Hospital Anxiety and Depression Scale

British researchers Zigmond and Snaith developed the Hospital Anxiety and Depression Scale (HADS) in 1983 for screening patients in general hospitals. Its 14 items form separate anxiety and depression subscales, with 7 items each. The scale avoids physical symptoms such as fatigue, insomnia, and appetite changes, since these can arise from physical illness itself. This helps distinguish emotional distress when assessing patients with medical conditions. HADS is widely used in hospitals, community screening, and research, particularly for assessing mood alongside physical illness.

Each item is scored 0–3. Anxiety and depression are scored separately, with each subscale ranging from 0–21. Zigmond and Snaith's original bands are 0–7 for no symptoms or the usual range, 8–10 for possible mild symptoms worth monitoring, and 11–21 for clear indications of moderate-to-severe symptoms that warrant professional assessment. Anxiety and depression are separate dimensions, but they may coexist. A score ≥8 on either subscale is a reason to seek further assessment or professional advice.

Originally designed for general hospital patients with physical illness, the HADS is now used across hospital specialties such as cardiology, oncology, and chronic pain, as well as community screening, primary care, and research. Avoiding physical symptom items reduces the chance that illness-related fatigue or insomnia inflates anxiety or depression scores. It is intended for adults and takes about five minutes.

The HADS was designed for physical illness and avoids physical symptom items. The SDS, SAS, and BDI include more such symptoms and are better suited to mental health settings. HADS has 14 items and takes about five minutes; SDS and SAS have 20 each, and the BDI has 21. HADS assesses both anxiety and depression, while SDS and BDI focus on depression and SAS on anxiety. HADS suits hospitals and community screening; other scales suit specialist assessment. Choose HADS for physical illness or a quick screen, and a dedicated scale for detailed assessment of particular symptoms.

Anxiety and depression often coexist, described clinically as comorbidity or mixed anxiety and depression. The HADS evaluates them separately. Anxiety items 1, 3, 5, 7, 9, 11, and 13 assess tension, worry, fear, restlessness, and panic. Depression items 2, 4, 6, 8, 10, 12, and 14 assess reduced interest and pleasure, pessimism, and loss of interest in appearance. High scores on both may suggest both kinds of difficulty. Seek counseling or medical advice, as combined difficulties can be more complex and need coordinated support.

Seek professional advice for a score of 11 or above on either subscale; a score of 8–10 lasting more than two weeks; scores of 8 or above on both; serious distress affecting life, work, or study despite lower scores; or emotional difficulties that may affect treatment or recovery from physical illness. Professionals can offer diagnosis, psychotherapy such as CBT, and medication when needed. HADS cannot replace diagnosis, but can indicate whether further assessment would help.