Normative data for the HADS from a large non-clinical sample
Open accessAbstract
OBJECTIVES: To provide normative data for the Hospital Anxiety Depression Scale (HADS). DESIGN: Repeated measures and correlational. METHODS: The HADS was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1792) in terms of the distributions of age, gender and occupational status. Correlational analysis was used to determine the influence of demographic variables on HADS scores. RESULTS: Demographic variables had only very modest influences on HADS scores. The reliability of the HADS is acceptable; the Anxiety and Depression scales are moderately correlated (.53). Tables to convert raw scores to percentiles are presented for females and males. CONCLUSIONS: The present normative data allow clinicians to assess the rarity of a given HADS score, and thus provide a useful supplement to existing cut-off scores.
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The proportions of the current sample meeting criteria for moderate-severe anxiety (10.1%) and depression (7.1%) were higher than those reported by Crawford et al. in their large, community, non-clinical sample of males (8% and 2%, respectively).
“The proportions of the current sample meeting the criteria for moderate-severe levels of symptoms for anxiety (n = 11, 10.1%) and depression (n = 8, 7.1%) were higher than those reported by Crawford et al. in their large, community, non-clinical sample of males (8% and 2%, respectively).”
From Psychological acceptance mediates the impact of the behaviour problems of children with intellectual disability on fathers' psychological adjustment. (2010) · cites this paper as Crawford et al. 2001
Scores of 11 or higher on each sub-scale of the HADS are recognized to suggest moderate to severe anxiety or depression.
“Scores of 11 or higher on each sub-scale of the HADS are recognized to suggest moderate to severe anxiety or depression (Crawford et al. 2001).”
From Psychological acceptance mediates the impact of the behaviour problems of children with intellectual disability on fathers' psychological adjustment. (2010) · cites this paper as Crawford et al. 2001
Even in very large non-clinical samples, the distribution of scores on common mood questionnaires can still be positively skewed.
“However, even in very large non-clinical samples, the distribution of scores on common mood questionnaires can still be positively skewed (Crawford et al ., 2001).”
From Acceptance and commitment therapy (ACT) for post-stroke adjustment difficulties via telerehabilitation in a working-age man (2023) · cites this paper as Crawford et al ., 2001
Baseline HADS-Total mean was 19.20 (SD=6.18), higher than a non-clinical Australian community sample mean of 9.82 (SD=5.98).
“Overall the baseline HADS-Total mean 19.20 (SD = 6.18) was high, as compared to a non-clinical Australian community sample mean 9.82 (SD = 5.98) (Crawford et al., 2001).”
From A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety (2021) · cites this paper as Crawford et al., 2001
A recommended cut-off score for clinical levels of depression is 10/11 (Crawford et al., 2001).
“a recommended cut-off score for clinical levels of depression suggested at 10/11 (Crawford, Henry, Crombie, & Taylor, 2001).”
From A mindfulness parent well-being course: evaluation of outcomes for parents of children with autism and related disabilities recruited through special schools (2018) · cites this paper as Crawford, Henry, Crombie, & Taylor, 2001
The small change in depression scores may not necessarily be due to a lack of treatment effect, but possibly because of relatively moderate levels of depression presented by the current sample (pre-intervention mean 6.75, clinical cut-off 10/11).
“In relation to the small change in depression scores, the small effect may not necessarily be due to a lack of treatment effect, but possibly because of relatively moderate levels of depression presented by the current sample, with a pre-intervention mean scores of 6.75, and a recommended cut-off score for clinical levels of depression suggested at 10/11 (Crawford, Henry, Crombie, & Taylor, 2001).”
From A mindfulness parent well-being course: evaluation of outcomes for parents of children with autism and related disabilities recruited through special schools (2018) · cites this paper as Crawford, Henry, Crombie, & Taylor, 2001
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“In some circumstances, it would be useful to have a single measure of GPD for each scale (Crawford et al., 2001; Spinhoven et al., 1997); see Cole (1987) and Tanaka and Huba (1984) for further discussion of the rationale for the construct of GPD.”
