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Hospital Anxiety and Depression Scale

HADS
health sciencespsychologyLicensed — permission required

A 14-item screening scale for anxiety and depression in medically ill and general-hospital populations, deliberately excluding somatic symptoms that confound physical illness.

Items
14
Response format
4-point scale (0-3), item-specific wording
Version
1.0
Subscales
2

Ready-to-cite methods sentence

Anxiety and depression were screened with the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983), whose two 7-item subscales showed good internal consistency (α ≈ .82–.83); subscale scores of 8 or more indicate possible cases.

Reliability & validation

Validation population
General medical outpatients (Zigmond & Snaith, 1983; Bjelland et al., 2002)
Cronbach's α
0.82–0.83

Subscales

Anxiety (HADS-A)Depression (HADS-D)

Known limitations

Licensed — permission required from the publisher. A screening instrument, not diagnostic, and its two-factor structure has been widely questioned, with evidence it largely captures general distress.

Original citation

Zigmond, A. S., Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370.

https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

This instrument is licensed. Obtain permission from the copyright holder before using it in your study.

Questions researchers ask

What does the HADS measure?

A 14-item screening scale for anxiety and depression in medically ill and general-hospital populations, deliberately excluding somatic symptoms that confound physical illness.

How many items does the HADS have?

The Hospital Anxiety and Depression Scale (HADS) has 14 items across 2 subscales: Anxiety (HADS-A), Depression (HADS-D).

Is the HADS free to use?

The HADS is licensed. You must obtain permission from the copyright holder before using it in a study — Folio does not distribute its item wording without that permission.

Is the HADS reliable?

Validation studies report Cronbach's α of 0.82–0.83. See the reliability section for the population studied and full statistics.

Who developed the HADS, and how do I cite it?

Zigmond, A. S., Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

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Library entry verified July 2026. Metadata is provided for reference; item wording is available inside Folio Surveyor, subject to each instrument's licensing.