The scoring system is straight forward. I have used this tool but only with a mental health population. The real cut off is the 8-10 score and the need to re assess. I actually find the individual questions interesting. Some that score highly are of personal interest to follow up with extra questions. But this is not recommended by the authors. Saying that there are moves to update and alter potentially in the pipeline.

As a screen it is really good, but why are you screening non-mentally ill people with such a tool? I have used it in Family Interventions work, but moved away and started using the PHQ9 for depression and GAD for anxiety. Initial simple questioning at first guided what to use.

Remember the guidance for the tool from the authors and the time and frequency of use. Most depression type tools use 2 weeks, but this tool is over the last week. We all know that for clinical presentations there is a need of constant presentation of 2 weeks. This returns me to my early question as for the need to use such a tool?

Thank you for your answer.

There are mainly one reason for using HAD in our questionnaire: our population is Sami reindeer herders (indigenous people of the Arctic). There is a problem with questions from mainstream questionnaires about psychological issues: they don't give meaning, do not match the way of speaking/thinking about psychological issues. And thus, the response rate decreases. However, in a Sweedish studie, HAD was used with succsess in the reindeer herder population, and both our own focus groups and our pilot study supported this. So, we use HAD because it seem to be useful to our population, and also because it might be relevant to compare results with Sweeden. In addition, we did not find other well-used screeing-instruments with a limited amount of questions that could be useful.

Our aim is not to measure level of anxiety or depression, but to use HAD as one (rude) indicator of level of psychological distress in different sub-groups of the population.

I understand that your experience with HAD is both with the cut-off score as well as with scores from individual questions. I wonder if you use certain criteria to pick out individual questions of interest - is it the extreme scores, is it spesific questions that seem to be more sensitive or other things ?

Hi,

My current research led me to the use of the HADS as a screening instrument for patiënts with tinnitus to see if they possible have anxiety problems.

The HADS is currently under fire for its psychometric meaning..

Recent literature (see attachement) shows that HADS is not a very good tool for measuring and/or differentiating between anxiety or depression. It seems to be a appropiate measure of general psychological distress. When using the HADS as such it would seem that the selected cut-off scores are wildly arbitrary and I would work with total scores.

I would only pick out individual questions if you plan to review the participants afterwards and probe deeper into those questions.

Tank you very much for a clarifying respons and the attachement, which I haven't been aware of until now.

I suppose the easiest way to establish if someone is depressed is to simply ask them that question. But you would need some supplementary questions to identify the level and severity. Experience of a range of tools has led to clinical judgement improvement but also the confusion and worry about the use of standardised tools such as the HAD, Becks, Hamilton, etc...I feel that as long as you can justify the questions being asked and don't try to make extravagant claims then you can generally say that a person is either depressed or not.

The tools are useful for comparative studies but are you aware of the way the tools were used in the other studies and the age and cultural background of participants?

All in all it will depend on the truthfulness of the person answering the questions and if they can comprehend what depression is.

I have used this tool with cancer patients and I like it - with the same cut off.

However, there are many studies question the benefit of this instruments.

Have you seen this articles?:

1. Coyne JC, van Sonderen E. No further research needed: Abandoning the hospital and anxiety depression scale (HADS). J Psychosom Res, 2012;72:173-174. DOI: 10.1016/j.psychores.2011.12.003

2. Coyne, J. C., & Sonderen, E. V. (2012b). The Hospital Anxiety and Depression Scale (HADS) is dead, but like Elvis, there will still be citing. Journal of Psychosomatic Research, 73, 77-78. DOI: 10.1016/j.psychores.2012,04.002

3. Pallant J, Tennant A. An introduction to the rasch measurement model: an example using the hospital anxiety and depression scale (HADS). Br J Clin Psychol, 2007;46(1):1-18. DOI: 10.1348/014466506X96931

4. Hagquist C, Bruce M, Gustavsson J. Using the rasch model in nursing research: an introduction and illustrative example. Int J Nurs Stud, 2009;46(3):380-393. DOI: 10.1016/j.ijnurstu.2008.10.007

5. Smith AB, Wright EP, Rush R, Stark DP, Velikova G, Selby PJ. Rasch analysis of the dimensional structures of the hospital anxiety and depression scale. Psycho-Oncol, 2005;15(9):817-827. DOI: 10.1002/pon.1015

I recommend too the PHQ-9 or PhQ-8 (better) for depression and the GAD-7 for anxiety.

Thank you very much for the references, Christiane