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“Snaith and Zigmond have identified three cut-off levels: a score between 8 and 10 indicate a mild case, 11–14 a moderate case, and 15 or above, a severe case [25,26].”
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“0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Percentile Crawford et al [15] EPIFUND”
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“Using the HADS, Crawford et al. (2001) described a prevalence of 33.2% and 11.4% of mild to severe symptoms of anxiety and depression, respectively, in a representative sample of the general adult UK population (n = 1,792), while Olsson et al. (2005) found 28.8% of anxiety and 18.5% of depression symptoms in a sample…”
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“Minimum glucose, mg/dL, mean (sd) 110 (23) 110 (25) 111 (21) 108 (23) 112 (22) 108 (20) 111 (23)”
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“Nevertheless, other studies assessing HADS factor structure [20,36] used convenience samples.”
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Pro‐social behaviour and behaviour problems independently predict maternal stress
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“The HADS has good reliability and validity as an index of this construct (Crawford et al., 2001).”
BackgroundSelf-citationThe role of emotion regulation in auditory hallucinations
Badcock, J. C., Paulik, G., & Maybery, M. T. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.07.011 · Cited by 141 · see citing works
“(Crawford et al., 2001).”
Broomfield, N., Quinn, T., Abdul-Rahim, A., Walters, M., & Evans, J. (2014) · BMC Neurology · doi:10.1186/s12883-014-0198-8 · Cited by 150 · see citing works
“8% depressed) [22,23].”
Depression and anxiety symptoms after lower limb amputation: the rise and fall
Singh, R. K., Ripley, D., Pentland, B. T., Todd, I. C., Hunter, J. A., Hutton, L., & Philip, A. (2009) · Clinical Rehabilitation · doi:10.1177/0269215508094710 · Cited by 141 · see citing works
Exploring autistic traits in anorexia: a clinical study
Tchanturia, K., Smith, E. L., Weineck, F., Fidanboylu, E., Kern, N., Treasure, J. L., & Baron‐Cohen, S. (2013) · Molecular Autism · doi:10.1186/2040-2392-4-44 · Cited by 136 · see citing works
“The HADS has good psychometric properties [51].”
Farquhar, M. C., Prevost, A. T., McCrone, P., Brafman-Price, B., Bentley, A., Higginson, I. J., Todd, C. J., & Booth, S. (2016) · Trials · doi:10.1186/s13063-016-1304-6 · Cited by 138 · see citing works
“07) [32]).”
Lambert, S. D., Girgis, A., Lecathelinais, C., & Stacey, F. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-012-1495-7 · Cited by 135 · see citing works
Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers
Jacobs, J. M., Shaffer, K. M., Nipp, R. D., Fishbein, J. N., MacDonald, J. J., El-Jawahri, A. R., Pirl, W. F., Jackson, V. A., Park, E. R., Temel, J. S., et al. (2017) · Annals of Behavioral Medicine · doi:10.1007/s12160-017-9875-3 · Cited by 135 · see citing works
O’Carroll, R. E., Couston, M., Cossar, J., Masterton, G., & Hayes, P. C. (2003) · Liver Transplantation · doi:10.1053/jlts.2003.50138 · Cited by 128 · see citing works
Crawford, J. R., Garthwaite, P. H., Lawrie, C. J., Henry, J. D., MacDonald, M. A., Sutherland, J., & Sinha, P. (2008) · British Journal of Clinical Psychology · doi:10.1348/014466508x377757 · Cited by 129 · see citing works
“Crawford et al. (2001) reported a modest gender effect on the Anxiety scale of the HADS and provided separate percentile norms for males and females.”
