occurrence of anxiety and depression, a simple scale that captures both is likely of value to the clinician.
• It is one of two instruments with an anxiety specific scale that has had its measurement properties evaluated for the SCI population.

Psychometric Summary

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

D = Depression subscale; A = Anxiety subscale.

References

• Snaith RP.The Hospital Anxiety And Depression Scale.Health and Quality of Life Outcomes2003; 1: 29.
• 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.
• Zigmond AS, Snaith RP. The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 1983; 67: 361–370
• Zigmond AS, Snaith RP. The HADS: Hospital Anxiety and Depression Scale. Windsor 1994: NFER Nelson.