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Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients
Abstract
Detecting clinically significant symptoms of depression and anxiety in medically ill patients using self-report rating scales presents a challenge because of somatic confounders. The Hospital Anxiety and Depression Scale (HADS) was developed with this in mind, but has never been validated for a multiple sclerosis population. Our objective was to validate the HADS for multiple sclerosis patients. Multiple sclerosis patients were interviewed for the presence of major depression (n = 180) and anxiety disorders (n = 140) with the Structured Clinical Interview for DSM-IV disorders. A receiver operating characteristic (ROC) analysis was undertaken to assess which HADS cut-off scores give the best yield with respect to diagnoses of major depression and all anxiety disorders defined by the Structured Clinical Interview for DSM-IV. A threshold score of 8 or greater on the HADS depression subscale provides a sensitivity of 90% and specificity of 87.3% (ROC area under the curve 0.938). The same cut-off score gives a sensitivity of 88.5% and a specificity of 80.7% on the anxiety subscale (ROC area under the curve 0.913), but for generalized anxiety disorder only. The study confirms the usefulness of the HADS as a marker of major depression and generalized anxiety disorder, but not other anxiety disorders, in multiple sclerosis patients.
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“A cut-off of >7 gives a high sensitivity and specificity for detecting clinically elevated depression and anxiety in pwMS (Honarmand & Feinstein, 2009).”
From Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study (2024) · cites this paper as Honarmand & Feinstein, 2009
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Cited by
Sorted by citations
The link between multiple sclerosis and depression
Feinstein, A., Magalhaes, S., Richard, J., Audet, B., & Moore, C. S. (2014) · Nature Reviews Neurology · doi:10.1038/nrneurol.2014.139 · Cited by 550
Self-citationRecommendations for cognitive screening and management in multiple sclerosis care
Kalb, R. C., Beier, M. L., Benedict, R. H. B., Charvet, L. E., Costello, K., Feinstein, A., Gingold, J. N., Goverover, Y., Halper, J., Harris, C. J., et al. (2018) · Multiple Sclerosis Journal · doi:10.1177/1352458518803785 · Cited by 413
“therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4)”
BackgroundSelf-citationMultiple sclerosis and depression
Feinstein, A. (2011) · Multiple Sclerosis Journal · doi:10.1177/1352458511417835 · Cited by 337
“Examples of these are the Hospital Anxiety andDepression Scale and the BeckFast Screen for depression in medically ill patients, both of which have been validated for patients with multiple sclerosis.(12,13) Useful as they are for screening purposes and clinical trials, self-report questionnaires cannot generate a dia…”
MethodSelf-citationPrevalence and concurrence of anxiety, depression and fatigue over time in multiple sclerosis
Wood, B., van der Mei, I., Ponsonby, A.-L., Pittas, F., Quinn, S., Dwyer, T., Lucas, R., & Taylor, B. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458512450351 · Cited by 294
Health-related quality of life in multiple sclerosis
Berrigan, L. I., Fisk, J. D., Patten, S. B., Tremlett, H. L., Wolfson, C. M., Warren, S., Fiest, K. M., McKay, K. A., Marrie, R. A., For the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS), et al. (2016) · Neurology · doi:10.1212/wnl.0000000000002564 · Cited by 236
“7% for generalized anxiety disorder.(16) Fatigue was operationalized as the continuous total score on the Fatigue Impact Scale for Daily Use, a validated 8-item instrument.”
BackgroundMethodInfluentialOutcome Measures in Clinical Trials for Multiple Sclerosis
van Munster, C. E. P., & Uitdehaag, B. M. J. (2017) · CNS Drugs · doi:10.1007/s40263-017-0412-5 · Cited by 202
“Hospital Anxiety and Depression Scale [94]”
Jones, K. H., Ford, D. V., Jones, P. A., John, A., Middleton, R. M., Lockhart-Jones, H., Osborne, L. A., & Noble, J. G. (2012) · PLoS ONE · doi:10.1371/journal.pone.0041910 · Cited by 190
Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art
Silveira, C., Guedes, R., Maia, D., Curral, R., & Coelho, R. C. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.0106 · Cited by 181
Neuropsychiatric syndromes of multiple sclerosis
Murphy, R., O’Donoghue, S., Counihan, T. J., McDonald, C., Calabresi, P. A., Ahmed, M. A., Kaplin, A. I., & Hallahan, B. P. (2017) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2016-315367 · Cited by 182
Ensari, I., Motl, R. W., & Pilutti, L. A. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.03.014 · Cited by 182
“We further performed post-hoc, exploratory moderator analyses based on the categorical variables of depressive symptom category (defined as none/mild or moderate based on the cut-off score for moderate depression per scale, [23–25,27–30]) and scale (i.”
