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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 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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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ResultYoung, E., EDDLESTON, J. M., Ingleby, S., Streets, J., McJanet, L., Wang, M., & Glover, L. (2004) · Intensive Care Medicine · doi:10.1007/s00134-004-2495-y · Cited by 84
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BackgroundQuality of Life and Non-Pain Symptoms in Patients with Cancer
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“75, and a recommended cut-off score for clinical levels of depression suggested at 10/11 (Crawford et al. 2001).”
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“Scores of 10 and below indicate normal levels of anxiety or depression (Crawford, Henry, Crombie, & Taylor, 2001 ).”
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The Association between Adiposity, Mental Well-Being, and Quality of Life in Extreme Obesity
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“They also completed the Hospital Anxiety and Depression Scale (HADS [29]), which is widely used in clinical practice and research and shows acceptable reliability [30].”
The burden of brain tumor: a single-institution study on psychological patterns in caregivers
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Cervical Spondylotic Myelopathy, Depression, and Anxiety: A Cohort Analysis of 89 Patients
Stoffman, M. R., Roberts, M. S., & King, J. T. (2005) · Neurosurgery · doi:10.1227/01.neu.0000166664.19662.43 · Cited by 65
Næss, H., Nyland, M., Hausken, T., Follestad, I., & Nyland, H. (2012) · BMC Gastroenterology · doi:10.1186/1471-230x-12-13 · Cited by 63
“There are normative data from Swedish and English studies [26,27].”
BackgroundAwsare, N., Green, J. S. A., Aldwinckle, B., Hanbury, D. C., Boustead, G. B., & McNicholas, T. (2008) · Prostate Cancer and Prostatic Diseases · doi:10.1038/pcan.2008.21 · Cited by 63
Saksvik‐Lehouillier, I., Saksvik, S. B., Dahlberg, J., Tanum, T. K., Ringen, H., Karlsen, H. R., Smedbøl, T., Sørengaard, T. A., Stople, M., Kallestad, H., et al. (2020) · SLEEP · doi:10.1093/sleep/zsaa078 · Cited by 66
“Also, the participants in our study had better scores on several baseline measures of health and sleep compared to norm samples [29] and comparable student samples [38].”
BackgroundMethodResultAnxiety in the management of localised prostate cancer by active surveillance
Anderson, J. B., Burney, S., Brooker, J., Ricciardelli, L. A., Fletcher, J. M., Satasivam, P., & Frydenberg, M. (2014) · British Journal of Urology · doi:10.1111/bju.12765 · Cited by 62
Shiraz, F., Rahtz, E., Bhui, K. S., Hutchison, I. L., & Korszun, A. (2014) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.bjoms.2014.03.019 · Cited by 62
The factor structure of the Hospital Anxiety and Depression Scale in acquired brain injury
Dawkins, N., Cloherty, M. E., Gracey, F., & Evans, J. J. (2006) · Brain Injury · doi:10.1080/02699050601076414 · Cited by 62
Saksvik‐Lehouillier, I., Bjorvatn, B., Hetland, H., Sandal, G. M., Moen, B. E., Magerøy, N., Harvey, A. G., Costa, G., & Pallesen, S. (2012) · Work & Stress · doi:10.1080/02678373.2012.686344 · Cited by 62
“The HADS is found to be reliable in the setting of a hospital medical outpatient clinic (Zigmond & Snaith, 1983 ), and a non-clinical sample (Crawford, Henry, Crombie, & Taylor, 2002 ).”
MethodTaylor, S. J. C., Carnes, D., Homer, K., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Pincus, T., Rahman, A., & Underwood, M. (2016) · PLoS Medicine · doi:10.1371/journal.pmed.1002040 · Cited by 63
“Nearly half our participants, 322/703 (46%), met the criterion for possible clinical depression at baseline [44].”
