Hospital Anxiety and Depression Scale

The Hospital Anxiety and Depression Scale or HADS is a questionnaire used to screen medically ill patients for anxiety and depression, and was designed to exclude physical symptoms that could possibly be caused by medical illness. It consists of 14 questions, seven for anxiety and 7 for depression. It does not contain all the necessary questions to make a firm diagnosis of anxiety or depression because it does not include questions about sleep, self-harm and suicidality are needed.

ME/CFS
The Hospital Anxiety and Depression Scale has been validated in many different patient populations, including cancer patients, and in patients with chronic fatigue syndrome.

Morriss & Wearden (1998) found a cut-off of 9/10 useful for anxiety or depression in the HADS scale when compared with a clinical interview, however this was based on the broad Oxford criteria of CFS, which may include patients with other forms of unexplained chronic fatigue.

McCue at al (2006) also found the HADS valid in patients with CFS, and noted that internet based use have higher scores. McCue et al used questions they devised from the CDC's Fukuda criteria, and the less common London ME criteria, and found that the in ME/CFS patients the HADS, which was designed to assess two dimensions (anxiety and depression), actually better fit a three-dimensional model of Anhedonic depression, Negative depression and Autonomic anxiety.

HADS in research
HADS is sometimes used in research studies to approximate levels is anxiety or depression in patients who are physically ill. It has been heavily used by British paediatrician Esther Crawley.

Notable studies

 * 1998, Screening instruments for psychiatric morbidity in chronic fatigue syndrome, (Full text)
 * 2006, Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome (Full text)
 * 2012, The validity of the Hospital Anxiety and Depression Scale: An updated literature review (Abstract)
 * 2014, Hospital Anxiety and Depression Scale (Abstract)

Learn more

 * Hospital Anxiety and Depression Scale ( View)