Hospital Anxiety and Depression Scale
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About Hospital Anxiety and Depression Scale
The study was conducted in the setting of a general medical hospital outpatient clinic. The result of the study undertaken for this purpose was published under the title of The Hospital Anxiety And Depression Scale . Full details of the method of construction of the HADS is given in the publication presenting it but, briefly, patients completed a questionnaire composed of statements relevant to either generalized anxiety or ‘depression’, the latter being largely (but not entirely) composed of reflections of the state of anhedonia.
Thought was also given to whether the wording of the items would be easily translated to other languages. After examination by the physician, the researchers conducted an interview but were blind to the knowledge of the patients’ responses to the questionnaire. During that interview, ‘depression’ was assessed according to the questions: ”
Do you take as much interest in things as you used to? Do you laugh as readily? Do you feel cheerful? Do you feel optimistic about the future?” i.e. there was no concentration on the anhedonic state alone. The ‘anxiety’ level was assessed by the questions: “Do you feel tense and wound up? Do you worry a lot? Do you have panic attacks? Do you feel something awful is about to happen?”.
The questionnaire responses were analyzed in light of the results of this estimation of the severity of both anxieties and of depression. This enabled a reduction of the number of items in the questionnaire to just seven reflecting anxiety and seven reflecting depression.(Of the seven depression items five reflected aspects of reduction in pleasure response). Each item had been answered by the patient on a four-point (0–3) response category so the possible scores ranged from 0 to 21 for anxiety and 0 to 21 for depression.
An analysis of scores on the two subscales of a further sample, in the same clinical setting, enabled the provision of information that a score of 0 to 7 for either subscale could be regarded as being in the normal range, a score of 11 or higher indicating the probable presence (‘caseness’) of the mood disorder and a score of 8 to 10 is just suggestive of the presence of the respective state.
Further work indicated that the two subscales, anxiety, and depression, were independent measures. The subsequent experience enabled a division of each mood state into four ranges: normal, mild, moderate, and severe and it is in this form that the HADS is now issued by its publisher In the case of illiteracy, or poor vision, the wording of the items and possible responses may be read to the respondent.
Hospital Anxiety and Depression Scale (English)
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