MethodMarrie, R. A., Zhang, L., Lix, L. M., Graff, L. A., Walker, J. R., Fisk, J. D., Patten, S. B., Hitchon, C. A., Bolton, J. M., Sareen, J., et al. (2018) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2017.12.007 · Cited by 169
“In prior studies that evaluated the HADS-A (Honarmand and Feinstein, 2009; Watson et al., 2014), sensitivities for the cut-point of 11 ranged from 43.”
InfluentialRooney, S., Wood, L., Moffat, F., & Paul, L. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.01.011 · Cited by 152
“The validity of the HADS has been demonstrated in MS populations [46].”
BackgroundPsychometric properties and validity of Beck Depression Inventory II in multiple sclerosis
Sacco, R., Santangelo, G., Stamenova, S., Bisecco, A., Bonavita, S., Lavorgna, L., Trojano, L., d’Ambrosio, A., Tedeschi, G., & Gallo, A. (2016) · European Journal of Neurology · doi:10.1111/ene.12932 · Cited by 140
“The Hospital Anxiety and Depression Scale has been validated in MS patients and has high criterion-related validity for depression and anxiety, but its depression score is strongly associated with fatigue [18].”
MethodComorbidity increases the risk of relapse in multiple sclerosis
Kowalec, K., McKay, K. A., Patten, S. B., Fisk, J. D., Evans, C. D., Tremlett, H. L., Marrie, R. A., For the CIHR Team in Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS), CIHR Team in Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS), Blanchard, J., et al. (2017) · Neurology · doi:10.1212/wnl.0000000000004716 · Cited by 130
“Among people with MS recruited through social media who responded to an online questionnaire, those who had 3 or more comorbidities had 2-fold increased odds of reporting a relapse as compared to those reporting no comorbidities.9 Hyperlipidemia was not associated with MS relapse risk in 2 Australian studies,10,11 but…”
BackgroundInfluentialAnxiety and depression in multiple sclerosis patients around diagnosis
Giordano, A., Granella, F., Lugaresi, A., Martinelli, V., Trojano, M., Confalonieri, P., Radice, D., & Solari, A. (2011) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2011.05.008 · Cited by 123
“These characteristics together with brevity and ease of administration explain the wide use of HADS in MS, giving rise to the advantage that anxiety and depressive symptoms can be compared in diverse MS populations and settings [7,10,12,13,18,20,28].”
BackgroundImpaired social cognition in multiple sclerosis
Pöttgen, J., Dziobek, I., Reh, S., Heesen, C., & Gold, S. M. (2013) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2012-304157 · Cited by 128
Honarmand, K., Akbar, N., Kou, N., & Feinstein, A. (2010) · Journal of Neurology · doi:10.1007/s00415-010-5736-8 · Cited by 117
“patients [18].”
Self-citationComorbid anxiety, depression, and cognition in MS and other immune-mediated disorders
Whitehouse, C. E., Fisk, J. D., Bernstein, C. N., Berrigan, L. I., Bolton, J. M., Graff, L. A., Hitchon, C. A., Marriott, J. J., Peschken, C. A., Sareen, J., et al. (2019) · Neurology · doi:10.1212/wnl.0000000000006854 · Cited by 112
Validation of Mood Measures for People with Multiple Sclerosis
Watson, T. M., Ford, E., Worthington, E. J., & Lincoln, N. B. (2014) · International Journal of MS Care · doi:10.7224/1537-2073.2013-013 · Cited by 112
Effects of cannabis on cognitive function in patients with multiple sclerosis
Honarmand, K., Tierney, M. C., O'Connor, P. W., & Feinstein, A. (2011) · Neurology · doi:10.1212/wnl.0b013e318212ab0c · Cited by 101
“The presence of lifetime psychiatric disorders was established using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Mood and Anxiety Disorder sections.12 In addition, all subjects completed the Hospital Anxiety and Depression Scale (HADS), validated for use with patients with MS.13 Fatigue was…”
MethodInfluentialSelf-citationPowell, D. J. H., Liossi, C., Schlotz, W., & Moss-Morris, R. (2017) · Journal of Behavioral Medicine · doi:10.1007/s10865-017-9840-4 · Cited by 99
“Covariates Participants completed the 7-item depression subscale from the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) which has been shown to be a valid measure for depression in MS (Honarmand & Feinstein, 2009).”
