The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.
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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Sorted by citations
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Cognitive impairment in patients with multiple sclerosis
Levin, O. S., Zakharova, M. N., & Шемякина, А. В. (2025) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202512504267
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“In line with 57% of our panel, eating disorders such as anorexia, bulimia, and binge eating are not speci fi cally associated with depressive disorder in MS (s 2.5), suggesting a more cautious approach in this context (30).”
InfluentialKuhlmann, J., Ebner, K. A., Zimmer, A., Rommers, N., Cerdá-Fuertes, N., Fischer‐Barnicol, B., Dinsenbacher, L. L., Marz, J., D’Souza, M., Parmar, K., et al. (2025) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/20552173251352712
“The following validated questionnaires were used to assess primary and secondary outcomes: hospital anxiety and depression scale (HADS-A/D), 22 for assessment of anxiety and depressive symptoms, modi fi ed fatigue impact scale (MFIS), 23 a self-reported measure of fatigue in daily life with…”
Obsa, M. S., Saul, A., Laslett, L. L., Lefever, K., Campbell, J. A., Taylor, B. V., & van der Mei, I. A. F. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106831
Depression as a Disease of White Matter Network Disruption: Learning From Multiple Sclerosis
Baller, E. B., Cooper, E. C., Schindler, M. K., Bar‐Or, A., Fox, M., Shinohara, R. T., & Satterthwaite, T. D. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.11.011
Kever, A., & Feinstein, A. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106874
Self-citationFarber, A. E., Menascu, S., Drori, T., & Kalron, A. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106895
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Gravesteijn, A. S., Beckerman, H., de Jong, B. A., Hulst, H. E., & de Groot, V. (2020) · Figshare · doi:10.6084/m9.figshare.12285098
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Facial Expression Metrics as Digital Biomarkers of Neurologic Disease
Nylander, A. N., Poole, S. T., Hsu, N. S., Henderson, K., Sisodia, N., Wijangco, J., Rowson, J., Halabi, C., Ostrem, J. L., Little, S. J., et al. (2025) · Neurology Open Access · doi:10.1212/wn9.0000000000000043
Podda, J., Antonio, F. D., Pedullà, L., Grange, E., Battaglia, M. A., Tacchino, A., & Brichetto, G. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.106984
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Kidwell-Chandler, A. L., Jeng, B., & Motl, R. W. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107084
“Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-reported assessment divided into seven anxiety-related items and seven depression-related items (Honarmand and Feinstein, 2009).”
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Physiopathologie et traitement de la fatigue dans la sclérose en plaques
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How useful is the expanded disability status scale to neuropsychiatrists?
Freedman, D., Oh, J., & Feinstein, A. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107193 · Cited by 1
Self-citationDiachenko, P. A., Andreeva, O. A., Lutsenko, V. Y., & Stefanyshyn, V. M. (2026) · INTERNATIONAL NEUROLOGICAL JOURNAL · doi:10.22141/2224-0713.22.1.2026.1232
Böckels, L., Lisnic, V., Alexa, D., Belenciuc, A., Cretu, R. A., Ropot, D., Bîlcu, R. V., & Cuciureanu, D. I. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15114165
“This feature is particularly relevant in MS, where fatigue, sleep disturbances, and autonomic symptoms are common and may interfere with the accurate evaluation of emotional distress [6,7].”
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Self-citationFunctional connectivity dynamics of monoaminergic circuits related to fatigue in multiple sclerosis
Bet, M. D. A., Helmlinger, B., Broeders, T. A. A., Hechenberger, S., Tinauer, C., Ropele, S., Barkhof, F., Khalil, M., Enzinger, C., Douw, L., et al. (2026) · Journal of Neurology · doi:10.1007/s00415-026-13876-0
“To distinguish fatigue from anxiety and depression [20, 21], we administered the Hospital Anxiety and Depression Scale (HADS) [22].”
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Fazazi, M. R., Champagne-Jorgensen, K. P., Islam, T., Tweed, K. T., & Horwitz, M. S. (2026) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2026.579043
Freedman, D., Oh, J., & Feinstein, A. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107424
Self-citationIntolerance of uncertainty and cyberchondria in multiple sclerosis: beyond anxiety and depression
Canpolat, İ. K. N., & Sökmen, O. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107877
Freedman, D., Oh, J., & Feinstein, A. (2026) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20260024
Self-citationMorrow, S. A., Rosehart, H., Smyth, P. S., Dumont, P., Everest, M. R., Thorne, M., & Lee, L. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107932
Grange, E., Susini, A., Brichetto, G., Antonio, F. D., & Podda, J. (2026) · Brain and Behavior · doi:10.1002/brb3.71796
“It has been translated and validated in the Italian population (Costantini et al. 1999 ) and in PwMS (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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