Cited by 436Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMultiple Sclerosis Research StudiesCancer survivorship and care

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Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients

Honarmand, Kimia, Feinstein, Anthony·2009·Multiple Sclerosis Journal

DOI 10.1177/1352458509347150

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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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“Concerning the Structured Clinical Interview for DSM-IV diagnosing MDD, the HADS has a sensitivity of 90% and a specificity of 87.3% with a score of 8 or higher on the depression subscale (Honarmand and Feinstein 2009).”
BackgroundMethodInfluential
Peer support impact on therapeutic adherence in patients with multiple sclerosis: a mixed-methods pilot trial protocol
Guilmault, L., Wiertlewski, S., Malloggi, L., Rousseau, C., Jacq-Foucher, M., Leclère, B., & Moret, L. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-071336 · Cited by 2
Psychosocial Factors are Associated With Walking-Related Goal Attainment in Multiple Sclerosis: A Preliminary Study
Gomes, K. E., Riegler, K. E., DelMastro, H. M., Turner, A. P., Neto, L. O., & Gromisch, E. S. (2025) · International Journal of MS Care · doi:10.7224/1537-2073.2024-045 · Cited by 1
Seizure history and cognitive dysfunction in people with multiple sclerosis
Freedman, D., Oh, J., Meza, C., & Feinstein, A. (2025) · Multiple Sclerosis Journal · doi:10.1177/13524585251326841 · Cited by 2
“28 Symptoms of anxiety and depression were recorded by the Hospital Anxiety and Depression Scale, 29 previously validated for use in pwMS. 30 We mean-cen-tred HADS-A and HADS-D sub-scales and multiplied these scores to compute an interaction score (HADS-A × HADS-D), in keeping with prior work.”
Self-citation
COVID-19 related knowledge, anxiety, depression and physical activity among Iranian people with relapsing-remitting multiple sclerosis during COVID-19 pandemic: an online cross-sectional survey
ShahAli, S., Choobsaz, H., & Takamjani, I. E. (2021) · European Journal of Physiotherapy · doi:10.1080/21679169.2021.1958055 · Cited by 1
A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol
Coote, S. B., Gallagher, S., Msetfi, R. M., Larkin, A., Newell, J., Motl, R. W., & Hayes, S. (2014) · BMC Neurology · doi:10.1186/s12883-014-0241-9 · Cited by 1
“The HADS has been validated among people with MS, demonstrating acceptable sensitivity (90% and 89% for the depression subscale) and specificity (87% and 81% for the anxiety subscale) [44].”
Method
Positive Mental Training in patients with Multiple Sclerosis experiencing psychological distress: A Preliminary Randomised Controlled TrialPreprint
Murray, K., Melchiorre, G., Dobbin, A., & Welch, K. A. (2021) · medRxiv · doi:10.1101/2021.07.15.21260604 · Cited by 1
Vitamin D and Multiple Sclerosis : immunological and clinical outcome
Knippenberg, S. A. M. (2013) · Research Publications (Maastricht University) · doi:10.26481/dis.20130328sk · Cited by 1
The Effect of Nurse Practitioner (NP-led) Care on Health-Related Quality of Life in People with Multiple Sclerosis - A Randomized TrialPreprint
Smyth, P. S., Watson, K. E., Hamarneh, Y. N. A., & Tsuyuki, R. T. (2022) · Research Square · doi:10.21203/rs.3.rs-1386216/v1 · Cited by 1
Psychological and Behavioral Therapies in Multiple Sclerosis
Arnett, P. A., Ukueberuwa, D. M., & Cadden, M. H. (2015) · Neuropsychiatric symptoms of neurological disease · doi:10.1007/978-3-319-18464-7_12 · Cited by 1
Prédiction d'une atteinte cognitive dans la sclérose en plaques : à qui se fier ?
