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Hospital Anxiety and Depression (HAD) scale

This is a self screening questionnaire for depression and anxiety. 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. Although it was designed for hospital General Medical Outpatients, it has been extensively used in Primary Care.1

Hospital Anxiety and Depression (HAD) scale
I feel tense or wound up
I still enjoy the things I used to enjoy
I get a sort of frightened feeling as if something awful is about to happen
I can laugh and see the funny side of things
Worrying thoughts go through my mind
I feel cheerful
I can sit at ease and feel relaxed
I feel as if I am slowed down
I get a sort of frightened feeling like butterflies in the stomach
I have lost interest in my appearance
I feel restless as if I have to be on the move
I look forward with enjoyment to things
I get sudden feelings of panic
I can enjoy a good book or radio or TV programme
Anxiety      /21
Depression /21

Two question test - An alternative screening tool for depression:

  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%).2 It is simple but does not test for anxiety.

References, footnotes and further reading

  1. 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.
  2. 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.
  3. Centre for Evidence Based Mental Health (Oxford)

Acknowledgements EMIS is grateful to Dr Huw Thomas for this article including the calculator. The final copy has passed peer review of the independent Mentor GP authoring team. ŠEMIS 2009.

Last issued 03 Feb 2009