Hospital Anxiety and Depression Scale (HADS) was originally developed by Zigmond and Snaith (1983) and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing. The HADS is a fourteen item scale that generates ordinal data. Seven of the items relate to anxiety and seven relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symtoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, whould create a tool for the detection of anxiety and depression in people with physical health problems.

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 feelings as if something bad 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 and 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

Scoring the questionnaire

Each item on the questionnaire is scored from 0-3 and this means that person can score between 0 and 21 for either anxiety or depression. The HADS uses     a scale and therfore the data returned from the HADS is ordinal.

Hospital Anxiety and Depression Scale (HADS)

Tick the box beside the reply that is closest to how you have been feeling in the past week. Don´t take too long over you replies: your immediate is best.

A   I feel tense or ”wound up”:

3   Most of the time

2   A lot of the time

1   From time to time, occasionally

0   Not at all

D    I still enjoy the things I used to enjoy:

0   Definitely as much

1   Not quite so much

2   Only a little

3   Hardly at all

A    I get a sort of frightened feeling as if something awful is about to happen:

3   Very definitely and quite badly

2   Yes, but not too badly

1   A little, but it doesn´t worry me

0   Not at all

D    I can laugh and see the funny side of things:

0   As much as I always could

1   Not quite so much now

2   Definitely not so much now

3   Not at all

A    Worrying thoughts go through my mind:

3   A great deal of the time

2   A lot of the time

1   From time to time, but not too often

0   Only occasionally

D    I feel cheerful:

3   Not at all

2   Not often

1   Sometimes

0   Most of the time

A    I can sit at ease and feel relaxed:

0   Definitely

1   Usually

2   Not often

3   Not at all

D    I feel as if I am slowed down:

3   Nearly all the time

2   Very often

1   Sometimes

0   Not at all

A    I get a sort of frightened feeling like ”butterflies” in the stomach:

0   Not at all

1   Occasionally

2   Quite often

3   Very often

D    I have lost interest in my appearance:

3   Definitely

2   I don´t take as much care as I should

1   I may not take quite as much care

0   I take just as much care as ever

A    I feel restless as I have to be on the move:

3   Very much indeed

2   Quite a lot

1   Not very much

0   Not at all

D    I look forward with enjoyment to things:

0   As much as I ever did

1   Rather less than I used to

2   Definitely less than I used to

3   Hardly at all

A    I get sudden feelings of panic:

3   Very often indeed

2   Quite often

1   Not very often

0   Not at all

D    I can enjoy a good book or radio or TV program:

0   Often

1   Sometimes

2   Not often

3   Very seldom

Scoring:

0-7         =   Normal

8-10       =   Borderline abnormal (borderline case)

11-21     =   Abnormal (depression or anxiety)

Total score:

Depression (D)   _____________

Anxiety (A)        _____________