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Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population
Open accessAbstract
Background: The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale. Aims: To examine the psychometric properties of the HAD scale in a large population. Method: All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations. Results: Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively. Conclusions: Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.
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“Also, it demonstrated good factor structure, intercorrelation, homogeneity and internal consistency.28”
From Protocol for a feasibility and acceptability study using a brief ACT-based intervention for people from Southwest Wales who live with persistent pain (2018) · cites this paper as [28]
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“The HADS is a validated (Bjelland, Dahl, Haug, & Neckelmann, 2002; Mykletun, Stordal, & Dahl, 2001), 14-item measure of anxiety and depression.”
From A pilot case series of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life and mood in muscle disorders (2017) · cites this paper as Mykletun, Stordal, & Dahl, 2001
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“Therefore, the Hospital Anxiety and Depression Scale (HADS) seems more appropriate to use: this instrument has shown solid psychometric properties regarding factor analysis and internal consistency.”
From The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries (2015) · cites this paper as Mykletun et al., 2001
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“However, the psychometric approach to evaluate depression used a self-administrated scale with strong psychometric properties.”
From The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries (2015) · cites this paper as Mykletun et al., 2001
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Citations
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Cited by
Sorted by citations
Santini, Z. I., Jose, P. E., York Cornwell, E., Koyanagi, A., Nielsen, L., Hinrichsen, C., Meilstrup, C., Madsen, K. R., & Koushede, V. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(19)30230-0 · Cited by 1,755
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“There is evidence for the two-factor structure of the instrument, although the two subscales are strongly intercorrelated (Spinhoven et al., 1997; Mykletun et al., 2001).”
BackgroundPallant, J., & Tennant, A. (2007) · British Journal of Clinical Psychology · doi:10.1348/014466506x96931 · Cited by 996
Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B. E., Misery, L., Szabo, C., Linder, D., Sampogna, F., et al. (2015) · Journal of Investigative Dermatology · doi:10.1038/jid.2014.530 · Cited by 968
“…variance of 30% of the subscales of depression and anxiety, the sensitivity and specificity for the anxiety and depression subscales are high, which allows separation of anxiety disorder from depression (Mykletun et al., 2001; Bjelland et al., 2002; Picardi et al., 2005; Breeman et al., 2014).”
BackgroundMethodInfluentialValidation study of a Portuguese version of the Hospital Anxiety and Depression Scale
Pais-Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007) · Psychology, Health & Medicine · doi:10.1080/13548500500524088 · Cited by 774
“Mykletun et al. (2001) explain that several psychometric issues of the HADS need further clarification namely because different studies show a factorial structure with one, two or three factors.”
BackgroundDepression rating scales in Parkinson's disease: Critique and recommendations
Schrag, A. E., Barone, P., Brown, R. G., Leentjens, A. F. G., McDonald, W. M., STARKSTEIN, S. E., Weintraub, D. A., Poewe, W. H., Rascol, O., Sampaio, C., et al. (2007) · Movement Disorders · doi:10.1002/mds.21333 · Cited by 690
Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression
Neckelmann, D., Mykletun, A., & Dahl, A. A. (2007) · Sleep · doi:10.1093/sleep/30.7.873 · Cited by 665
“34 We excluded from the sample individuals with a clinically significant symptom burden of anxiety and/or depression in HUNT-1 based on an earlier published index measure (ADI).”
BackgroundMethodSelf-citationDoes a higher educational level protect against anxiety and depression? The HUNT study
Bjelland, I., Krokstad, S., Mykletun, A., Dahl, A. A., Tell, G. S., & Tambs, K. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.12.019 · Cited by 656
Self-citationReliability, Internal Consistency, and Validity of Data Obtained With the Functional Gait Assessment
Wrisley, D. M., Marchetti, G. F., Kuharsky, D. K., & Whitney, S. L. (2004) · Physical Therapy · doi:10.1093/ptj/84.10.906 · Cited by 660
(2003) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-1-14 · Cited by 640
“In contrast, apart from findings from several studies that showed the HADS is a two-factor instrument [10], it has been suggested that inter-correlation between the anxiety and the depression subscales is not surprising since this is mainly due to a real coincidence of anxious and depressed symptoms and only to a less…”
Olssøn, I., Mykletun, A., & Dahl, A. A. (2005) · BMC Psychiatry · doi:10.1186/1471-244x-5-46 · Cited by 580
“The internal consistency of the HADS was found in accordance with other studies [16,13].”
