HOSPITAL ANXIETY AND DEPRESSION SCALE

Experiment No: 01

Date: 09/07/2025

Introduction

Anxiety and depression are among the most prevalent psychological disorders globally, affecting
individuals across all age groups and socio-economic backgrounds. Anxiety is marked by excessive
worry, nervousness, restlessness, and physiological symptoms such as increased heart rate or difficulty
concentrating. It often stems from uncertainty, fear of future events, or unresolved stress. Depression, on
the other hand, is characterized by persistent feelings of sadness, hopelessness, low energy, loss of interest
or pleasure in daily activities, and cognitive difficulties such as poor concentration or indecisiveness. Both
conditions not only impair psychological functioning but also negatively influence physical health
outcomes. In clinical settings, especially among patients with chronic or acute illnesses, these
psychological issues may go unnoticed due to an emphasis on physical symptoms. However, unaddressed
anxiety and depression can significantly impact treatment adherence, recovery, and quality of life,
highlighting the need for reliable and efficient screening tools in healthcare environments.

The Hospital Anxiety and Depression Scale (HADS) was developed by Zigmond and Snaith (1983)
specifically to identify and quantify symptoms of anxiety and depression among non-psychiatric patients
in hospital and outpatient settings. The primary aim of HADS was to detect emotional disturbances while
excluding somatic complaints that could overlap with symptoms of physical illness. Unlike traditional
diagnostic instruments that incorporate physical symptoms such as fatigue, sleep disturbances, or appetite
changes, HADS focuses purely on psychological and emotional dimensions. This makes it particularly
valuable in general medical settings, where physical symptoms may be attributed to the patient’s medical
condition rather than to underlying mental health issues. As a result, HADS has become a preferred tool
for identifying psychological comorbidities in patients suffering from various physical illnesses, such as
cancer, cardiovascular disease, diabetes, and chronic pain.

The scale includes 14 items, divided equally into two subscales: HADS-A (Anxiety) and HADS-D
(Depression), with 7 questions each. Each item is rated on a 4-point Likert scale ranging from 0 to 3,
based on the severity or frequency of symptoms experienced in the past week. This yields a total score
between 0–21 for each subscale, with thresholds typically interpreted as: 0–7 (normal), 8–10 (borderline
abnormal), and 11–21 (abnormal). The anxiety subscale assesses symptoms such as nervousness, tension,
and fear, while the depression subscale evaluates factors like loss of interest, low mood, and inability to
experience pleasure. HADS is simple to administer, taking only 2–5 minutes, and is easy to interpret by
both psychologists and non-psychologist health professionals, making it ideal for routine psychological
screening in hospitals.

Over the decades, HADS has gained widespread clinical and research acceptance for its validity,
reliability, and cross-cultural applicability. It has been translated into more than 30 languages and
validated in multiple countries and populations, including patients with cancer, heart disease, neurological
disorders, and in primary care. Research supports its psychometric soundness, with good internal
consistency (Cronbach’s alpha typically > 0.80) and construct validity. The scale is frequently used not
only for initial screening but also for tracking psychological changes over the course of treatment or
rehabilitation. In summary, the Hospital Anxiety and Depression Scale is a practical, efficient, and
psychometrically robust tool that plays a vital role in the early detection and management of mental
health issues in physically ill patients, promoting holistic care and improved health outcomes.

Aim

To access the level of anxiety and depression symptoms in individuals, the Hospital Anxiety and
Depression Scale (HADS) is utilized, particularly in non-psychiatric medical settings.

Method

Experimenter details:

Name: AG

Age: 22 Years

Sex: Female

Participant details:

Name: AJ

Age: 22Years

Sex: Female

Materials Required

 HADS Questionnaire Form

Plan

The HADS is administered by providing the 14-item questionnaire to the individual in a quiet setting. The
responses are then scored to assess the severity of anxiety and depression symptoms separately.

