Hospital Anxiety and Depression Scale

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Hospital Anxiety and Depression Scale

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About Hospital Anxiety and Depression Scale

Scale Name

Hospital Anxiety and Depression Scale

Author Details

Anthony S. Zigmond and Robert P. Snaith

Translation Availability

Urdu

Hospital Depression and Anxiety Scale
Hospital Depression and Anxiety Scale

Background/Description

The Hospital Anxiety and Depression Scale (HADS) is a self-assessment questionnaire widely used to screen and measure the severity of anxiety and depression symptoms in individuals, particularly those in medical settings such as hospitals and clinics. It was developed by psychiatrists Zigmond and Snaith in 1983 as a tool specifically designed for use in non-psychiatric medical outpatient settings.

Background:

The motivation behind creating the Hospital Anxiety and Depression Scale was to address the need for a brief and effective instrument to assess anxiety and depression in patients with physical health problems. Many existing psychiatric assessment tools were considered too lengthy or impractical for use in medical settings where time and resources were limited.

Introduction:

The HADS consists of 14 items, divided into two subscales: one for anxiety (HADS-A) and one for depression (HADS-D). Each subscale contains seven items that inquire about the emotional and cognitive aspects of anxiety and depression. Respondents are asked to rate the extent to which they have experienced specific symptoms over the past week.

The scoring system typically involves assigning a score of 0 to 3 for each item, with higher scores indicating more severe symptoms. This results in possible scores ranging from 0 to 21 for each subscale, with higher scores indicating greater levels of anxiety or depression.

The scale is designed to be easily administered and interpreted, making it suitable for use by non-specialist healthcare professionals. It doesn’t include items related to somatic symptoms that might overlap with physical illness, which helps in distinguishing between psychological distress and symptoms related to a person’s physical health.

The Hospital Anxiety and Depression Scale has been validated and utilized in various medical settings and diverse populations. It is considered a valuable tool for identifying individuals who may benefit from further mental health evaluation and intervention. However, it’s important to note that the HADS is a screening tool and not a diagnostic instrument. A comprehensive clinical assessment is typically required to confirm the presence of anxiety or depression disorders.

Administration, Scoring and Interpretation

The Hospital Anxiety and Depression Scale can be administered in a variety of settings, including:

  • Clinical settings: The HADS can be used by healthcare professionals, such as doctors, nurses, and psychologists, to assess anxiety and depression symptoms in their patients.
  • Research settings: The HADS can be used by researchers to study anxiety and depression in various populations.
  • Community settings: The HADS can be used in community screenings to identify individuals who may be at risk for anxiety or depression.

The HADS can be administered in two ways:

  • Self-report: The HADS can be completed by individuals independently. The questionnaire is typically provided in paper-and-pencil format, but it can also be administered electronically.
  • Interviewer-administered: The HADS can be administered by a healthcare professional. In this case, the healthcare professional will read each question to the individual and record their responses.

Reliability and Validity

Reliability refers to the consistency or dependability of a test or measure. In the context of the Hospital Anxiety and Depression Scale, reliability means that the scale should produce consistent results when administered to the same people on different occasions, or when administered by different people.

The HADS has been shown to be a reliable measure of anxiety and depression symptoms. Internal consistency reliability, which is assessed using Cronbach’s alpha, is typically high for both the anxiety and depression subscales, with alpha coefficients ranging from 0.80 to 0.90. Test-retest reliability, which is assessed by administering the HADS to the same people on two different occasions, is also good, with correlation coefficients between scores on the two occasions ranging from 0.70 to 0.80.

Validity refers to the extent to which a test or measure actually measures what it is intended to measure. In the context of the HADS, validity means that the scale should accurately assess anxiety and depression symptoms.

The HADS has been shown to have good convergent validity, which means that it correlates with other measures of anxiety and depression. For example, the HADS correlates highly with the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI).

Available Versions

14-Items

Reference

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Important Link

Scale File:

Frequently Asked Questions

What is the Hospital Anxiety and Depression Scale (HADS)?
The Hospital Anxiety and Depression Scale (HADS) is a 14-item self-report questionnaire used to assess the severity of anxiety and depression symptoms in adults. It was developed in 1983 by Anthony S. Zigmond and Robert P. Snaith and has been translated into over 40 languages.

How does the Hospital Anxiety and Depression Scale work?
The HADS consists of two subscales:

  • Anxiety subscale: This subscale asks about symptoms of anxiety, such as feeling tense, restless, or worried.
  • Depression subscale: This subscale asks about symptoms of depression, such as feeling sad, down, or unmotivated.

What are the limitations of the Hospital Anxiety and Depression Scale?
The HADS is a self-report questionnaire, which means that it is subject to bias. It does not assess all of the symptoms of anxiety and depression, and it should not be used as a diagnostic tool.

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