BackgroundResultInfluentialSelf-citationAnxiety and depression symptoms in patients with diabetes
Collins, M. M., Corcoran, P., & Perry, I. J. (2009) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02648.x · Cited by 465
Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study.
Mahoney, R., Regan, C., Katona, C., & Livingston, G. (2005) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200509000-00008 · Cited by 461
Insomnia and the Risk of Acute Myocardial Infarction: A Population Study
Laugsand, L. E., Vatten, L. J., Platou, C., & Janszky, I. (2011) · Circulation · doi:10.1161/circulationaha.111.025858 · Cited by 438
Pun, V. C., Manjourides, J., & Suh, H. H. (2016) · Environmental Health Perspectives · doi:10.1289/ehp494 · Cited by 441
“The Hospital Anxiety and Depression Scale (HADS) has been used successfully as a self-rating instrument to measure current state of anxiety, with well-established reliability and validity in population-based studies (Mykletun et al. 2001).”
MethodQuintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.00062.x · Cited by 428
“As several groups were included in our study, we performed separate exploratory principal-component analysis for each of them as described in previous articles, which confronted the same problem (28, 29).”
MethodSkodje, G. I., Sarna, V. K., Minelle, I. H., Rolfsen, K. L., Muir, J. G., Gibson, P. R., Veierød, M. B., Henriksen, C., & Lundin, K. E. A. (2017) · Gastroenterology · doi:10.1053/j.gastro.2017.10.040 · Cited by 425
A European consensus on outcome measures for psychosocial intervention research in dementia care
Moniz-Cook, E. D., Vernooij-Dassen, M. J. F. J., Woods, B. T., Verhey, F. R. J., Chattat, R., de Vugt, M. E., Mountain, G. A., O’connell, M., Harrison, J., Vasse, E., et al. (2008) · Aging & Mental Health · doi:10.1080/13607860801919850 · Cited by 406
“The 12-item version suits clinical settings (Bedard et al, 2003 ; O’Rourke & Tuokko, 2003a ).”
Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample
Michopoulos, I., Douzenis, A., Kalkavoura, C., Christodoulou, C., Michalopoulou, P., Kalemi, G., Fineti, K., Patapis, P., Protopapas, K., & Lykouras, L. (2008) · Annals of General Psychiatry · doi:10.1186/1744-859x-7-4 · Cited by 389
Depression and anxiety disorders associated with headache frequency. The Nord‐Trøndelag Health Study
Zwart, J., Dyb, G. A., Hagen, K., Ødegård, K. J., Dahl, A. A., Bovim, G., & Stovner, L. J. (2003) · European Journal of Neurology · doi:10.1046/j.1468-1331.2003.00551.x · Cited by 386
“Recent studies and reviews conclude that HADS is a reliable and valid instrument for assessing the separate dimensions, symptom severity and caseness of anxiety and depression in somatic, psychiatric and primary-care patients, as well as in the general population (Herrmann, 1997; Lisspers et al., 1997; Spinhoven et al…”
BackgroundMethodSelf-citationHaug, T. T., Mykletun, A., & Dahl, A. A. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000145823.85658.0c · Cited by 360
Self-citationBocéréan, C., & Dupret, É. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0354-0 · Cited by 347
Relaxation training for anxiety: a ten-years systematic review with meta-analysis
Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-41 · Cited by 480
“The interpretation of this data is quite complex, because, against the less discriminant result in the intergroup analysis, international literature demonstrated good psychometric properties of the instrument [48].”
ResultThe role of depression and anxiety in onset of diabetes in a large population-based study
Engum, A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.07.009 · Cited by 330
Djukanovic, I., Carlsson, J., & Årestedt, K. (2017) · Health and Quality of Life Outcomes · doi:10.1186/s12955-017-0759-9 · Cited by 326
“The hypothesized two-factor structure is most often confirmed [8, 10, 11] but studies have also suggested one factor [12], three factors [13] and also four factors [14].”
BackgroundGrav, S., Hellzèn, O., Romild, U. K., & Stordal, E. (2011) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2011.03868.x · Cited by 329
“The psychometric properties of the Norwegian version of HADS have been found to be excellent (Mykletun et al. 2001).”
