title: The validity of the Hospital Anxiety and Depression Scale. An updated literature review.
abstract: OBJECTIVE
  To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS).
  
  
  METHODS
  A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression?
  
  
  RESULTS
  Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83.
  
  
  CONCLUSIONS
  HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
authors.affiliation: Department of Public Health and Primary Health Care, Section for Preventive Medicine, Haukeland Hospital, Armauer Hansen Building, University of Bergen, N-5021, Bergen, Norway. ingvar.bjelland@uib.no
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bjelland
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
authors.forename: Tone Tangen
authors.initials: TT
authors.lastname: Haug
authors.forename: Dag
authors.initials: D
authors.lastname: Neckelmann
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D006801:Humans; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires