Clinimetrics: Hospital Anxiety and Depression Scale

摘要

The Hospital Anxiety and Depression Scale (HADS) was developed to assess depression and anxiety in patients with illness and in the general population.1 It is a self-rating patient-reported outcome measure (PROM) for both hospital and community settings.2 Fourteen items are equally divided in two subscales: anxiety (HADS-A) and depression (HADS-D). The HADS-A includes items such as tension, worry, fear, panic, difficulties in relaxing, and restlessness. The HADS-D includes items predominantly measuring anhedonia (not experiencing joy). Respondents indicate how they currently feel. Responses are rated on a 4-point Likert scale and range from 0 to 3, with higher scores indicating higher severity. Anchor points for the Likert items vary depending on the item (eg, ‘I can sit still and feel relaxed’ scores as 0 and ‘not at all’ scores as 3).1 The ratings of the 14 items are summed to yield a total score (0 to 42), or for each subscale separately (0 to 21), with special attention to reversed items. The HADS is used in many different populations, including medical populations and healthy able-bodied individuals (aged 16 to 65?years).3, 4Accessibility and feasibility: The HADS is copyrighted and available from: permissions@gl-assessment.co.uk. The HADS is an easy to use and short questionnaire,3 with an accompanying test manual.5 It takes around 2 to 5?minutes to fill in the questionnaire and no training is required to administer the HADS. The HADS is available in 115 languages, including English.2Validity, reliability and responsiveness: Several studies have confirmed the two-factor structure,6, 7 but others have implicated some caution in the use of the two subscales as independent measures.7, 8 The internal consistency for the subscales is high (Cronbach’s alphas ranging from 0.68 to 0.93 for the HADS-A and from 0.67 to 0.90 for the HADS-D).3, 6 Studies found high test-retest correlations (r?>?0.80).9 Compared to other commonly used (but often longer) depression and anxiety measures (eg, the Beck Depression Inventory, the General Health Questionnaire), validity is adequate, with correlations ranging between 0.60 (good) and 0.80 (very good).3, 4, 6 The questionnaire’s ability to discriminate is moderate to high, with sensitivities and specificities?≥?0.80, which is similar to other self-rating screening tools.