MethodSelf-citationGrov, E. K., Dahl, A. A., Moum, T., & Fosså, S. D. (2005) · Annals of Oncology · doi:10.1093/annonc/mdi210 · Cited by 315
“The psychometric properties of the Norwegian version of HADS were tested in HUNT study and found to be excellent [41].”
Self-citationPsychometric evaluation of the Arabic version of the Fear of COVID-19 Scale
Alyami, M., Henning, M., Krägeloh, C. U., & Alyami, H. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00316-x · Cited by 313
“The HADS has demonstrated satisfactory psychometric properties in different patient groups as well as in general populations (Bjelland et al. 2002; Mykletun et al. 2001).”
BackgroundUpdate on Bispectral Index monitoring
Johansen, J. W. (2006) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2005.08.004 · Cited by 312
Jacka, F. N., Mykletun, A., Berk, M., Bjelland, I., & Tell, G. S. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318222831a · Cited by 304
Self-citationInfluence of anxiety on health outcomes in COPD
Eisner, M. D., Blanc, P. D., Yelin, E. H., Katz, P. P., Sanchez, G., Iribarren, C., & Omachi, T. A. (2010) · Thorax · doi:10.1136/thx.2009.126201 · Cited by 284
“Anxiety was measured using the 7-item anxiety subscale of the Hospital Anxiety and Depression Scale, which is a widely used validated instrument designed to detect clinically significant anxiety among patients who attend outpatient medical clinics.”
MethodLevels of anxiety and depression as predictors of mortality: the HUNT study
Mykletun, A., Bjerkeset, O., øverland, S., Prince, M., Dewey, M., & Stewart, R. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.054866 · Cited by 279
Bränström, R., Duncan, L. G., & Moskowitz, J. T. (2011) · British Journal of Health Psychology · doi:10.1348/135910710x501683 · Cited by 266
Anxiety, Depression, and Cause-Specific Mortality: The HUNT Study
Mykletun, A., Bjerkeset, O. A., Dewey, M. E., Prince, M. J., Øverland, S. N., & Stewart, R. J. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31803cb862 · Cited by 265
“In accordance with the findings on anxiety disorders and depression in the National Comorbidity Survey (21), we found a 30% shared variance between HADS-A and HADS-D (26).”
BackgroundResultSelf-citationRomero, L. M., & Remage‐Healey, L. (2000) · General and Comparative Endocrinology · doi:10.1006/gcen.2000.7491 · Cited by 259
Clark, C. A. C., Woodward, L. J., Horwood, L. J., & Moor, S. (2008) · Child Development · doi:10.1111/j.1467-8624.2008.01198.x · Cited by 251
Insomnia and the risk of incident heart failure: a population study
Laugsand, L. E., Strand, L. B., Platou, C., Vatten, L., & Janszky, I. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht019 · Cited by 261
“The psychometric properties of the scale have previously been validated as part of the HUNT study.(14) Laboratory measurements”
MethodBjerkeset, O. A., Romundstad, P., Evans, J., & Gunnell, D. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm280 · Cited by 251
“The psychometric properties of the Norwegian version of HADS have been found to be excellent in HUNT 2 (15).”
MethodInfluentialComparison of two self-rating scales to detect depression: HADS and PHQ-9
Hansson, M., Chotai, J., Nordstöm, A., & Bodlund, O. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x454070 · Cited by 246
“These finding are supported by several earlier studies.(12,21,27) The HADS has shown good internal consistency in previous studies, with Cronbach’s α around 0.”
ResultEnhancing the Validity of a Quality of Life Measure for Autistic People
McConachie, H., Mason, D., Parr, J. R., Garland, D., Wilson, C., & Rodgers, J. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3402-z · Cited by 245
“76 (Mykletun et al. 2001) and for a young adult autistic sample: anxiety, alpha = 0.”
