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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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Men's experiences of having lower urinary tract symptoms: factors relating to bother
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ResultInterventions to help support caregivers of people with a brain or spinal cord tumour
Boele, F. W., Rooney, A. G., Bulbeck, H., & Sherwood, P. R. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012582.pub2 · Cited by 57
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Gotink, R. A., Younge, J. O., Wery, M. F., Utens, E. M. W. J., Michels, M., Rizopoulos, D., van Rossum, L. F. C., Roos-Hesselink, J. W., & Hunink, M. M. G. (2017) · PLOS ONE · doi:10.1371/journal.pone.0175923 · Cited by 47
Prevalence of depression in patients referred with snoring and obstructive sleep apnoea
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“In the absence of Australian norms, comparisons were made with a representative community sample of Australian women aged 18 to 59 (Osborne et al., 2004) and with U.K. norms (men and women) (Crawford et al., 2001).”
MethodEvaluation of screening instruments for depression and anxiety in breast cancer survivors
Alexander, S. B., Palmer, C., & Stone, P. C. (2009) · Breast Cancer Research and Treatment · doi:10.1007/s10549-009-0669-6 · Cited by 52
“Using the recommended [14, 16] cut-off score of [12 to screen for depression, the sensitivity and specificity of the EDS were found to be 72% (95% CI 0.”
BackgroundZhang, D., Yang, Y., Sun, Y., Wu, M., Xie, H. W., Wang, K., Zhang, J., Jia, J., & Su, Y. (2017) · Geriatric Nursing · doi:10.1016/j.gerinurse.2017.02.005 · Cited by 53
Mannan, A., Ghani, S., Clarke, A. M., White, P., Salmanta, S., & Butler, P. E. M. (2006) · Burns · doi:10.1016/j.burns.2005.08.027 · Cited by 53
“Hospital anxiety and depression scale [16,17]”
Tromp, D. M., Brouha, X. D. R., Hordijk, G. J., Winnubst, J. A. M., Gebhardt, W. A., van der Doef, M., & de Leeuw, J. R. J. (2005) · Health Education Research · doi:10.1093/her/cyh031 · Cited by 53
“A score above the cut-off score of 19 is an indication of a major depressive disorder (Razavi et al., 1990).”
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“Percentile plots for anxiety scores for (a) adult men with CF (solid line) and n women (broken line), (c) adult men with CF (solid line) and boys with CF (broken Normative UK adult data from [23].”
BackgroundFactors influencing uptake of familial long QT syndrome genetic testing
Burns, C., McGaughran, J. M., Davis, A. M., et al. (2015) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.37455 · Cited by 51
“These are higher than expected given previous studies in genetic heart disease patient groups, as well as normative data and data from Australian cancer cohorts [Crawford et al., 2001; Boyes et al., 2009; Ingles et al., 2013a; Ingles et al., 2015].”
ResultGreen, M. J., & Benzeval, M. (2010) · Psychological Medicine · doi:10.1017/s0033291710000851 · Cited by 55
“Crosssectional normative data for the HADS in the UK has shown similar prevalence rates (Crawford et al. 2001) ; in the normative data 33% had scores of 8 or more on the anxiety subscale and 11.4% had scores of 8 or more for depression, whereas in the fourth wave of Twenty-07 (the closest time…”
BackgroundInfluentialClarke, S.-A., Newell, R., Thompson, A. R., Harcourt, D. M., & Lindenmeyer, A. (2013) · Psychology Health & Medicine · doi:10.1080/13548506.2013.855319 · Cited by 51
Barlow, J. H., Powell, L. A., & Gilchrist, M. (2005) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2005.02.005 · Cited by 51
Group cognitive analytic therapy for female survivors of childhood sexual abuse
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“For a chronic pain patient population, our subjects showed relatively low anxiety and depression levels (mean anxiety from HADS at baseline 7.0 ± 1.5, post-TMS 6.3 ± 1.5; depression at baseline 7.0 ± 1.5, post-TMS 6.3 ± 1.5).”