MethodHenry, A., Tourbah, A., Camus, G., Deschamps, R., Mailhan, L., Castex, C., Gout, O., & Montreuil, M. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2018.09.039 · Cited by 95
Hughes, A. J., Dunn, K. M., Chaffee, T., Bhattarai, J., & Beier, M. L. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2018.05.029 · Cited by 98
“Recent efforts have been made to validate similar tools for the assessment of anxiety symptoms in MS, including the 7-item anxiety subscale from the Hospital Anxiety and Depression Scale (HADS) and the 7-item Generalized Anxiety Disorder Scale (GAD-7).(16,17) The HADS anxiety subscale and the GAD-7 exhibit good to exc…”
An introduction to Rasch analysis for Psychiatric practice and research
da Rocha, N. S., Chachamovich, E., Fleck, M. P. D. A., & Tennant, A. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.09.014 · Cited by 100
Validity of four screening scales for major depression in MS
Patten, S. B., Burton, J., Fiest, K. M., Wiebe, S., Bulloch, A. G., Koch, M. W., Dobson, K. S., Metz, L. M., Maxwell, C. J., & Jetté, N. (2015) · Multiple Sclerosis Journal · doi:10.1177/1352458514559297 · Cited by 88
“Eligibility criteria for this study were: (1) age 18 or older; (2) residence in the province of Alberta; (2) being able to speak and read English; (3) having no severe hearing impairment; and (4) an absence of neurologistdiagnosed dementia, severe developmental delay or aphasia.”
BackgroundΣκώκου, Μ., Soubasi, E., & Gourzis, P. (2012) · ISRN Neurology · doi:10.5402/2012/427102 · Cited by 87
“The Hospital Anxiety and Depression Scale [41] is a selfassessed questionnaire consisting of 14 items, suitable for use in persons with medical conditions, if items corresponding to somatic symptoms are omitted [42], and recently validated for people with multiple sclerosis [43].”
Kierkegaard, M., Lundberg, I. E., Olsson, T. P., Johansson, S., Ygberg, S. E., Opava, C. H., Holmqvist, L. W., & Piehl, F. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.01.063 · Cited by 89
“A score of eight or greater in MS patients indicates a generalized anxiety disorder or depression, respectively [19].”
BackgroundMethodMultiple sclerosis relapses and depression
Moore, P., Hirst, C., Harding, K. E., Clarkson, H., Pickersgill, T. P., & Robertson, N. P. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.08.004 · Cited by 80
“The depression subscale has been found to be a sensitive case finder for depression in MS patients; however the anxiety subscale has been shown to be less sensitive in the detection of anxiety disorders [24].”
Kallaur, A. P., Lopes, J. M., Oliveira, S. R., Simão, A. N. C., Reiche, E. M. V., de Almeida, E. R. D., Morimoto, H. K., de Pereira, W. L. C. J., Alfieri, D. F., Borelli, S. D., et al. (2015) · Molecular Neurobiology · doi:10.1007/s12035-015-9443-4 · Cited by 82
Terrill, A. L., Hartoonian, N., Beier, M. L., Salem, R., & Alschuler, K. N. (2014) · International Journal of MS Care · doi:10.7224/1537-2073.2014-008 · Cited by 84
da Silva, A. M., Vilhena, E., Lopes, A., Santos, E., Gonçalves, M. A., Pinto, C., Moreira, I., Mendonça, D., & Cavaco, S. (2011) · Journal of Neurological Sciences · doi:10.1016/j.jns.2011.03.042 · Cited by 86
“These limitations may result in an overestimation of anxiety and depression [15].”
Papapetropoulos, S., Pontius, A., Finger, E. C., Karrenbauer, V. D., Lynch, D. S., Brennan, M. J., Zappia, S., Koehler, W., Schöls, L. J., Hayer, S. N., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2021.788168 · Cited by 80
“Hospital, anxiety, depression scale (HADS) is a useful self-assessment scale for anxiety and depression and a screening tool for mood disorders (140).”
