What is the Hospital Anxiety and Depression Scale (HADS)?

The HADS is a self-assessment mood scale specifically designed for use in medical settings to detect anxiety and depression in patients with physical illness. Unlike many other mood scales, the HADS was specifically developed to avoid reliance on somatic symptoms that might be confused with physical illness symptoms, making it particularly valuable in hospital and medical outpatient settings.

Who developed the HADS and when?

Developed by Dr. Anthony S. Zigmond and Dr. R. Philip Snaith in 1983 at Leeds University in the UK. It was created in response to the need for a tool that could accurately assess mood disorders in medical patients without being confounded by physical symptoms of illness.

What makes the HADS unique for medical settings?

• Somatic symptom exclusion: Items were specifically chosen to exclude physical symptoms that overlap with medical conditions
• Medical patient focus: Designed and validated specifically for patients with physical health problems
• Brief assessment: Takes only 2-5 minutes to complete, making it practical for busy medical settings
• Self-administered: Can be completed by patients independently, reducing clinical time
• Clear subscales: Provides separate anxiety and depression scores for targeted assessment

What do the HADS subscales measure?

HADS-Anxiety (HADS-A) - 7 items measuring:

• Feeling tense, wound up, or restless
• Worrying thoughts and fears
• Panic feelings and butterflies in stomach
• Ability to sit at ease and relax
• Frightened feelings and sudden feelings of panic

HADS-Depression (HADS-D) - 7 items measuring:

• Loss of interest and enjoyment in activities
• Feeling slowed down or restless
• Loss of interest in appearance and self-care
• Ability to laugh and see the funny side of things
• Feeling cheerful and looking forward to things
• Enjoyment of books, radio, or TV programs

How is the HADS scored and interpreted?

Each subscale (Anxiety and Depression) scores from 0-21:

• 0-7: Normal/No significant anxiety or depression
• 8-10: Borderline abnormal/Mild anxiety or depression
• 11-14: Abnormal/Moderate anxiety or depression
• 15-21: Severe anxiety or depression

Clinical Cutoff Points:

• Score ≥8: Suggests possible anxiety or depression (sensitivity focus)
• Score ≥11: Suggests probable anxiety or depression (specificity focus)

Clinical Applications and Medical Conditions

The HADS has been extensively validated in patients with:

• Cancer and oncology settings
• Cardiovascular disease
• Chronic pain conditions
• Respiratory diseases
• Neurological conditions
• Renal disease and dialysis patients
• Post-surgical recovery
• Emergency department settings

Research and Validation

The HADS has been:

• Translated into over 50 languages
• Used in thousands of research studies
• Validated across diverse medical populations
• Recommended by multiple clinical guidelines
• Shown to be sensitive to treatment changes