BackgroundSelf-citationRasch analysis of the Hospital Anxiety and Depression Scale (HADS) for use in motor neurone disease
Gibbons, C. J., Mills, R. J., Thornton, E. W., Ealing, J., Mitchell, J. D., Shaw, P. J., Talbot, K., Tennant, A., & Young, C. A. (2011) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-9-82 · Cited by 130 · see citing works
“The Hospital Anxiety and Depression Scale (HADS) [1] is a reliable and potentially valid [2,3] measure for detecting depression and anxiety.”
BackgroundMethodBienvenu, O. J., Colantuoni, E., Mendez-Tellez, P. A., Shanholtz, C., Dennison-Himmelfarb, C. R., Pronovost, P. J., & Needham, D. M. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000000752 · Cited by 128 · see citing works
“To calculate the RCI, we used sd and test-retest reliability estimates from previous studies (21, 22).”
MethodSample Size Requirements for Traditional and Regression-Based Norms
Oosterhuis, H. E. M., van der Ark, L. A., & Sijtsma, K. (2015) · Assessment · doi:10.1177/1073191115580638 · Cited by 129 · see citing works
Talley, N. J., Kellow, J. E., Boyce, P. M., Tennant, C., Huskic, S., & Jones, M. (2007) · Digestive Diseases and Sciences · doi:10.1007/s10620-007-9830-4 · Cited by 130 · see citing works
“Hospital Anxiety and Depression Scale (HADS) is a 14-item scale for detecting mood disorders in nonpsychiatric patients [19].”
BackgroundThe psychosocial well-being of parents of children with cerebral palsy: a comparison study
Cheshire, A., Barlow, J. H., & Powell, L. A. (2010) · Disability and Rehabilitation · doi:10.3109/09638281003649920 · Cited by 128 · see citing works
“Using recommended cut-off points [29] 59% and 43% of the CPG were at risk of clinically anxious mood and clinically depressed mood, respectively.”
BackgroundSubjective caregiver burden of parents of adults with Duchenne muscular dystrophy
Pangalila, R. F., van den Bos, G. A. M., Stam, H. J., van Exel, J. N. A., Brouwer, W. B. F., & Roebroeck, M. E. (2011) · Disability and Rehabilitation · doi:10.3109/09638288.2011.628738 · Cited by 126 · see citing works
“Anxiety and depression in parents and patients are not more prevalent than in the general population [53]; nevertheless, anxious parents experience a heavier burden.”
BackgroundPsychological Symptoms of Family Members of High-Risk Intensive Care Unit Patients
McAdam, J. L., Fontaine, D. K., White, D. B., Dracup, K., & Puntillo, K. (2012) · American Journal of Critical Care · doi:10.4037/ajcc2012582 · Cited by 128 · see citing works
Neilson, K., Pollard, A. C., Boonzaier, A., Corry, J. F., Castle, D. J., Smith, D., Trauer, T., & Couper, J. W. (2012) · Psycho-Oncology · doi:10.1002/pon.3228 · Cited by 126 · see citing works
“However, the HNC sample in the current study scored higher on the depression subscale 3 weeks post-treatment when compared with a general population [36] and a general oncology sample [37], with one third of patients reporting symptoms above the cut-off threshold for depression at 3 weeks following radiotherapy.”
ResultHenry, J. D., Rendell, P. G., Green, M. J., McDonald, S., & O'Donnell, M. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.2.473 · Cited by 126 · see citing works
“The HADS is a 14-item self-report measure, frequently used in clinical practice and research, and reported to demonstrate good internal consistency and test-retest reliability ( Crawford, Henry, Crombie, & Taylor, 2001 ).”
MethodSelf-citationGillanders, D. T., Sinclair, A. K., MacLean, M., & Jardine, K. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.07.003 · Cited by 124 · see citing works
GOLDSTEIN, L. H., ATKINS, L., LANDAU, S., BROWN, R., & LEIGH, P. N. (2006) · Psychological Medicine · doi:10.1017/s0033291706007124 · Cited by 123 · see citing works
“The sum of the anxiety and depression scores was used to measure general psychological distress (Crawford et al. 2001).”