BackgroundHistory of Foot Ulcer Increases Mortality Among Individuals With Diabetes
Iversen, M. M., Tell, G. S., Riise, T., Hanestad, B. R., Østbye, T., Graue, M., & Midthjell, K. (2009) · Diabetes Care · doi:10.2337/dc09-0651 · Cited by 244
Spada, M. M., Mohiyeddini, C., & Adrian Wells, A. (2008) · Personality and Individual Differences · doi:10.1016/j.paid.2008.04.005 · Cited by 243
Vert, C., Sánchez‐Benavides, G., Martinez, D. R., Gotsens, X., Gramunt, N., Cirach, M., Molinuevo, J. L., Sunyer, J., Nieuwenhuijsen, M. J., Crous‐Bou, M., et al. (2017) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2017.06.009 · Cited by 238
“In the same line, Pun et al. (2016) reported increased odds [e.g., OR=1.20 (95% CI: 1.08, 1.33)] of moderate-tosevere depressive symptoms [measured with the Hospital Anxiety and Depression Scale (HADS)] for each 5 µg/m3 increment in PM2.”
MethodInfluentialThe association between age and depression in the general population: a multivariate examination
Stordal, E., Mykletun, A., & Dahl, A. A. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.02056.x · Cited by 231
Self-citationFatigue, anxiety, and depression in long-term survivors of testicular cancer
Fosså, S. D., Dahl, A. A., & Loge, J. H. (2003) · Journal of Clinical Oncology · doi:10.1200/jco.2003.08.163 · Cited by 222
Self-citationMetacognition, perceived stress, and negative emotion
Spada, M. M., Nikčević, A. V., Moneta, G. B., & Adrian Wells, A. (2008) · Personality and Individual Differences · doi:10.1016/j.paid.2007.11.010 · Cited by 247
Coping strategies and anxiety in caregivers of people with Alzheimer’s disease: the LASER-AD study
Cooper, C., Katona, C., Orrell, M., & Livingston, G. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.08.017 · Cited by 208
“In addition, caregivers completed: HADS (Zigmond and Snaith, 1983) This does not include somatic items (which can be misleading in older subjects) and has been validated throughout the age range and in all settings to identify clinically significant anxiety and depression (Mykletun et al., 2001).”
BackgroundMykletun, A., Overland, S., Aarø, L. E., Liabø, H.-M., & Stewart, R. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2007.10.005 · Cited by 213
“Anxiety and depression are commonly comorbid [38].”
MethodSelf-citationStrandberg, R. B., Graue, M., Wentzel-Larsen, T., Peyrot, M., & Rokne, B. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.06.015 · Cited by 208
“The psychometric properties of the Norwegian version of the HADS showed to be satisfactory [33].”
MethodPun, V. C., Manjourides, J., & Suh, H. H. (2018) · Environmental Health · doi:10.1186/s12940-018-0381-2 · Cited by 220
Mykletun, A. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.8.1412 · Cited by 237
Self-citationSelf-reported mood, general health, wellbeing and employment status in adults with suspected DCD.
Kirby, A., Williams, N., Thomas, M., & Hill, E. (2013) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2013.01.003 · Cited by 148
An association between depression, anxiety and thyroid function – a clinical fact or an artefact?
Engum, A., Bjøro, T., Mykletun, A., & Dahl, A. A. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2002.01250.x · Cited by 208
Self-citationZhao, X., Zhang, D., Wu, M., Yang, Y., Xie, H., Li, Y., Jia, J., & Su, Y. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.011 · Cited by 202
Psychological processes and repeat suicidal behavior: a four-year prospective study
O'Connor, R. C., Smyth, R., Ferguson, E., Ryan, C., & Williams, J. M. G. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033751 · Cited by 194
Omachi, T. A., Blanc, P. D., Claman, D. M., Chen, H., Yelin, E. H., Julian, L. J., & Katz, P. (2012) · Sleep Medicine · doi:10.1016/j.sleep.2011.12.007 · Cited by 202
“was assessed using the anxiety portion of the Hospital Anxiety and Depression (HAD) scale [27,28].”
Engum, A., Mykletun, A., Midthjell, K., Holen, A., & Dahl, A. A. (2005) · Diabetes Care · doi:10.2337/diacare.28.8.1904 · Cited by 205
Self-citationBerle, J. Ø., Mykletun, A., Daltveit, A. K., Rasmussen, S., Holsten, F., & Dahl, A. A. (2005) · Archives of Women’s Mental Health · doi:10.1007/s00737-005-0090-z · Cited by 195
“The psychometric properties of HADS are considered to be excellent (Mykletun et al., 2001; Bjelland et al., 2002; Thompson et al., 2001), and HADS has good case-finding properties in primary health care (Bjelland et al., 2002).”