Burnout and Cognitive Performance
Koutsimani, P., Montgomery, A., Masoura, E. V., & Panagopoulou, E. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18042145 · Cited by 68
“Although it was originally developed for use in hospital patients, now it is widely used across all settings, including normal populations [66].”
BackgroundDetection and treatment of postnatal depression (perinatal depression or anxiety)
Matthey, S. (2004) · Current Opinion in Psychiatry · doi:10.1097/00001504-200401000-00005 · Cited by 61
Web-based depression treatment: Associations of clients׳ word use with adherence and outcome
van der Zanden, R. A., Curie, K., van Londen, M., Kramer, J., Steen, G. J., & Cuijpers, P. J. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.01.005 · Cited by 61
Stock, N. M., Costa, B., White, P., & Rumsey, N. (2020) · The Cleft Palate Craniofacial Journal · doi:10.1177/1055665619862457 · Cited by 61
An investigation of the subjective experiences of sex after alcohol or drug intoxication
Sumnall, H. R., Beynon, C. M., Conchie, S. M., Riley, S. C. E., & Cole, J. C. (2007) · Journal of Psychopharmacology · doi:10.1177/0269881106075590 · Cited by 60
The role of clinical and social cognitive variables in parasuicide
O'Connor, R. C., Armitage, C. J., & Gray, L. (2006) · British Journal of Clinical Psychology · doi:10.1348/014466505x82315 · Cited by 60
“Both subscales are reliable and valid (Bjelland, Dahl, Haug, & Neckelmann, 2002; Crawford, Henry, Crombie, & Taylor, 2001).”
Anxiety and panic fear in adults with asthma: prevalence in primary care
Cooper, C. L., Parry, G. D., Saul, C., Morice, A. H., Hutchcroft, B. J., Moore, J., & Esmonde, L. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-62 · Cited by 59
“Table 1: Hospital Anxiety and Depression Scale anxiety: Comparison of asthma population survey data with population norms [22]”
InfluentialPiil, K., Jakobsen, J., Christensen, K. B., Juhler, M., & Jarden, M. (2015) · Journal of Neuro-Oncology · doi:10.1007/s11060-015-1821-2 · Cited by 58
“…and Depression Scale, SD standard deviation, Test 2 week 6, Test 3 week 28, Test 4 week 40, Test 5 week 52 a n = 25 b n = 22 c Based on 1.792 individuals representative of the general adult population in the UK (Crawford et al. 2001) d One sample t-tests of average for change scores from test 5…”
BackgroundResultInfluentialFarren, J. A., Jalmbrant, M., Falconieri, N., Mitchell‐Jones, N., Bobdiwala, S., Al‐Memar, M., Tapp, S., CALSTER, B. V., Wynants, L., Timmerman, D., et al. (2020) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.23147 · Cited by 61
Comparison of upper limb amputees and lower limb amputees: a psychosocial perspective
Desteli, E. E., İmren, Y., Erdoğan, M., Sarísoy, G., & Coşgun, S. (2014) · European Journal of Trauma and Emergency Surgery · doi:10.1007/s00068-014-0418-3 · Cited by 61
“Mean total ABIS-R score indicated significantly greater body image disturbance for UL amputees (p \ 0.001).”
MethodInfluentialHinz, A., Finck, C., Gómez, Y., Daig, I., Glaesmer, H., & Singer, S. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0714-y · Cited by 59
“Such normative studies have been performed in several countries: Germany [17], UK [18, 19], Norway [20] (depression subscale only), Sweden [21], Hong Kong [22], and South Korea [23].”
BackgroundAdaptation to Physical Disabilities: The Role of Meaning in Life and Depression
Psarra, E., & Kleftaras, G. (2013) · The European Journal of Counselling Psychology · doi:10.5964/ejcop.v2i1.7 · Cited by 60
Robertson, N., Javed, N., Samani, N. J., & Khunti, K. K. (2007) · Heart · doi:10.1136/hrt.2006.100537 · Cited by 59
Metadata
- 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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