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.
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Publication history
Published online: August 27, 2019
Footnotes
Highlights From the Rehabilitation Measures Database
This content is provided as a service by the American Congress of Rehabilitation Medicine and is not peer reviewed by the Archives.