MethodOne is the loneliest number: Involuntary celibacy (incel), mental health, and loneliness
Sparks, B., Zidenberg, A. M., & Olver, M. E. (2023) · Current Psychology · doi:10.1007/s12144-023-04275-z · Cited by 85
Campbell, J. L., Langdon, D. W., Cercignani, M., & Rashid, W. (2016) · Neural Plasticity · doi:10.1155/2016/4292585 · Cited by 88
“Although devised as a generic scale it has been validated in MS [481] showing a high degree of specificity and sensitivity [226].”
BackgroundMethodCognitive Impairment in Multiple Sclerosis: An Update on Assessment and Management
Portaccio, E., & Amato, M. P. (2022) · NeuroSci · doi:10.3390/neurosci3040048 · Cited by 79
Morrow, S. A., Rosehart, H., & Pantazopoulos, K. (2015) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.15070167 · Cited by 81
Psychiatric disorders in multiple sclerosis
Sparaco, M., Lavorgna, L., & Bonavita, S. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09426-6 · Cited by 79
Factors affecting anxiety in multiple sclerosis
Garfield, A., & Lincoln, N. (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.667503 · Cited by 83
“A HADS subscale score of eight or more was used to classify a clinically significant level of depression or anxiety [32].”
BackgroundMethodInfluentialDisability identity predicts lower anxiety and depression in multiple sclerosis.
Bogart, K. R. (2015) · Rehabilitation Psychology · doi:10.1037/rep0000029 · Cited by 90
“Future studies should examine the intersection of disability identity and other minority statuses.”
BackgroundThe hospital anxiety and depression scale, in patients with multiple sclerosis
Ribeiro, J. L. P., SILVA, A. C. F. D., Vilhena, E., Moreira, I. C., Santos, E., & Mendonça, D. M. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s184260 · Cited by 72
“Because anxiety and depression seem to be common in people with MS, 17 it seems appropriate to screen for possible mood elevation in these patients.”
InfluentialThe emotional impact of the COVID-19 pandemic on individuals with progressive multiple sclerosis
Chiaravalloti, N. D., Amato, M. P., Brichetto, G., Chataway, J., Dalgas, U., DeLuca, J., Meza, C., Moore, N. B., Feys, P., Filippi, M., et al. (2020) · Journal of Neurology · doi:10.1007/s00415-020-10160-7 · Cited by 71
Self-citationFatigue at time of CIS is an independent predictor of a subsequent diagnosis of multiple sclerosis
Runia, T. F., Jafari, N., Siepman, D. A. M., & Hintzen, R. Q. (2015) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2014-308374 · Cited by 70
Contribution of symptom clusters to multiple sclerosis consequences
Shahrbanian, S., Duquette, P., Kuspinar, A., & Mayo, N. E. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0804-7 · Cited by 70
Jones, K. H., Jones, P. A., Middleton, R. M., Ford, D. V., Tuite-Dalton, K., Lockhart-Jones, H., Peng, J., Lyons, R. A., John, A., & Noble, J. G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104604 · Cited by 69
“The HADS has been validated for use with people who have MS [33].”
MethodAnxiety, emotional processing and depression in people with multiple sclerosis
Gay, M., Bungener, C., Thomas, S., Vrignaud, P., Thomas, P., Baker, R. D., Montel, S., Heinzlef, O., Papeix, C., Assouad, R., et al. (2017) · BMC Neurology · doi:10.1186/s12883-017-0803-8 · Cited by 75
“79) compared to a healthy French adult reference population (N = 948) [30].”
BackgroundSpasticity in multiple sclerosis: Associations with impairments and overall quality of life
Milinis, K., Tennant, A., & Young, C. A. (2015) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2015.10.007 · Cited by 67
“HADS consists of anxiety and depression subscales, each containing 7 items and has been previously validated in MS (Honarmand and Feinstein, 2009).”
MethodThe prevalence of anxiety and associated factors in persons with multiple sclerosis
Pham, T., Jetté, N., Bulloch, A. G. M., Burton, J. M., Wiebe, S., & Patten, S. B. (2018) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2017.11.003 · Cited by 64
Effects of cannabis on cognition in patients with MS
Pavisian, B., MacIntosh, B. J., Szilagyi, G., Staines, R. W., O'Connor, P. W., & Feinstein, A. (2014) · Neurology · doi:10.1212/wnl.0000000000000446 · Cited by 66
Self-citationMarrie, R. A., Patten, S. B., Berrigan, L. I., Tremlett, H. L., Wolfson, C. M., Warren, S., Leung, S., Fiest, K. M., McKay, K. A., Fisk, J. D., et al. (2017) · International Journal of MS Care · doi:10.7224/1537-2073.2016-110 · Cited by 65
Self-assessment of Cognition in Multiple Sclerosis
Akbar, N., Honarmand, K., & Feinstein, A. (2011) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0b013e31822a20ae · Cited by 64
“Depression and anxiety were measured in the office using the HADS that has been validated for use in MS patients.(26) Scores Z8 on each subscale signify clinically significant depression and anxiety.”
