PROMs

Hospital Anxiety and Depression Scale (HADS) Flow

Hospital Anxiety and Depression Scale flow

Introduction

Hospital Anxiety and Depression Scale (HADS) is a screening tool that quickly and effectively identifies patients that show symptoms of depression and/or anxiety. It was was developed by Zigmond and Snaith in 1983 [1]. Its use in the health-care setting increased over time, since it evaluates cognitive, emotional, and behavioral symptoms, excluding physical symptoms. Thus, it avoids possible false positives, and excludes symptoms associated with severe mental disorders. Once patients are identified as having possible symptoms of depression and/or anxiety, they can be selected for a diagnostic confirmation.

The Hospital Anxiety and Depression Scale flow contains the Hospital Anxiety and Depression Scale (HADS) questionnaire and associated calculation. After form submission, the Hospital Anxiety and Depression Scale calculation is executed automatically. It's easy to extend this flow with conditional logic based on the interpretation of the Hospital Anxiety and Depression Scale calculation.

Hospital Anxiety and Depression Scale (HADS) questionnaire

Questions and Scoring

The HADS has fourteen item scale that generates of which seven items relate to anxiety and the other 7 relate to depression.

The items on the questionnaire that relate to anxiety are:

  • I feel tense or wound up
  • I get a sort of frightened feeling as if something awful 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 as I 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

Interpretation

0-7    = Normal
8-10   = Borderline abnormal (borderline case)
11-21  = Abnormal (case)

References

[1] Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x

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