BackgroundSelf-citationEmotional distress in cancer patients: the Edinburgh Cancer Centre symptom study
Strong, V, Waters, R., Hibberd, C., Rush, R., Cargill, A., Storey, D., Walker, J., Wall, L., Fallon, M., & Sharpe, M. (2007) · British Journal of Cancer · doi:10.1038/sj.bjc.6603626 · Cited by 189
Berg‐Nielsen, T. S., Vika, A., & Dahl, A. A. (2003) · Child Care Health and Development · doi:10.1046/j.1365-2214.2003.00332.x · Cited by 186
Self-citationSiddaway, A. P., Taylor, P. J., Wood, A. M., & Schulz, J. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.05.046 · Cited by 198
Hopelessness and positive and negative future thinking in parasuicide
MacLeod, A. K., Tata, P., Tyrer, P., Schmidt, U., Davidson, K., & Thompson, S. (2005) · British Journal of Clinical Psychology · doi:10.1348/014466505x35704 · Cited by 175
Chronic pain and sex-differences; women accept and move, while men feel blue
Rovner, G. S., Sunnerhagen, K. S., Björkdahl, A., Gerdle, B., Börsbo, B., Johansson, F., & Gillanders, D. (2017) · PLOS ONE · doi:10.1371/journal.pone.0175737 · Cited by 179
Comparison of Combined Bupropion and Naltrexone Therapy for Obesity with Monotherapy and Placebo
Greenway, F. L., Dunayevich, E., Tollefson, G., Erickson, J., Guttadauria, M., Fujioka, K., Cowley, M. A., & for the NB-201 Study Group (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1350 · Cited by 179
Study of anxiety disorder and depression in long-term survivors of testicular cancer
Dahl, A. A., Haaland, C. F., Mykletun, A., Bremnes, R., Dahl, O., Klepp, O., Wist, E., & Fosså, S. D. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.05.061 · Cited by 176
Self-citationGonzales, G. F., Cordova, A., Vega, K., Chung, A., Villena, A., Gonez, C., & Castillo, S. (2002) · Andrologia · doi:10.1046/j.1439-0272.2002.00519.x · Cited by 177
“Mood was assessed using the Hamilton Depression Rating Scale (Mykletun et al., 2001), which has 17 questions.”
MethodThe role of metacognitions in problematic Internet use
Spada, M. M., Langston, B., Nikčević, A. V., & Moneta, G. B. (2008) · Computers in Human Behavior · doi:10.1016/j.chb.2007.12.002 · Cited by 173
Larsen, B., Seitz, A., & Larsen, R. (2000) · Anesthesia & Analgesia · doi:10.1097/00000539-200001000-00035 · Cited by 172
Woolrich, R. A., Kennedy, P., & Tasiemski, T. (2006) · Psychology, Health & Medicine · doi:10.1080/13548500500294211 · Cited by 168
“, 2000; Flint & Rifat, 2002) and non-clinical populations from various countries (Mykletun et al., 2001; Quintana et al., 2003).”
BackgroundMethodThe association of air pollution and depressed mood in 70,928 individuals from four European cohorts
Zijlema, W. L., Wolf, K., Emeny, R. T., Ladwig, K., Peters, A., Kongsgård, H. W., Hveem, K., Kvaløy, K., Yli‐Tuomi, T., Partonen, T., et al. (2015) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2015.11.006 · Cited by 172
“In HUNT, depressed mood was assessed with the depression subscale of the Hospital Anxiety Depression Scale (HADS) [28].”
MethodInfluentialHjermstad, M. J., Knobel, H., Brinch, L., Fayers, P. M., Loge, J. H., Holte, H., & Kaasa, S. (2004) · Bone Marrow Transplantation · doi:10.1038/sj.bmt.1704561 · Cited by 166
Mindfulness and its efficacy for psychological and biological responses in women with breast cancer
Kenne Sarenmalm, E., Mårtensson, L. B., Andersson, B. A., Karlsson, P., & Bergh, I. (2017) · Cancer Medicine · doi:10.1002/cam4.1052 · Cited by 160
Help-seeking behaviour in patients with anxiety disorder and depression
Roness, A., Mykletun, A., & Dahl, A. A. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00433.x · Cited by 197
“Factor analyses of HADS in HUNT resulted in a twofactor solution consistent with the two sub-scales (29).”
