Measurement Characteristics and Clinical Utility of the Hospital Anxiety and Depression Scale Among Adults With Cardiovascular Disease

Adults with cardiovascular disease often experience symptoms of anxiety and depression that interfere with treatment, decrease quality of life, and increase mortality rates.^{1.,  2.,  3.} The Hospital Anxiety and Depression Scale (HADS) is a brief, descriptive self-report questionnaire validated in cardiovascular disease populations, offering an efficient way to screen patients for psychological comorbidities. Compared with other common depression and anxiety screening instruments originally designed for use in psychiatric settings, the HADS excludes physical symptoms that may be related to somatic medical conditions, such as weight loss and insomnia, and aims to detect the milder levels of distress commonly seen in cardiac patients.^{3.,  4.,  5.} The instrument consists of 14 items that can be administered via paper and pencil in<7 minutes. Two 7-item subscales assess distinct dimensions of anxiety and depression: HADS-A describes levels of generalized anxiety, and HADS-D focuses on symptoms of anhedonia. Each item is rated on a 4-point Likert scale where 0 indicates absence and 3 indicates extreme presence; 5 of the items are reverse-coded for a total possible score of 42, or 21 for each subscale, with higher scores indicating higher levels of anxiety or depression. For broader application, total HADS score is considered a representative measure of overall psychological distress.³ The HADS has demonstrated excellent discriminant validity, construct validity, test-retest reliability, and internal consistency.^1,2,4,5 This strong psychometric evidence, along with the instrument’s efficiency and consideration of somatic symptomology, make the HADS a useful screening measurement for anxiety and depression in cardiovascular disease populations.