MethodSelf-citationKnippenberg, S. A. M., Damoiseaux, J. G. M. C., Bol, Y., Hupperts, R., Taylor, B. V., Ponsonby, A., Dwyer, T., Simpson, S., & van der Mei, I. A. F. (2013) · Acta Neurologica Scandinavica · doi:10.1111/ane.12155 · Cited by 64
“HADS is designed to screen physically ill patients (25), and reliability and validity have been demonstrated in MS (26).”
BackgroundAnxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory
Santangelo, G., Sacco, R., Siciliano, M., Bisecco, A., Muzzo, G., Docimo, R., Stefano, M. D., Bonavita, S., Lavorgna, L., Tedeschi, G., et al. (2016) · Acta Neurologica Scandinavica · doi:10.1111/ane.12564 · Cited by 66
“Honarmand and Feinstein (12) assessed the Hospital Anxiety and Depression Scale (HADS) in MS against the Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria, and provided a cut-off score for identification of generalized anxiety disorder.”
MethodBol, Y., Duits, A., Lousberg, R. L., Hupperts, R., Lacroix, M. H. P., Verhey, F. R. J., & Vlaeyen, J. W. S. (2010) · Journal of Behavioral Medicine · doi:10.1007/s10865-010-9266-8 · Cited by 69
“Reliability and validity are adequate for several clinical populations, including MS (Bjelland et al. 2002; Honarmand and Feinstein 2009; Spinhoven et al. 1997).”
BackgroundKahraman, T., Savcı, S., Özdoğar, A. T., Gedik, Z., & İdıman, E. (2019) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x18822355 · Cited by 62
Burns, M. N., Nawacki, E., Kwasny, M., Pelletier, D., & Mohr, D. C. (2013) · Psychological Medicine · doi:10.1017/s0033291713000755 · Cited by 60
“…or a cytotoxic drug; (4) non-MS autoimmune or endocrine disorder; (5) inability to undergo MRI procedures; (6) pregnancy or intention to become pregnant; (7) severe psychiatric condition; (8) current psychotherapy or intention to pursue psychotherapy; and (9) dementia (Mohr et al. 2012).”
BackgroundMethodFatigue and Comorbidities in Multiple Sclerosis
Fiest, K. M., Fisk, J. D., Patten, S. B., Tremlett, H. L., Wolfson, C. M., Warren, S., McKay, K. A., Berrigan, L. I., Marrie, R. A., & for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS) (2016) · International Journal of MS Care · doi:10.7224/1537-2073.2015-070 · Cited by 63
Brassington, L., Ferreira, N. B., Yates, S., Fearn, J., Lanza, P., Kemp, K., & Gillanders, D. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.09.001 · Cited by 59
“This measure, originally designed for medical outpatients, has been validated for use with a number of chronic health problems, including coronary heart disease (Stafford et al., 2007), myocardial infarction and stroke (Johnston et al., 2000) and multiple sclerosis (Honarmand & Feinstein, 2009).”
BackgroundExploration of Undertreatment and Patterns of Treatment of Depression in Multiple Sclerosis
Raissi, A., Bulloch, A. G. M., Fiest, K. M., McDonald, K. C., Jetté, N., & Patten, S. B. (2015) · International Journal of MS Care · doi:10.7224/1537-2073.2014-084 · Cited by 60
Vitamin D 3 supplementation in multiple sclerosis: Symptoms and biomarkers of depression
Rolf, L., Muris, A., Bol, Y., Damoiseaux, J. G. M. C., Smolders, J., & Hupperts, R. (2017) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2017.04.017 · Cited by 61
Hoogerwerf, A., Bol, Y., Lobbestael, J., Hupperts, R., & Heugten, C. (2017) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2237 · Cited by 58
Carletto, S., Borghi, M., Bertino, G., Oliva, F., Cavallo, M., Hofmann, A., Zennaro, A., Malucchi, S., & Ostacoli, L. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00526 · Cited by 68
Nguyen, C., Ranque, B., Baubet, T., BEREZNE, A., Mestre-Stanislas, C., Rannou, F., Papelard, A., Morell‐Dubois, S., Revel, M., Moro, M. R., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090484 · Cited by 57
“9% were free of both clinically significant symptoms of anxiety and of depression, using the easy to use selfrated psychiatric questionnaire HAD with a cut-off of 8 [15,44].”