MethodHastings, R. P. (2016) · International review of research in developmental disabilities · doi:10.1016/bs.irrdd.2016.05.002 · Cited by 120 · see citing works
Cumming, G., Klein, S., Bolsover, D., Lee, A., Alexander, D., Maclean, M., & Jurgens, J. (2007) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2007.01452.x · Cited by 121 · see citing works
Prospective memory impairment in former users of methamphetamine
Rendell, P. G., Mazur, M., & Henry, J. D. (2008) · Psychopharmacology · doi:10.1007/s00213-008-1408-0 · Cited by 120 · see citing works
“The HADS is a 14-item self-report measure, frequently used in clinical practice and research, and reported to demonstrate good internal consistency and test–retest reliability (Crawford et al. 2001).”
MethodSelf-citationPrice, M. A., Butow, P. N., Costa, D. S. J., King, M. T., Aldridge, L. J., Fardell, J. E., DeFazio, A., & Webb, P. M. (2010) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03929.x · Cited by 116 · see citing works
Cognitive interpersonal maintenance model of eating disorders: intervention for carers
Goddard, E., Macdonald, P., Sepúlveda, A. R., Naumann, U., Landau, S., Schmidt, U. H., & Treasure, J. L. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.088401 · Cited by 116 · see citing works
Prevalence of depression in a 12‐month consecutive sample of patients with ALS
Wicks, P. J., Abrahams, S., Masi, D., Hejda-Forde, S., Leigh, P. N., & Goldstein, L. H. (2007) · European Journal of Neurology · doi:10.1111/j.1468-1331.2007.01843.x · Cited by 117 · see citing works
“In terms of the measures used, it has been suggested [26,46] that self-report questionnaires measure general levels of distress rather than the psychological constructs of depression or anxiety, and it should be noted that a label of severe depression from a self-report questionnaire does not have the validity of a di…”
BackgroundCrawley, E. M., Emond, A. M., & Sterne, J. A. C. (2011) · BMJ Open · doi:10.1136/bmjopen-2011-000252 · Cited by 115 · see citing works
“The following self-completed inventories were collected prior to assessment, at 6 weeks and 6 months: the 11-question Chalder fatigue scale14; the 10-question physical function subscale of the SF3615 (a well-validated health survey questionnaire where the worst physical function scored 10 and good physical function sc…”
MethodDoes active surveillance for men with localized prostate cancer carry psychological morbidity?
Whitaker, K. L., Parker, C. C., Dearnaley, D. P., Brewin, C. R., & Watson, M. (2007) · British Journal of Urology · doi:10.1111/j.1464-410x.2007.07009.x · Cited by 115 · see citing works
Desmond, D. M. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.07.027 · Cited by 115 · see citing works
“3%) for the current sample was almost three times greater than rates reported in a nonclinical sample broadly representative of UK adults [33].”
ResultHopwood, P., Sumo, G., Mills, J., Haviland, J., & Bliss, J. M. (2009) · The Breast · doi:10.1016/j.breast.2009.11.007 · Cited by 116 · see citing works
- Authors
- Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P.
- Affiliations
- University of Aberdeen (GB)
- Corresponding author
- Crawford, J. R.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2001-11
- Volume
- 40
- Issue
- 4
- Pages
- 429-434
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2014718757
- Cited by
- 815
- References
- 0
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 21 · 2023: 19 · 2022: 39 · 2021: 50 · 2020: 26 · 2019: 42 · 2018: 43 · 2017: 39 · 2016: 42 · 2015: 61 · 2014: 58 · 2013: 56 · 2012: 59
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- 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
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- reference values, anxiety, depression, non-clinical population, scoring reliability, cut-off values
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Female, United Kingdom, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Reference Values, Reproducibility of Results
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