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Hospital Anxiety and Depression (HAD) scale

This is a self screening questionnaire for depression and anxiety¹. The patient should be instructed not to take too long over their replies: their immediate reaction to each item will probably be more accurate than a long thought-out response. It consists of 14 questions, seven for anxiety and seven for depression. Although it was designed for hospital General Medical Outpatients, it has been extensively used in Primary Care.²

The HAD scale is available at www.alanpriest.f2s.com, but any commercial use requires copyright permissions or purchase of the questionnaires, both which must be obtained from www.nfer-nelson.co.uk.

Alternative screening tools for depression

1. Two question test³
   1. "During the last month, have you often been bothered by feeling down, depressed or hopeless?".
   2. "During the last month, have you often been bothered by little interest or pleasure in doing things?"
   The two-question test is sensitive (96%) at picking up depression but like all screening tests less specific (57%).³ It is simple but does not test for anxiety.
2. Patient Health Questionnaire #9 - (PHQ-9) available online

References, footnotes and further reading

1. Zigmond AS, Snaith RP The Hospital Anxiety And Depression Scale. Acta Psychiatr Scand 1983, 67:361-70
2. Wilkinson MJ, Barczak P. Psychiatric screening in general practice: comparison of the general health questionnaire and the hospital anxiety depression scale.J R Coll Gen Pract. 1988 Jul; 38(312):311-3.
3. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997 Jul; 12(7):439-45.
4. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69-77. Review.

Acknowledgements EMIS is grateful to Dr Huw Thomas for this article. The final copy has passed peer review of the independent Mentor GP authoring team. ©EMIS 2006.

Last issued 08 May 2006