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Type D Personality Is Associated with Social Anxiety in the General Population
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Correlates of health related quality of life in adult patients with spinal muscular atrophy
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“The self-report measures of mood and burnout indicated that the doctors in the present study were reporting levels of functioning largely comparable to what has been reported previously in populations of healthy adults (Watson et al. 1988; Crawford et al. 2001; Argentero et al. 2008).”
ResultCollin, S. M., Nuevo, R., van de Putte, E. M., Nijhof, S. L., & Crawley, E. M. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008830 · Cited by 48
“The HADS is a 14-item inventory with anxiety and depression subscales.(24) Cut-off scores for HADS depression were >9 for boys, >10 for girls(25) and >12 for adults.”
BackgroundPrefrontal control of attention to threat
Peers, P. V., Simons, J. S., & Lawrence, A. D. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00024 · Cited by 55
“ACS scores ranged from 45 to 70 (mean 57.1, SD 6.2) whilst HADS anxiety scores ranged from 2 to 18 (mean 5.5, SD 2.5) and were comparable to published norms of healthy populations (Crawford et al., 2001).”
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“77 for the depression scale for a non-clinical population (Crawford et al. 2001).”
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McBain, H. B., MacKenzie, K. A., Au, C., Hancox, J. C., Ezra, D. G., Adams, G. G. W., & Newman, S. P. (2014) · British Journal of Ophthalmology · doi:10.1136/bjophthalmol-2013-304220 · Cited by 48
In multiple sclerosis anxiety, not depression, is related to gender
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“A high combined HADS total score (HADS-T) may indicate psychological distress and, as such, was used in the bivariate and multivariate analyses in our study [28].”
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“Some studies report no difference or less depression among women [7–9], whereas one study reports more depression among women [10].”
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“68) for the HADs depression subscale (Crawford, Henry, Crombie, & Taylor, 2001 ).”
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Al‐Adawi, S., Dorvlo, A. S. S., Al‐Naamani, A., Glenn, M. B., Karamouz, N., Chae, H., Zaidan, Z. A. J., & Burke, D. T. (2007) · Brain Injury · doi:10.1080/02699050701311059 · Cited by 44
“Although HADS was essentially designed to diagnose and measure the severity of depression and generalized anxiety [15], it has also been employed for case identification in non-clinical populations [16, 17].”
MethodPsychological Well-Being of Mothers and Siblings in Families of Girls and Women with Rett Syndrome
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“Crawford et al. (2001) recommended using a cut-off score of [10 on either the HADS anxiety and depression scales to indicate clinical levels of problems, and also reported normative data for British women.”
MethodGeneral anxiety symptoms after acute lung injury: Predictors and correlates
Stevenson, J. E., Colantuoni, E., Bienvenu, O. J., Sricharoenchai, T., Wozniak, A. W., Shanholtz, C. B., Méndez-Téllez, P. A., & Needham, D. M. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.06.002 · Cited by 44
“The 38% prevalence of ALI survivors having a positive screening test for general anxiety symptoms at 3 month follow-up is much higher than the 18% 12-month prevalence of any anxiety disorder in the United States general population [5] and the 21% point prevalence of a HAD-A score ≥8 in a large non-clinical sample of a…”
BackgroundWilliams, S. E., Carroll, D., Zanten, J. V., & Ginty, A. T. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.051 · Cited by 47
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“Their levels of anxiety and depression were higher than those from a non-clinical sample [28] but comparable to those of cancer patients in North America and Northwest Europe”
ResultRavn, S. L., Vægter, H. B., Cardel, T., & Andersen, T. E. (2018) · Journal of Pain Research · doi:10.2147/jpr.s155241 · Cited by 45
“21 Test-retest reliability was good for both the anxiety subscale ( r = 0.89, p < 0.05) and the depression subscale ( r = 0.92, p < 0.05), 21 and likewise, Crawford et al. 22 found good internal consistency on both scales ( α= 0.82; α= 0.77).”
