Hospital anxiety and depression scale (HADS)

The HADS is a widely used self-assessment of anxiety and depressive symptoms, focusing mostly on the cognitive and psychological aspects^60–62. Somatic concerns and physical symptoms are not assessed by this scale. It is commonly used in general medical populations as well as in healthy populations⁶³. The psychometric properties, including the internal consistency, discriminatory ability, validity and test–retest correlations, are considered satisfactory; thus, the HADS is one of the most commonly used self-assessment questionnaires for anxiety/depression symptom screening⁶².

The HADS consists of a total of 14 items in 2 separate subscales: anxiety (HADS-A) and depression (HADS-D), each of which includes 7 items. All items were scored by the participant using a Likert scale (4 points, from 0 to 3 points). The total score varies from 0 to 42 points, and both subscale scores vary from 0 to 21 points.

The originally recommended cutoff scores for the subscales were as follows: a score from 0 to 7 indicates a noncase, a score from 8 to 10 indicates a possible case, and a score from 11 to 21 indicates a probable case⁶³. Currently, the categorization system includes more groups: 0 –7, normal; 8 –10, mild; 11–15, moderate; and > 16, severe⁶¹.

In this study, scores of 11 or more were considered to indicate a “high risk of anxiety/depression”, according to the cutoff values described above.