Procedure

The Hospital Anxiety and Depression Scale (HADS) is administered by presenting the participant with a
14-item questionnaire, consisting of 7 items assessing anxiety (HADS-A)and 7 items assessing depression
(HADS-D). Each item presents a statement with four response options, scored from 0 to 3, reflecting the
frequency or intensity of the symptom over the past week. The participant is instructed to choose one
option per item that best represents how they have been feeling recently.The administration is typically
self-report, but it can also be conducted via interview if necessary (e.g., due to reading difficulties). The
environment should be quiet and private to allow the participant to respond freely and without
distractions. Once all responses are recorded, each item is scored according to the official HADS scoring
guide, and the scores for the 7 anxiety items and 7 depression items are summed separately to yield two
subscale scores:
HADS-A (Anxiety subscale): 0–21

HADS-D (Depression subscale): 0–21

Each subscale score is then interpreted as follows:

0–7: Normal

8–10: Borderline abnormal (borderline case)

11–21: Abnormal (clinical case)

Scoring

The scoring of the Hospital Anxiety and Depression Scale (HADS) involves summing the responses to its
14 items, which are divided into two subscales: HADS-A (Anxiety) and HADS-D (Depression), each
containing 7 items. Each item is rated on a 4-point Likert scale ranging from 0 to 3, where higher scores
indicate greater symptom severity. The maximum score for each subscale is 21, and the minimum is 0.
After the participant completes the questionnaire, the individual scores for the anxiety-related items and
the depression-related items are added separately. The resulting subscale scores are then interpreted as
follows: a score of 0–7 is considered normal, 8–10 indicates borderline abnormal, and 11–21 suggests the
presence of clinically significant anxiety or depression. This scoring method allows clinicians to quickly
identify emotional distress levels and determine whether further psychological assessment or intervention
is needed. Importantly, the HADS scoring system avoids the influence of physical symptoms, making it
suitable for use in hospital or medical settings.

Precautions

• Ensure privacy and a quiet environment to allow the participant to respond honestly without distraction
or discomfort.

• Clarify instructions clearly before administration, especially for individuals who may have read or
comprehension difficulties.

• Avoid administering during times of acute physical distress, as it may affect the participant’s
concentration and responses.

• Do not interpret scores in isolation; consider the patient’s overall medical, psychological, and social
context.

• Use only validated translations when administering the scale in a non-native language to ensure
accuracy and cultural relevance.

Result

Based on the results shown in Table 1, the participant obtained a raw score of 9 on the Depression
subscale and a score of 10 on the Anxiety subscale of the Hospital Anxiety and Depression Scale
(HADS). Both scores fall within the mild range (8–10), indicating that the participant is experiencing
mild symptoms of both depression and anxiety. While these levels are not severe, they suggest the need
for continued monitoring and possibly supportive psychological interventions to prevent further
escalation.
Discussion

The Hospital Anxiety and Depression Scale (HADS) is a commonly utilized self-report instrument aimed
at identifying anxiety and depression in individuals within non-psychiatric hospital environments. In this
instance, the participant achieved a score of 9 on the Depression subscale and 10 on the Anxiety subscale.
According to the HADS classification, these scores, which range from 8 to 10, indicate mild symptoms of
both anxiety and depression that are clinically significant . A depression score of 9 implies the individual
may be experiencing mild symptoms such as low mood, diminished interest, fatigue, or lack of
motivation, while the anxiety score of 10 suggests mild anxiety symptoms, including restlessness,
excessive worry, and tension. Although these symptoms are mild, they can still affect daily functioning
and overall quality of life if not addressed. It is crucial to consider contextual factors, such as recent
stressors or medical issues, that may be influencing these emotional states. Mild distress can serve as an
early warning sign of more serious psychological challenges, and timely interventions—such as
psychoeducation, stress management, or counseling—can help mitigate the risk of developing more
severe symptoms. Early identification and support are essential for fostering mental health resilience.

Conclusion

The participant’s HADS scores indicate mild levels of depression and anxiety, underscoring the necessity
for ongoing monitoring and early psychological intervention.

Reference

Snaith, R. P., & Zigmond, A. S. (1994). The Hospital Anxiety and Depression Scale Manual.

Windsor, UK: NFER-Nelson Publishing Company Ltd.

Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital

Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic

Research, 52(2), 69–77. https://doi.org/10.1016/S0022-3999(01)00296-3