Current Psychiatry Reviews, 2005, 1, 69-73
What does the Hospital Anxiety and Depression Scale (HADS) Really
Measure in Liaison Psychiatry Settings?
Colin R. Martin*
Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Peoples Republic of China
Abstract: The hospital anxiety and depression scale (HADS) is a widely used and popular self-report measure
that has been extensively translated and utilized in a broad variety of clinical populations. This 14-item
measure has been subject to two previous reviews exploring a number of psychometric aspects of this tool. A
relatively consistent finding of previous reviews of this instrument is that it is a reliable and valid measure of
two independent and separable dimensions of anxiety and depression; indeed, this aspect of the HADS is
crucial to the validity of the measure in clinical practice. The current review examines contemporary research
reports that use factor analytic techniques, which suggest that the assumed bi-dimensionality of the HADS is,
in fact, erroneous. The findings from the current review suggest that the HADS is underpinned by a tri-
dimensional factor structure comprising dimensions of anhedonia, negative affectivity and autonomic arousal.
Implications for the use of the HADS in light of these observations are discussed and recommendations made
within the context of screening practice for the referral to liaison psychiatry services.
Keywords: Hospital anxiety and depression scale, factor structure, psychometrics.
formulation was explicit from the outset of the development
of the tool, the goal of which was to make available a
screening tool that could be used in any general medicine
setting, since it would not be confounded by psychical
symptoms of illness or disease. This is both a laudable and
noble goal in terms of identification of psychiatric cases in
medical settings and facilitation of referral to specialist
liaison psychiatry services.
innovative contribution to psyc