The DOI matches its Crossref record; 55 of the 55 references it cites were found in a registry or an index.
The Hospital Anxiety and Depression Scale: A diagnostic meta-analysis of case-finding ability
Abstract
Objective To quantify the accuracy of the Hospital Anxiety and Depression Scale (HADS) as a case-finding instrument for anxiety and depressive disorders.Method MEDLINE, PSYCHINFO, EMBASE, CINAHL, BNI, and AMED were searched from January 1983 to June 2006. Studies were included that administered the HADS, used a standardized psychiatric interview to establish a diagnosis of anxiety or depression, and provided sufficient data on sensitivity and specificity (N=41). Summary sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were calculated for each study. Random effects meta-analytic pooling across studies at the recommended clinical (7/8) and research (10/11) cutoff points was undertaken and summary receiver operating characteristic curves constructed.Results For major depressive disorders, a cut point of ≥8 gave a sensitivity of 0.82 (95% CI, 0.73-0.89) and a specificity of 0.74 (95% CI, 0.60-0.84) and a cut point ≥11 gave a sensitivity of 0.56 (95% CI, 0.40-0.71) and a specificity of 0.92 (95% CI, 0.79-0.97).Conclusions Many studies have shown that the HADS is a useful screening tool to identify emotional distress in nonpsychiatric patients. However, it does not appear to be superior to other screening instruments in terms of identifying specific mental disorders in physical health settings.
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In the citing paper
“a number of tools have been utilised and validated to screen depression (PHQ-9 [50, 51], HADS [52, 53]) and anxiety (HADS [52], Generalised Anxiety Disorder 7-item scale (GAD-7) [54, 55]) in diabetes.”
In the citing paper
“Although the diagnostic accuracy of the scale has been questioned, it may be used as a relevant screening instrument for emotional distress (Brennan et al., 2010).”
From Postponement of elective cardiac surgery: A prospective observational analysis of anxiety, depression, social support and clinical complications. (2023) · cites this paper as Brennan et al., 2010
In the citing paper
“The depression symptoms were reduced from clinical range at baseline to subclinical range post-intervention, according to previously defined cut-off limits (Brennan et al., 2010).”
From Mindfulness-based stress reduction for autistic adults: A feasibility study in an outpatient context. (2024) · cites this paper as Brennan et al., 2010
In the citing paper
“In the current study, the HADS was used as a screening tool to capture symptoms of anxiety or depression and not a clinical diagnosis [104].”
From The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study (2025) · cites this paper as [104]
In the citing paper
“Depressive symptoms were measured with the Hospital Anxiety and Depression Scale's (HADS) subscale for depression (HADS-D). 23 Following well-established criteria, the presence of depression was defined as HADS-D ≥ 11, indicating probable moderate or severe depression. 24-26”
From Depressive symptoms predict clinical recurrence of inflammatory bowel disease (2022) · cites this paper as [25]
In the citing paper
“a HADS-D score of ≥ 11 represents a well-established cut off strongly indicating depression, 23-26”
From Depressive symptoms predict clinical recurrence of inflammatory bowel disease (2022) · cites this paper as [25]
Citations
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Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139
Kessler, R. C. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950010008002 · Cited by 12,370
The validity of the Hospital Anxiety and Depression Scale
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00296-3 · Cited by 9,779
Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-5-200703060-00004 · Cited by 4,741
Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Murray, C. J., & Lopez, A. D. (1997) · The Lancet · doi:10.1016/s0140-6736(96)07495-8 · Cited by 4,492 · cited 1×
“Depressive disorders are common [1–4] and a leading cause of disability worldwide [5,6].”
BackgroundThe Structured Clinical Interview for DSM-III-R (SCID): I: History, Rationale, and Description
Spitzer, R. L. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080032005 · Cited by 4,336
The Handbook of Research Synthesis.
Howel, D., Cooper, H., & Hedges, L. V. (1995) · Biometrics · doi:10.2307/2533295 · Cited by 3,657
Reitsma, J. B., Glas, A. S., Rutjes, A. W. S., Scholten, R. J. P. M., Bossuyt, P. M., & Zwinderman, A. H. (2005) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2005.02.022 · Cited by 3,369 · cited 2×
“Summary ROC (sROC) curves [16] were then constructed using the bivariate model to produce a 95% confidence ellipse within ROC space [14].”
Method
Cited by
Sorted by citations
Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review
Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.06.008 · Cited by 417
The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis
Norton, S., Cosco, T. D., Doyle, F., Done, J., & Sacker, A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.10.010 · Cited by 426
Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients
Annunziata, M. A., Muzzatti, B., Bidoli, E., Flaiban, C., Bomben, F., Piccinin, M., Gipponi, K. M., Mariutti, G., Busato, S., & Mella, S. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05244-8 · Cited by 310
Wu, Y., Levis, B., Sun, Y. B., He, C., Krishnan, A., Neupane, D., Bhandari, P. M., Negeri, Z., Benedetti, A., & Thombs, B. D. (2021) · BMJ · doi:10.1136/bmj.n972 · Cited by 292
Self-reported physical activity and aerobic fitness are differently related to mental health
Lindwall, M., Ljung, T., Hadžibajramović, E., & Jónsdóttir, I. H. (2012) · Mental health and physical activity · doi:10.1016/j.mhpa.2011.12.003 · Cited by 241
Metadata
- Authors
- Brennan, C., Worrall-Davies, A., McMillan, D., Gilbody, S., & House, A.
- Affiliations
- University of Leeds (GB)
- Corresponding author
- Brennan, Cathy
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 69
- Issue
- 4
- Pages
- 371-378
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2017953368
- Cited by
- 374
- References
- 54
- Citations by year
- 2026: 22 · 2025: 22 · 2024: 34 · 2023: 23 · 2022: 34 · 2021: 33 · 2020: 36 · 2019: 23 · 2018: 21 · 2017: 26 · 2016: 17 · 2015: 21 · 2014: 13 · 2013: 21 · 2012: 19
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- Hospital Anxiety and Depression Scale, anxiety disorders, depressive disorders, case finding, screening accuracy, sensitivity and specificity, diagnostic odds ratio, likelihood ratios, receiver operating characteristic, cut-off values
- MeSH terms
- Anxiety, Anxiety Disorders, Depression, Depressive Disorder, Humans, Predictive Value of Tests, Psychiatric Status Rating Scales, Sensitivity and Specificity, Odds Ratio
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