Hospital Anxiety and Depression Scale Urdu

Aamir Ranjha

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Hospital Anxiety and Depression Scale Urdu

Hospital Anxiety and Depression Scale Urdu

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About Scale Name

Scale Name

Hospital Anxiety and Depression Scale Urdu

Author Details

Iram Fatima

Translation Availability

Not Sure

Hospital Anxiety and Depression Scale Urdu
Hospital Anxiety and Depression Scale Urdu


State well being was measured with Hospital Anxiety and Depression Scale. Zigmond and Snaith (1983) developed the scale to measure depression and anxiety. Seven items in the scale measure anxiety and seven measure depression. The scale measures state aspect of anxiety and depression as the person is asked to respond to the statements
according to his or her feelings in the past week.

Though, interestingly the scale has the word “hospital” in its name, it was designed to use with outpatients as well as general population. Bjelland, Dahl, Haug, and Neckelmann (2002) in their review of the 747 identified papers that had used HADS, found that most factor analyses demonstrated a two factor solution in good accordance with the HADS subscales for Anxiety (HADSA) and Depression (HADS-D).

Cronbach’s alpha for HADS-A varied from .68 to .93 and for HADS-D from .67 to .90. Correlations between HADS and other commonly used questionnaires for measuring anxiety and depression were in the range of .49 to .83. The HADS has also been used and validated with Pakistanis living in Pakistan and abroad. Suhail (2000) found HADS reasonably valid to use with native and British Pakistanis. This study used original English version of the scale, whereas Mumford, Tareen, Bajwa, Bhatti, and Karim (1991) have reported the equivalence of Urdu version with the original version in a study on 120 bilingual Pakistani students.

On each item answers are to be given on 4-point scale ranging from zero to three with the options that are relevant to each item as each item has different response options. Conventionally the scores on the HADS-A and HADS-D have been calculated as sum of scores on all items of a scale but in the present study the scale scores were obtained
by averaging the scores across the items. Possible scale scores range from 0 to 3 with high scores meaning high anxiety and depression. Thus low scores indicated high state well-being.

Administration, Scoring and Interpretation

  • Explain the purpose of the scale and how it will be used.
  • Read each item to the patient or ask the patient to read the item themselves.
  • The patient will circle the number that best describes how they have been feeling in the past week.
  • Repeat steps 2 and 3 for all 14 items.
  • Calculate the total score for the HADS by adding the scores for the anxiety and depression subscales.
  • Interpret the HADS scores using the cut-offs provided in the scale manual.

Reliability and Validity

The Urdu version of the Hospital Anxiety and Depression Scale (HADS) has been found to be a reliable and valid measure of anxiety and depression in Urdu-speaking populations.

Reliability refers to the consistency of the scale’s scores. In other words, if a person takes the scale twice, their scores should be similar. The Urdu version of the HADS has good reliability, with Cronbach’s alpha coefficients of 0.82 for the anxiety subscale and 0.64 for the depression subscale.

Validity refers to the extent to which the scale measures what it is supposed to measure. In other words, the Urdu version of the HADS should be able to distinguish between people with anxiety and depression, and people with no or mild symptoms of anxiety or depression. The Urdu version of the HADS has good validity, with good correlations between the scale scores and clinical diagnoses of anxiety and depression.

In addition to reliability and validity, the Urdu version of the HADS has also been found to be sensitive to change over time. This means that the scale can be used to track changes in anxiety and depression symptoms over the course of treatment.

Available Versions



Fatima, I. (2009). Belief in a just world and subjective well-being in mothers of normal and Down syndrome children (dissertation).

Important Link

Scale File:

Frequently Asked Questions

What is the Urdu version of the HADS?
It is a self-report scale that is used to measure symptoms of anxiety and depression in Urdu-speaking populations.

How many items does the Urdu version of the HADS have?
It has 14 items, with 7 items for anxiety and 7 items for depression.

How is the Urdu version of the HADS scored?
Each item is rated on a scale of 0 to 3, where 0 indicates “not at all” and 3 indicates “severely.”

What are the cut-offs for the Urdu version of the HADS?
A score of 8 or more on either subscale indicates probable anxiety or depressive disorder.


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I am a senior clinical psychologist with over 11years of experience in the field. I am the founder of Psychology Roots, a platform that provides solutions and support to learners and professionals in psychology. My goal is to help people understand and improve their mental health, and to empower them to live happier and healthier lives.

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