MethodMcKay, K. A., Tremlett, H. L., Patten, S. B., Fisk, J. D., Evans, C. D., Fiest, K. M., Campbell, T. L., Marrie, R. A., & for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS) (2016) · Multiple Sclerosis Journal · doi:10.1177/1352458516657440 · Cited by 59
Cognitive and neuropsychiatric disease manifestations in MS.
Feinstein, A., DeLuca, J., Baune, B., Filippi, M., & Lassman, H. (2013) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2012.08.001 · Cited by 68
“Two of these self report instruments have been validated for use with MS patients, namely the Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983;Honarmand and Feinstein, 2009) and the Beck Fast Screen (Beck et al., 2007; Benedict et al., 2003).”
MethodSelf-citationNguyen, C., BEREZNE, A., Baubet, T., Mestre-Stanislas, C., Rannou, F., Papelard, A., Morell‐Dubois, S., Revel, M., Guillevin, L., Poiraudeau, S., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0017551 · Cited by 55
“The definition of clinical anxiety and/or depression was based on the HADS score cutoff $8 found to be relevant in patients with autoimmune diseases [36].”
MethodFatigue, Depression, and Anxiety Among Ambulating Multiple Sclerosis Patients
AlSaeed, S., Aljouee, T., Alkhawajah, N. M., Alarieh, R., AlGarni, H., Aljarallah, S., Ayyash, M., & Abu-Shaheen, A. K. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.844461 · Cited by 52
“Nevertheless, the instruments exhibited robust psychometric characteristics that have been applied across a wide range of studies (14, 29, 33, 35, 61, 62).”
BackgroundDiGiuseppe, G., Blair, M., & Morrow, S. A. (2017) · International Journal of MS Care · doi:10.7224/1537-2073.2017-029 · Cited by 50
In multiple sclerosis anxiety, not depression, is related to gender
Théaudin, M., Romero, K., & Feinstein, A. (2016) · Multiple Sclerosis · doi:10.1177/1352458515588582 · Cited by 46
Self-citationFatigue and heat sensitivity in patients with multiple sclerosis
Bol, Y., Smolders, J., Duits, A., Lange, I., Romberg-Camps, M. J. L., & Hupperts, R. (2012) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2012.01660.x · Cited by 47
“Reliability and validity have been proven good (26, 27).”
BackgroundHung, C., Liu, C., Wang, S., Yao, Y.-C., & Yang, C. (2011) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2011.617456 · Cited by 47
van der Hiele, K., Kamminga, N. G. A., Ruimschotel, R. P., Middelkoop, H. A. M., & Visser, L. H. (2011) · European Journal of Neurology · doi:10.1111/j.1468-1331.2011.03538.x · Cited by 47
“The HADS provides valid markers of major depression and generalized anxiety disorder in MS [23].”
BackgroundPredictors of anxiety in multiple sclerosis.
Hartoonian, N., Terrill, A. L., Beier, M. L., Turner, A. P., Day, M. A., & Alschuler, K. N. (2014) · Rehabilitation Psychology · doi:10.1037/rep0000019 · Cited by 47
“The HADS-A has been validated for use in identifying anxiety in individuals with MS (Honarmand & Feinstein, 2009).”
Gill, S., Santo, J., Blair, M., & Morrow, S. A. (2019) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/appi.neuropsych.18010011 · Cited by 46
Bove, R. M., Rush, G. Q., Zhao, C., Rowles, W. M., Garcha, P., Morrissey, J., Schembri, A. J., Alailima, T., Langdon, D. W., Possin, K. L., et al. (2018) · Neurology and Therapy · doi:10.1007/s40120-018-0121-0 · Cited by 44
Self-citationPatient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations
Piccolo, L. D., Pietrolongo, E., Radice, D., Tortorella, C., Confalonieri, P. A., Pugliatti, M., Lugaresi, A., Giordano, A., Heesen, C., Solari, A., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0127734 · Cited by 44
“HADS is widely-used in MS patients, and cutoff scores of 8 or above are considered an accurate indicator of major depression (HADS-D) or generalized anxiety disorder (HADS-A) in this population [28].”
