The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.
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
In the citing paper
“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
Cites
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
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
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Hospital anxiety and depression scale (had): Some psychometric data for a swedish sample
Lisspers, J., Nygren, A., & Söderman, E. (1997) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1997.tb10164.x · Cited by 706
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Screening for Adjustment Disorders and Major Depressive Disorders in Cancer In-Patients
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Flagged first, then by citations
Research works printed but not linked: 3
- Nunnally, 1994, Psychometric Theory
- Bjelland, I. , Neckelmann, D. , Tangen Haug, T. , et al (2001) A review of validation studies of the Hospital Anxiety and Depression Scale. Journal of Psychosomatic Research, in press.
- Üstun, 1995, Mental Illness in General Health Care
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Sagen, Å. M., Eide, G. E., Grimstad, T. B., & Reime, M. H. (2026) · Nursing Reports · doi:10.3390/nursrep16090301
“The Norwegian version of the HADS has demonstrated satisfactory validity and reliability, with internal consistency values between 0.73 and 0.85 [36].”
InfluentialSkudal, H. K., Lorentzen, Å. R., Stenstad, T., Quist‐Paulsen, E., Fevang, B., Jaioun, K., Veje, M., Kersten, H., Eikeland, R., & Egeland, J. (2026) · Journal of Neurology · doi:10.1007/s00415-026-14095-3
“The symptoms of anxiety and depression were assessed with the validated Norwegian version of the Hospital Anxiety and Depression Scale (HADS) [33], which comprises 14 items divided into anxiety (HADS-A) and depression (HADS-D) subscales (score range, 0–21 for each).”
Pensri, C., Treleaven, J. M., Jull, G. A., Liang, Z., & Thomas, L. C. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103656
Wang, Y., Wei, L., Cao, C., Chai, Q., & Lu, M. (2026) · Psychology Health & Medicine · doi:10.1080/13548506.2026.2734035
Davey, C. J. (2011) · Bradford Scholars (University of Bradford)
Powell, F. C. (2013) · Loughborough University Research Repository (Loughborough University)
The implications of attachment style for outcomes in young people who self-harm
Glazebrook, K. (2012)
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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