Hospital Anxiety and Depression Scale
Self-report mood disorder questionnaire
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Through Anxiety
Items on the questionnaire
The items on the questionnaire that relate to anxiety are
- I feel tense or wound up
- I get a sort of frightened feeling as if something awful is about to happen
- Worrying thoughts go through my mind
- I can sit at ease and feel relaxed
- I get a sort of frightened feeling like 'butterflies' in the stomach
- I feel restless as I have to be on the move
- I get sudden feelings of panic
The items that relate to depression are:
- I still enjoy the things I used to enjoy
- I can laugh and see the funny side of things
- I feel cheerful
- I feel as if I am slowed down
- I have lost interest in my appearance
- I look forward with enjoyment to things
- I can enjoy a good book or radio or TV program
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Scoring the questionnaire
Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.
Caseness of anxiety and depression
A number of researchers have explored HADS data to establish the cut-off points for caseness of anxiety or depression. Bjelland et al (2002) through a literature review of a large number of studies identified a cut-off point of 8/21 for anxiety or depression. For anxiety (HADS-A) this gave a specificity of 0.78 and a sensitivity of 0.9. For depression (HADS-D) this gave a specificity of 0.79 and a sensitivity of 0.83.
Factor structure
There are a large number of studies that have explored the underlying factor structure of the HADS. Many support the two-factor structure but there are others that suggest a three or four factor structure. Some argue that the tool is best used as a unidimensional measure of psychological distress.
Criticisms
The factor structure of the HADS has been questioned. Coyne and Sonderen argue in a letter published in the same issue, that Cosco, et al. provides grounds for abandoning HADS altogether. The HADS has also been criticised for its over reliance on anhedonia as being the core symptom of depression, how single-item measures of depression may have the same predictive value as the HADS scale, as well as its use of British colloquial expressions which can be difficult to translate.