MethodPloughman, M., Beaulieu, S., Harris, C. A., Hogan, S., Manning, O. J., Allderdice, P. W., Fisk, J. D., Sadovnick, A. D., O'Connor, P. W., Morrow, S. A., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005718 · Cited by 43
“The Hospital Anxiety and Depression Scale (HADS) is a selfassessment scale found to reliably screen for depression and anxiety in patients with MS.(27) It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) each containing 7 intermingled items scored of 21; higher score indicating greater s…”
BackgroundMethodAnxiety in multiple sclerosis is related to depressive symptoms and cognitive complaints
Wallis, O. C., Bol, Y., Köhler, S., & Heugten, C. M. V. (2019) · Acta Neurologica Scandinavica · doi:10.1111/ane.13191 · Cited by 43
The impact of resilience on healthy aging with multiple sclerosis
Ploughman, M., Downer, M. B., Pretty, R. W., Wallack, E. M., Amirkhanian, S., & Kirkland, M. C. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02521-6 · Cited by 47
“Participants’ reported levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), a selfassessment screening tool found to reliably screen for anxiety and depression in MS [48].”
MethodMcKay, K. A., Tremlett, H. L., Fisk, J. D., Patten, S. B., Fiest, K. M., Berrigan, L. I., Marrie, R. A., & for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS) (2015) · Multiple Sclerosis Journal · doi:10.1177/1352458515599073 · Cited by 42
Revisiting cognitive reserve and cognition in multiple sclerosis: A closer look at depression
Patel, V., Walker, L. A. S., & Feinstein, A. (2017) · Multiple Sclerosis Journal · doi:10.1177/1352458517692887 · Cited by 42
Self-citationMultiple sclerosis, cannabis, and cognition: A structural MRI study
Romero, K., Pavisian, B., Staines, R. W., & Feinstein, A. (2015) · NeuroImage Clinical · doi:10.1016/j.nicl.2015.04.006 · Cited by 41
“Mood and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) (Zigmond and Snaith, 1983), using a cut-off score of 8 or greater to denote clinically significant anxiety or depression, respectively (Honarmand and Feinstein, 2009).”
MethodSelf-citationCard, K. G., Lachowsky, N. J., Armstrong, H. L., Cui, Z., Wang, L., Sereda, P., Jollimore, J., Patterson, T. L., Corneil, T., Hogg, R. S., et al. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.03.005 · Cited by 40
Diagnostic accuracy for major depression in multiple sclerosis using self‐report questionnaires
Fischer, A., Fischer, M. M., Nicholls, R. A., Lau, S., Poettgen, J., Patas, K., Heesen, C., & Gold, S. M. (2015) · Brain and Behavior · doi:10.1002/brb3.365 · Cited by 41
Terluin, B., Oosterbaan, D. B., Brouwers, E. P. M., van Straten, A., van de Ven, P. M., Langerak, W., & van Marwijk, H. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-121 · Cited by 40
“, social phobia) [13-15].”
Hasselmann, H., Bellmann–Strobl, J., Ricken, R., Oberwahrenbrock, T., Rose, M., Otte, C., Adli, M., Paul, F., Brandt, A. U., Finke, C., et al. (2016) · Multiple Sclerosis Journal · doi:10.1177/1352458515622826 · Cited by 41
Predominant cognitive phenotypes in multiple sclerosis: Insights from patient-centered outcomes
Podda, J., Ponzio, M., Pedullà, L., Bragadin, M. M., Battaglia, M. A., Zaratin, P., Brichetto, G., & Tacchino, A. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.102919 · Cited by 39
Home-based exercise training influences gut bacterial levels in multiple sclerosis
Mokhtarzade, M., Shamsi, M. M., Abolhasani, M., Bakhshi, B., Sahraian, M. A., Quinn, L. S., & Negaresh, R. (2021) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2021.101463 · Cited by 38
Screening Tools for Anxiety in People with Multiple Sclerosis
Litster, B., Fiest, K. M., Patten, S. B., Fisk, J. D., Walker, J. R., Graff, L. A., Bolton, J. M., Sareen, J., Marriott, J. J., Berrigan, L. I., et al. (2016) · International Journal of MS Care · doi:10.7224/1537-2073.2016-004 · Cited by 42
Explaining fatigue in multiple sclerosis: cross-validation of a biopsychosocial model
Wijenberg, M., Stapert, S. Z., Köhler, S., & Bol, Y. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9749-3 · Cited by 40
“Depression was assessed with the subscale depression of the Hospital Anxiety and Depression Scale (HADS) (Zig-mond & Snaith, 1983), a valid and reliable screening instrument for patients with MS (Honarmand & Feinstein, 2009).”