InfluentialCopeland, L. (2003) · Family Practice · doi:10.1093/fampra/cmg410 · Cited by 44
Quality of Life, Depression, and Anxiety in Patients with Uveal Melanoma: A Review
Miniati, M., Fabrini, M. G., Ebert, F. G., et al. (2018) · Journal of Oncology · doi:10.1155/2018/5253109 · Cited by 43
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The role of patient appraisal and coping in predicting distress in IVF
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“These levels of anxiety exceed community norms with use of the same HADS ‘caseness’ criteria (Crawford et al., 2001).”
MethodHinz, A., Krauß, O., Stolzenburg, J., Schwalenberg, T., Michalski, D., & Schwarz, R. (2008) · Urologic Oncology Seminars and Original Investigations · doi:10.1016/j.urolonc.2008.02.003 · Cited by 43
Facial affect recognition and schizotypy
Williams, B. T., Henry, J. D., & Green, M. J. (2007) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2007.00023.x · Cited by 43
“The HADS has been shown to have good reliability and validity as an index of this construct.(20) Procedure”
MethodSelf-citationon behalf of the LSOS Study Group, Ulrich, N. H.-B., Burgstaller, J. M., et al. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-1022-y · Cited by 43
“The HADS was originally developed to measure anxiety and depression in a hospital setting [30], however, it is nowadays common to use it in all settings [31].”
BackgroundA hybrid emotion-focused exposure treatment for chronic pain: A feasibility study
Linton, S. J., & Fruzzetti, A. E. (2014) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2014.05.008 · Cited by 41
“Scores are interpreted as 8–10, mild; 11–15 moderate; and >15 severe levels of anxiety and depression respectively [25].”
BackgroundKamboj, S. K., Irez, D., Serfaty, S., Thomas, E., Das, R. K., & Freeman, T. P. (2017) · International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyx064 · Cited by 41
Löfvenmark, C., Saboonchi, F., Edner, M., Billing, E., & Mattiasson, A. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2012.04201.x · Cited by 42
Halliwell, G., Dheensa, S., Fenu, E., Jones, S. K., Asato, J., Jacob, S., & Feder, G. S. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4621-0 · Cited by 49
Depressive symptoms predict clinical recurrence of inflammatory bowel disease
Jordi, S. B. U., Lang, B. M., Auschra, B., von Känel, R., Biedermann, L., Greuter, T., Schreiner, P., Rogler, G., Krupka, N., Sulz, M. C., et al. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izab136 · Cited by 41
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Appearance concerns in ophthalmic patients
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The Psychological Effects of Short-Term Fasting in Healthy Women
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Australian population norms for the Index of Dental Anxiety and Fear (IDAF‐4C)
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Mental health, anxiety, and depression in patients with cerebral aneurysms
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“However, relative to normative values derived from a sample drawn from the general adult population (M = 10.1, SD = 6.39), mean scores for the control group (M = 11.5) and in particular the schizophrenia group (M = 15.2) are elevated (Crawford et al., 2001).”
InfluentialSelf-citationBody-image disturbance in adult dialysis patients
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“The HADS has satisfactory internal consistency, test–retest reliability [12,13], face, construct and concurrent validity [12], and recent use of the HADS with patients with ESRF found it to have satisfactory internal reliability [14].”
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“HADS and FACTBr data refer to the normative values (Brucker et al., 2005; Crawford et al., 2001).”
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“It has good reliability((47)) and high convergent validity with other measures of anxiety((48)).”
BackgroundBrief metacognitive therapy for emotional distress in adult cancer survivors.
Fisher, P. L., Byrne, A., Fairburn, L., Ullmer, H., Abbey, G., & Salmon, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00162 · Cited by 38
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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