MethodInfluentialSelf-citationAssociation of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study
Hildrum, B., Mykletun, A., Stordal, E., Bjelland, I., Dahl, A. A., & Holmen, J. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2005.044966 · Cited by 162
Self-citationChappell, N. L., Dujela, C., & Smith, A. P. (2014) · Research on Aging · doi:10.1177/0164027514549258 · Cited by 178
Skalická, V., van Lenthe, F. J., Bambra, C. L., Krokstad, S., & Mackenbach, J. P. (2009) · International Journal of Epidemiology · doi:10.1093/ije/dyp262 · Cited by 156
Physical activity and mental health in a student population
Tyson, P. J., Wilson, K., Crone, D., Brailsford, R., & Laws, K. R. (2010) · Journal of Mental Health · doi:10.3109/09638230902968308 · Cited by 196
“This scale has good psychometric properties in terms of factor structure, intercorrelation and internal consistency (Mykletun et al., 2001).”
MethodEffect of anxiety and depression on blood pressure: 11-year longitudinal population study
Hildrum, B., Mykletun, A., Holmen, J., & Dahl, A. A. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.045013 · Cited by 155
Self-citationRevisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas.
Cantero, M. C. T., Cabrera‐Perona, V., & Gelabert, M. M.-A. (2015) · Anales de Psicología · doi:10.6018/analesps.31.2.172701 · Cited by 181
“Cabe recordar que en los métodos exploratorios basados en valores Eigen (Kaiser, Scree plots) se compromete la solución al forzar factores (Mykletun et al., 2001).”
BackgroundRivenes, A. C., Harvey, S. B., & Mykletun, A. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.07.012 · Cited by 154
“Weighting according to the procedure used in the National Comorbidity Survey was performed to adjust for difference in response rate according to age and gender differences between the population of Nord-Trøndelag County and the population of Norway [30].”
BackgroundMethodSelf-citationSkogen, J. C., Harvey, S. B., Henderson, M., Stordal, E., & Mykletun, A. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02659.x · Cited by 151
“Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale (HADS), which comprises 14 four-point Likert-scaled items distributed equally between the two conditions [20].”
MethodSelf-citationWalker, J., Postma, K., McHugh, G. S., Rush, R., Coyle, B., Strong, V., & Sharpe, M. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.01.009 · Cited by 149
“The reliability, validity, and factor structure of the HADS has been established in a variety of clinical populations [14–18].”
BackgroundBystad, M. K., Grønli, O., Rasmussen, I. D., Gundersen, N., Nordvang, L., Wang-Iversen, H., & Aslaksen, P. M. (2016) · Alzheimer s Research & Therapy · doi:10.1186/s13195-016-0180-3 · Cited by 147
“They completed the Hospital Anxiety and Depression Scale [9], a questionnaire used to screen for depression and anxiety.”
MethodIs Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation?
Romero, M. C. C., Vivas-Consuelo, D., & Alvis‐Guzmán, N. (2013) · SpringerPlus · doi:10.1186/2193-1801-2-664 · Cited by 150
The relationship between age, anxiety, and depression in older adults with cancer
Wiesel, T. W., Nelson, C. J., Tew, W. P., Hardt, M. E., Mohile, S. G., Owusu, C., Klepin, H. D., Gross, C. P., Gajra, A., Lichtman, S. M., et al. (2014) · Psycho-Oncology · doi:10.1002/pon.3638 · Cited by 151
Personality traits as risk factors of depression and anxiety among Japanese students
Matsudaira, T., & Kitamura, T. (2005) · Journal of Clinical Psychology · doi:10.1002/jclp.20215 · Cited by 139
Mundal, I. P., Gråwe, R. W., Bjørngaard, J. H., Linaker, O. M., & Fors, E. A. (2014) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-15-213 · Cited by 136
“It comprises seven items for depression (HADS-D) and seven for anxiety (HADS-A), in which each item includes a four-point Likert-scale response category (0–3) [40,41].”
BackgroundOedegaard, K., Neckelmann, D., Mykletun, A., Dahl, A. A., Zwart, J.-A., Hagen, K., & Fasmer, O. B. (2005) · Cephalalgia · doi:10.1111/j.1468-2982.2005.00974.x · Cited by 138
Self-citationBiomedical and Psychosocial Factors Associated with Disability After Peripheral Nerve Injury
Novak, C. B., Anastakis, D. J., Beaton, D., Mackinnon, S. E., & Katz, J. D. (2011) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.j.00110 · Cited by 143
Chan, Y.-F., Leung, D. Y. P., Fong, D. Y. T., Leung, C.-M., & Lee, A. M. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9645-1 · Cited by 135
“While a good level of internal consistency was found for the anxiety subscale, which is in accordance with or higher than that of prior adult studies using Chinese [15, 16], English [27], and other-language versions [13, 18 , 19], it was less salient for the depression subscale.”