Hind, D., Kaklamanou, D., Beever, D., Webster, R., Lee, E. C., Barkham, M., & Cooper, C. L. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0931-5 · Cited by 41
“The median of the mean ages of people with MS reported in 18 out of 21 studies (Appendix 3, data missing from three studies [34, 42, 45]) was 45.”
InfluentialMyotonic dystrophy - the burden for patients and their partners
Timman, R., Tibben, A., & Wintzen, A. (2010) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0598 · Cited by 37
Alcohol and substance use in multiple sclerosis
Beier, M. L., D’Orio, V. L., Spat‐Lemus, J., Shuman, M. A., & Foley, F. W. (2014) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.12.029 · Cited by 36
Oliveira, S. R., Kallaur, A. P., Lopes, J. M., Simão, A. N. C., Reiche, E. M. V., de Almeida, E. R. D., Morimoto, H. K., Pereira, W. L. D. C. J., Alfieri, D. F., Flauzino, T., et al. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.039 · Cited by 37
Rosso, A. D., Mikhaylova, S., Baccini, M., Lupi, I., Matucci‐Cerinic, M., & Bongi, S. M. (2013) · BioMed Research International · doi:10.1155/2013/507493 · Cited by 36
Current perspectives on the diagnosis and management of fatigue in multiple sclerosis
Marchesi, O., Vizzino, C., Filippi, M., & Rocca, M. A. (2022) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2022.2106854 · Cited by 41
“to the patient for a rapid detection of depression or anxiety symptoms, such as the Beck Depression Inventory-II [80] and the Hospital Anxiety and Depression Scale [81].”
MethodBuilding a monitoring matrix for the management of multiple sclerosis
Voigt, I., Inojosa, H., Wenk, J., Akgün, K., & Ziemssen, T. (2023) · Autoimmunity Reviews · doi:10.1016/j.autrev.2023.103358 · Cited by 40
Loneliness in Multiple Sclerosis: Possible Antecedents and Correlates
Balto, J. M., Pilutti, L. A., & Motl, R. W. (2018) · Rehabilitation Nursing · doi:10.1097/rnj.0000000000000128 · Cited by 34
Pilutti, L. A., & Motl, R. W. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.01.009 · Cited by 34
Ploughman, M., Wallack, E. M., Chatterjee, T., Kirkland, M. C., & Curtis, M. E. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.101919 · Cited by 35
Mind wandering in anxiety disorders: A status report
Fell, J., Chaieb, L., & Hoppe, C. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105432 · Cited by 48
“Anxiety and depression symptoms were assessed using the two subscales of the Hospital Anxiety and Depression Scale (HADS-A, HADS-D; Honarmand and Feinstein, 2009).”
Metadata
- Authors
- Honarmand, K., & Feinstein, A.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Venue
- Multiple Sclerosis Journal
- Publisher
- SAGE Publications
- Published
- 2009-11-13
- Volume
- 15
- Issue
- 12
- Pages
- 1518-1524
- ISSN
- 1352-4585 (ISSN-L)
- 1477-0970
- OpenAlex
- W2114728329
- Cited by
- 436
- References
- 43
- Citations by year
- 2026: 23 · 2025: 32 · 2024: 36 · 2023: 31 · 2022: 34 · 2021: 43 · 2020: 23 · 2019: 27 · 2018: 34 · 2017: 26 · 2016: 32 · 2015: 26 · 2014: 23 · 2013: 12 · 2012: 15
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Multiple Sclerosis Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Multiple Sclerosis Society
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- Hospital Anxiety and Depression Scale, multiple sclerosis, depression, anxiety disorders, generalized anxiety disorder, psychometric validation, cut-off values, sensitivity and specificity, self-report scale
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Predictive Value of Tests, Psychiatric Status Rating Scales, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Logistic Models, Young Adult
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