Grosset-Janin, D. (2014) · HAL
Therapeutic exercise for those moderately affected with Multiple Sclerosis
Learmonth, Y. C. (2012) · Enlighten: Theses (The University of Glasgow)
Incidence of Anxiety in Patients with Multiple Sclerosis (MS)
Green, R. R., Kalina, J. T., & Pandey, K. S. (2015) · Journal of Intellectual Disability - Diagnosis and Treatment · doi:10.6000/2292-2598.2015.03.02.6
“In MS populations, depression is prevalent in approximately 50% of the MS population [2], and often may occur with anxiety [6, 9-10].”
BackgroundMethod
Response: relationship between vitamin D and depression in multiple sclerosis
Knippenberg, S. A. M., Bol, Y., Smolders, J., Hupperts, R., & Damoiseaux, J. G. M. C. (2012) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2011.01640.x
“In addition, the HADS is validated in MS patients (6).”
I disturbi dell’umore
Siracusano, A., Niolu, C., Sacchetti, L., & Ribolsi, M. (2011) · Springer eBooks · doi:10.1007/978-88-470-1711-5_4
Facteurs influençant les symptômes d’anxiété et de dépression chez les sujets atteints de sclérodermie systémique : à propos d’une étude transversale
Nguyen, C., BEREZNE, A., Baubet, T., Mestre-Stanislas, C., Rannou, F., Papelard, A., Revel, M., Moro, M. R., Guillevin, L., Poiraudeau, S., et al. (2010) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2010.03.438
For peer review only The Canadian Survey of Health, Lifestyle and Aging with Multiple Sclerosis; Methodology and Initial Results
Beaulieu, S., Hogan, S., Fisk, J. D., O'Connor, P. W., Metz, L. M., Marrie, R. A., Knox, K. B., & Stefanelli, M. (2014)
Depression in multiple sclerosis
Kaplin, A. I., & Stagg, R. E. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9781139023986.062
Cognition, disease activity and MRI changes in early multiple sclerosis
Nygaard, G. O. (2016) · NORA - Norwegian Open Research Archives
The Association of Pathological Laughing and Crying and Cognitive Impairment in Multiple Sclerosis (P2.176)
Hanna, J., Feinstein, A., & Morrow, S. A. (2016) · Neurology · doi:10.1212/wnl.86.16_supplement.p2.176
Self-citation
The effects of resilience and disability on participation and health-related quality of life among older Canadians with multiple sclerosis
Amirkhanian, S. (2015) · Memorial University Research Repository (Memorial University)
Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: A Terror Management Perspective
Siegel, J. D. (2015) · ScholarWorks (Walden University)
Validation of an Internet-based Approach to Cognitive Screening in Multiple Sclerosis
Akbar, N. (2011) · TSpace (University of Toronto)
ASSESSMENT OF MOOD MEASURES FOR PEOPLE WITH MULTIPLE SCLERSOIS
Hopkins, T. M. (2011)
Using Computers to Assess Cognition in MS: Improving Tried and Tested Indices to Capture Real World Challenges
Patel, V. (2016) · TSpace (University of Toronto)
Detecting Cognitive Dysfunction in Multiple Sclerosis: Assessing the Validity of a Computer Generated Battery
Lapshin, Y. (2013) · TSpace (University of Toronto)
The Role of Metacognition in Emotional Distress in People with Multiple Sclerosis
Heffer-Rahn, P. (2017) · University of Liverpool · doi:10.17638/03009731
The effect of spaced presentation of treatment information on recall and understanding of risk relating to medication in Multiple Sclerosis
Burns, M. (2015)
Models for Assessing Anxiety and Depression in Multiple Sclerosis: from Mouse to Man
Ellwardt, E., & Luchtman, D. W. (2021) · Neuromethods · doi:10.1007/978-1-0716-1213-2_13
Exploring the fear-avoidance model after brain injury
Wijenberg, M. (2021) · Research Publications (Maastricht University) · doi:10.26481/dis.20210705mw
