Hospital Anxiety and Depression Scale – HADS
A 14-item self-report scale designed to detect and measure the severity of anxiety and depression in clinical and general populations.
Scale Development & Technical Details
Scale Overview
The Hospital Anxiety and Depression Scale – HADS was developed by A. S. Zigmond and R. P. Snaith (1983). It is designed to measure Anxiety and Depression. The scale is intended for use with Adults, clinical and general populations.
Scale Structure
This instrument consists of 14 items organized into 2 factors/subscales: Anxiety, Depression.
| Factor / Subscale | Items | N |
|---|---|---|
| Anxiety | 1,3,5,7,9,11,13 | 7 |
| Depression | 2,4,6,8,10,12,14 | 7 |
Response Format
Respondents rate each item using a custom response format.
Response anchors: 0 = 0 (No symptoms / Normal), 1 = 1 (Mild symptoms), 2 = 2 (Moderate symptoms), 3 = 3 (Severe symptoms).
The scale includes 6 reverse-scored items to reduce acquiescence bias.
Scoring
Items are scored by subscale, with each subscale sum representing a distinct dimension.
Total scores range from 0 to 21. Interpretation guidelines:
- Normal (per subscale): 0 – 7
- Borderline abnormal (per subscale): 8 – 10
- Abnormal (per subscale): 11 – 21
Psychometric Properties
Internal Consistency: The scale has demonstrated good to excellent internal consistency with reported Cronbach’s alpha values of Cronbach's alpha ranges from 0.68 to 0.93 for HADS-A, and 0.67 to 0.90 for HADS-D.
Administration
The scale is self-administered and typically takes approximately 5 minutes to complete. It can be administered individually or in group settings. No special training is required for administration.