International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results

J Psychosom Res. 1997 Jan;42(1):17-41. doi: 10.1016/s0022-3999(96)00216-4.


More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.

Publication types

  • Review

MeSH terms

  • Anxiety / diagnosis*
  • Anxiety / therapy
  • Cross-Sectional Studies
  • Depression / diagnosis*
  • Depression / therapy
  • Global Health
  • Humans
  • Longitudinal Studies
  • Outcome Assessment, Health Care
  • Prognosis
  • Psychiatric Status Rating Scales / standards*
  • Reproducibility of Results
  • Sensitivity and Specificity