Effects of the Coronavirus Disease-2019 Pandemic on Physical Activity Level, Depression, and Anxiety in Persons with Multiple Sclerosis
Özdoğar, A. T., Yiğit, P., Abasıyanık, Z., Daştan, S., Hançer, P., Sağıcı, Ö., Baba, C., & Özakbaş, S. (2021) · Journal of Multiple Sclerosis Research · doi:10.4274/jmsr.galenos.2021.2021.8-1
What has changed in patients with multiple sclerosis after the pandemic? Fatigue, Physical Activity, Sleep Quality, and Anxiety Levels
Ünlüer, N. Ö., Özkan, T., Ateş, Y., & Yaşa, M. E. (2021) · Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.21020/husbfd.884214
Anxiété et dépression dans la sclérose en plaques : à propos de 100 patients tunisiens
Damak, M., Nsir, S. B., Turki, E., Bouchhima, I., Miladi, M. I., & Mhiri, C. (2014) · L information psychiatrique · doi:10.3917/inpsy.9005.0381
Measuring the Effects of Nurse-Practitioner (NP)-Led Care on Depression and Anxiety Levels in People with Multiple Sclerosis: A Study Protocol for a Randomized Controlled TrialPreprint
Smyth, P. S., Watson, K. E., & Tsuyuki, R. T. (2021) · Research Square · doi:10.21203/rs.3.rs-537085/v1
EEG Microstates in Major Depressive Disorder: Evidence Against Trait Markers of IllnessPreprint
Bissonnette, J. N., Francis, A. M., Hull, K. M., Leckey, J., Pimer, L., Berrigan, L. I., & Fisher, D. J. (2022) · Research Square · doi:10.21203/rs.3.rs-1708824/v1
Comparison of spouse and patient personality change judgments following MS onset
Weddell, R. A., & Fisher-Hicks, S. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2022.2101478
Cognitive deficits in multiple sclerosis: Auditory and Visual Attention and inhibitory ControlPreprint
Roozbeh, M., Shojaei, M., Rostami, M., & Simani, L. (2022) · Research Square · doi:10.21203/rs.3.rs-2280685/v1
Sommeil, fatigue, troubles du sommeil et troubles cognitifs
Henry, A. (2021) · De Boeck Supérieur eBooks · doi:10.3917/dbu.azouv.2021.01.0109
Fragiles but Resilient. The Key Strategies to Cope with Pandemic in Persons with Multiple Sclerosis. A Controlled Web Survey
Sgoifo, A., Marazzi, M. R., Susani, E. L., Saraceno, L., Esposito, M. G., Campagna, C., Agostoni, E. C., & Protti, A. (2022) · Journal of Neurological Research And Therapy · doi:10.14302/issn.2470-5020.jnrt-22-4106
Evaluating a Tree of Life group for individuals with Multiple Sclerosis
Coppock, C., Adlington, R., Fisher, K., & MacCormack, M. (2019) · Health Psychology Update · doi:10.53841/bpshpu.2019.28.1.4
Does multilingualism act as a protective factor (cognitive reserve) against cognitive impairment in multiple sclerosis?: A retrospective cohort study
Morrow, S. A., Balusha, A. A. K., Rosehart, H., Casserly, C. S., & Racosta, J. M. (2023) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2023.105060
Etiology and pathogenesis of mental disorders in patients with multiple sclerosis: anxiety, psychotic, and personality disorders, chemical addictions, pathological affect
", F. S. B. E. I. O. H. E., Zimina, P. A., GUBSKAIA, K. V., Sinitsyna, L. V., Malygin, Y. V., & Akhpashev, A. A. (2024) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2402-03

Authors: Honarmand, K., & Feinstein, A.
Affiliations: Sunnybrook Health Science Centre (CA)
ORCID: Honarmand, Kimia
Feinstein, Anthony
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
DOI: 10.1177/1352458509347150
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
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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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Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients

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