Roberge, P., Doré, I., Menear, M., Chartrand, E., Ciampi, A., Duhoux, A., & Fournier, L. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.10.029 · Cited by 153
Matsudaira, T., Igarashi, H., Kikuchi, H., Kano, R., Mitoma, H., Ohuchi, K., & Kitamura, T. (2009) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-7-42 · Cited by 134
Guo, C., Tomson, G. B., Jizhi, G., Li, X., Keller, C., & Söderqvist, F. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0394-2 · Cited by 130
“It was designed for patients with various diseases but showed high tolerance on general populations [37] and also adolescents [38, 39].”
BackgroundHigh Prevalence/Low Severity Language Delay in Preschool Children Born Very Preterm
Foster‐Cohen, S., Friesen, M. D., CHAMPION, P. R., & Woodward, L. J. (2010) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181e5ab7e · Cited by 133
Heesterbeek, T. J., van der Aa, H. P. A., van Rens, G. H. M. B., Twisk, J. W. R., & van Nispen, R. M. A. (2017) · Ophthalmic and Physiological Optics · doi:10.1111/opo.12388 · Cited by 133
“The HADS-A is a 7-item subscale with total scores ranging from 0 to 21.(26) Subthreshold anxiety is defined as a cut-off score of ≥8 with a sensitivity of 64–93% and specificity of 72–94%.”
Orgeta, V., Leung, P., Yates, L., Kang, S., Hoare, Z., Henderson, C., Whitaker, C. J., Burns, A. S., Knapp, M. R. J., Leroi, I., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19640 · Cited by 136
“Week 13 iCST, mean (SE) (n= 129) TAU, mean (SE) (n= 135) Mean difference (95% CI) Hospital 253 (57) 198 (46) 55 (–89 to 199) Primary and community health 125 (13) 142 (12) –17 (–51 to 17) Respite in residential/nursing home 31 (22) 0 (0) 31 (–11 to 73) Community-based social care 845 (245) 1072 (235) –227 (–895 to 441…”
Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors
Desai, K., Mao, J. J. J., Su, I. H., DeMichele, A. M., Li, Q., Xie, S. X., & Gehrman, P. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1490-z · Cited by 129
Sivertsen, B., Øverland, S. N., Pallesen, S., Bjorvatn, B., Nordhus, I. H., Mæland, J. G., & Mykletun, A. (2008) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00697.x · Cited by 124
Self-citationHildrum, B., Romild, U., & Holmen, J. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-601 · Cited by 124
“Using a categorical approach, we defined a high symptom level of anxiety/ depression at all three measurements as scores above the 80th percentile on the ADI-12 Index at baseline and as combined HADS-A and HADS-D scores ≥12 (equals around the 80th percentiles) at 11-year and at 22-year follow-up.”
InfluentialEngum, A., Bjøro, T., Mykletun, A., & Dahl, A. A. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.04.002 · Cited by 123
Self-citation
Metadata
- Authors
- Mykletun, A., Stordal, E., & Dahl, A. A.
- Affiliations
- University of Bergen (NO)
- University of Oslo (NO)
- Corresponding author
- Mykletun, Arnstein
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2001-12
- Volume
- 179
- Issue
- 6
- Pages
- 540-544
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2106572906
- Cited by
- 908
- References
- 23
- Citations by year
- 2026: 16 · 2025: 28 · 2024: 33 · 2023: 31 · 2022: 39 · 2021: 31 · 2020: 28 · 2019: 31 · 2018: 36 · 2017: 38 · 2016: 48 · 2015: 60 · 2014: 58 · 2013: 61 · 2012: 56
- FWCI
- 21.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Nursing › Research and Theory › Health Education and Validation
- Keywords
- Hospital Anxiety and Depression Scale, psychometric properties, factor structure, internal consistency, anxiety, depression, self-report questionnaire, Nord-Trøndelag Health Study, item analysis
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety Disorders, Mental Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results
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