S
Soveriaclinical platform
For SpecialistsFor ClientsInstrumentsHow It WorksPricingContact
Log InStart Free →
For SpecialistsFor ClientsInstrumentsHow It WorksPricingContact
Log InStart Free →
  1. Home
  3. Instruments
  5. HADS

HADS — Hospital Anxiety and Depression Scale

Zigmond & Snaith, 198314 items · 2 subscales2–5 minValidated on a Russian sampleRU · EN
CalculatorNormsAboutFAQ
CalculatorAboutNormsClinical useSourcesFAQ

What HADS measures

The Hospital Anxiety and Depression Scale (HADS) is a 14-item self-report questionnaire developed by Zigmond and Snaith in 1983 to detect anxiety and depression in patients in non-psychiatric hospital settings. Two subscales — anxiety (HADS-A) and depression (HADS-D) — are scored independently, each with 7 items.

A distinctive feature of the scale is that it deliberately excludes somatic symptoms (fatigue, sleep and appetite disturbance) that may stem from physical illness. This makes HADS suitable for assessing emotional state even in patients with significant physical comorbidity.

HADS is not intended to establish a diagnosis. It is a screening instrument: elevated scores indicate the need for a more detailed clinical assessment, not the presence of a disorder.
Each item is scored from 0 to 3. The range for each subscale is 0 to 21. Some items are reverse-scored — keep this in mind when scoring by hand.

Norms & cut-offs

HADS-A — Anxiety subscale (per Zigmond & Snaith, 1983)
Score rangeLevelClinical meaning
0–7NormalNo clinically significant anxiety detected
8–10BorderlineSubclinical symptoms; re-assessment recommended
11–21Clinically significantHigh likelihood of an anxiety disorder; extended assessment indicated
HADS-D — Depression subscale (per Zigmond & Snaith, 1983)
Score rangeLevelClinical meaning
0–7NormalNo clinically significant depression detected
8–10BorderlineSubclinical signs of depression; monitoring recommended
11–21Clinically significantHigh likelihood of a depressive disorder; comprehensive assessment required

Use in clinical practice

HADS is used for initial screening, monitoring the course of a condition, and assessing treatment response. Its brevity (2–5 minutes) makes it convenient for repeated administration.

Screening

A cut-off of 8 on either subscale is traditionally used as a signal for in-depth assessment. Sensitivity and specificity at this cut-off are around 0.8 for both subscales.

Monitoring

For longitudinal follow-up, a change of 2 points or more on a subscale is considered clinically meaningful (Deary et al., 2003). Smaller fluctuations usually fall within measurement error.

When interpreting, consider the context: a single elevated score requires confirmation by clinical interview rather than a standalone conclusion about a diagnosis.

Sources

  • Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–370.
  • Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research. 2002;52(2):69–77.
  • Deary IJ, Whiteman MC, Fowkes FGR. Medical research and the Hospital Anxiety and Depression Scale. British Journal of Health Psychology. 2003.
  • Andryushchenko AV, Drobizhev MYu, Dobrovolsky AV. A comparative evaluation of the CES-D, BDI and HADS scales in diagnosing depression in general medical practice. Zhurnal Nevrologii i Psikhiatrii. 2003.
HADS calculator
0 of 14 items completed14 items left
AnxietyI feel tense or wound up
DepressionI still enjoy the things I used to enjoy
AnxietyI get a sort of frightened feeling as if something awful is about to happen
DepressionI can laugh and see the funny side of things
AnxietyWorrying thoughts go through my mind
DepressionI feel cheerful
AnxietyI can sit at ease and feel relaxed
DepressionI feel as if I am slowed down
AnxietyI get a sort of frightened feeling like butterflies in the stomach
DepressionI have lost interest in my appearance
AnxietyI feel restless as if I have to be on the move
DepressionI look forward with enjoyment to things
AnxietyI get sudden feelings of panic
DepressionI can enjoy a good book or radio or TV programme
Anxiety (HADS-A)0 / 21
Depression (HADS-D)0 / 21

Clinical use of HADS

Questions about scoring, interpretation, and the scale's limits

A range of 8–10 reflects a subclinical level: symptoms are present but do not reach the threshold for a probable disorder. This is a cue for closer monitoring and a clinical interview, not an immediate conclusion about a diagnosis. Re-assessment in 2–4 weeks is recommended.
No. HADS contains no items about suicidal ideation and is not designed to assess risk. With an elevated depression-subscale score, use dedicated instruments (C-SSRS, SBQ-R) and a clinical interview.
HADS was designed for non-psychiatric hospital settings and excludes physical symptoms, so the cut-off of 8 applies here as well. With a high somatic burden, some authors suggest a cut-off of 10–11 to increase specificity — the choice depends on the screening goals.
Because it is brief, HADS is convenient for repeated use — for example, every 2–4 weeks. A change of 2 points or more on a subscale is considered clinically meaningful (Deary et al., 2003); smaller fluctuations are usually within measurement error.
The original methodology assumes separate scoring of the anxiety and depression subscales. The total score (HADS-T) is used in some research as a general distress index, but for clinical interpretation, separate subscale analysis is preferable.
Soveria · MBC Platform

HADS — one of 42 instruments in your practice

Send HADS to a client by link, get the result scored automatically, and track session-to-session change without manual entry.

  • Send to the client by link
  • Trajectory on a chart
  • 42 instruments in one place
Start free →Sign in

Used together with HADS

Anxiety disorders
GAD-7

Extended assessment of generalized anxiety differentiated across 7 criteria. Used for clarification after HADS-A ≥8.

Coming soon
Depression
PHQ-9

Criterion-based depression scale per DSM-5. Includes a suicide-risk item. Used together with HADS-D after a positive screen.

Coming soon
Depression · Gold standard
HAM-D (Hamilton)

Clinician-rated depression scale for a structured clinical interview. Used to verify the diagnosis and grade severity.

Open
This tool is intended for mental-health professionals. Results are not a diagnosis and do not replace clinical judgment. Scoring follows the original Zigmond & Snaith (1983) methodology.
S
Soveriaclinical platform

Clinical measurement-based care platform for mental health professionals. 42+ validated instruments, progress tracking, supervision module.

Platform
For SpecialistsFor ClientsInstrument LibrarySupervision ModuleWhat's NewPricing
Company
About the PlatformMBC ResearchBlogSupportContact UsPrice Calculator
Legal
Privacy PolicyTerms of UseCookie PolicyGDPRsupport@soveria.co
© 2026 Soveria. All rights reserved.
PrivacyTermsCookies