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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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“A score higher than 11 indicates elevated levels of anxiety and depression [26], which was also recommended as a cut-off in a later normative data study with a non-clinical sample [27].”
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“In the non-clinical population, a cut-off of >10 has been suggested to distinguish between cases and non-cases [43].”
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“These figures are broadly representative of HADS scores seen for women in the general UK population (Crawford et al, 2001).”
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“”(10) If only moderate and severe cases are considered to be indicative of an anxiety disorder or depression, prevalence scores based on both subscales correspond well with the prevalence scores of anxiety and depression in the general adult population.(11) In the present study we therefore regard the moderate and sev…”
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“Scores ≥ 11 on either subscale qualify for clinical levels of anxiety and depression symptoms [32].”
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“23”
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“depressive symptoms in the UK general population.(36) A large proportion of participants in this study represent a group that is hard to engage in follow-up and into research studies.”
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“It is noteworthy that pre-lockdown scores for stress, anxiety and depression fall below the norms for these measures (Cohen et al., 1983; Crawford et al., 2001) indicating a relatively healthy sample; however, scores exceed norm values during lockdown.”
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“It has been validated against longer established standardised questionnaires [18] such as the Beck’s Depression Inventory [19] and has been shown to be reliable within the general population [20].”
MethodTaporoski, T. P., Negrão, A. B., Horimoto, A. R. V. R., Duarte, N. E., Alvim, R. D. O., de Oliveira, C. M., Krieger, J. E., von Schantz, M., Vallada, H., & Pereira, A. C. (2015) · PLoS ONE · doi:10.1371/journal.pone.0144255 · Cited by 27
“symptoms of anxiety and depression in men compared with women, as reported in previous studies world-wide [29, 30].”
ResultHigh psychosocial burden in relatives of malignant brain tumor patients
Stieb, S., Fischbeck, S., Wagner, W., Appels, J., & Wiewrodt, D. (2018) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2018.04.023 · Cited by 27
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Redhead, A. P., Turkington, D., Rao, S., Tynan, M., & Bourke, J. P. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.06.002 · Cited by 26
“2% in the general UK population [17–19].”
BackgroundResultInfluentialThe Male Cosmetic Surgery Patient
Dowling, N. A., Honigman, R. J., & Jackson, A. C. (2010) · Annals of Plastic Surgery · doi:10.1097/sap.0b013e3181a72f50 · Cited by 26
“77 for depression).(31) The internal consistency for the sample reported in the current study was high for the anxiety subscale ( 0.”
BackgroundRecurrent brain tumour: the impact of illness on patient's life
Lamperti, E., Pantaleo, G., Finocchiaro, C. Y., et al. (2011) · Supportive Care in Cancer · doi:10.1007/s00520-011-1220-y · Cited by 26
“Data of our sample were compared with normative data from a large (1,792 person, representative of the general adult British population) non-clinical sample [25] (Fig.”
ResultBeesley, V. L., Hughes, M. C. B., Smithers, B. M., Khosrotehrani, K., Malt, M. K., von Schuckmann, L. A., & Green, A. C. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00885-9 · Cited by 26
Increased Set Shifting Costs in Fasted Healthy Volunteers
Bolton, H., Burgess, P. W., Gilbert, S. J., & Serpell, L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0101946 · Cited by 29
“Fasted Satiated Normed sample (Crawford et al., 2001) Anxiety 5.86 6.29 6.14 (SD = 3.59) (SD = 3.58) Depression 2.17 2.9 3.68 (SD = 2.46) (SD = 3.22) doi:10.1371/journal.pone.0101946.t002 PLOS ONE | www.plosone.org 5 July 2014 | Volume 9 | Issue 7 | e101946 this was not specific to set shifting, it…”
InfluentialRead, J., Simonds, A. K., Kinali, M., Francesco Muntoni, A., & Garralda, M. E. (2010) · Neuromuscular Disorders · doi:10.1016/j.nmd.2010.05.011 · Cited by 26
“Normative data from a UK population of 1792 individuals was used as a comparison for patients and carers in the present study [18].”
InfluentialKasparian, N. A., Meiser, B., Butow, P. N., Simpson, J., & Mann, G. J. (2007) · Clinical Genetics · doi:10.1111/j.1399-0004.2007.00949.x · Cited by 26
“As previously found in hereditary breast/ovarian cancer (21, 46, 47), average scores for affected and unaffected participants for all outcome measures were relatively low (39, 45), and below clinical cutoffs, suggesting healthy psychological adjustment after notification of a family mutation in a melanoma susceptibili…”
ResultFigueras, A. D., Celis, R. R., Arroyo, L. M., & Rayo, I. G. (2011) · Revista de psicología · doi:10.5354/0719-0581.2011.17937 · Cited by 26
Briscoe, L., Lavender, T., O׳Brien, E., Malcom, C., & McGowan, L. (2015) · Midwifery · doi:10.1016/j.midw.2014.12.010 · Cited by 26
The Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome
Gotts, Z. M., Ellis, J. G., Deary, V., Barclay, N. L., & Newton, J. L. (2015) · PLoS ONE · doi:10.1371/journal.pone.0117136 · Cited by 26
Type D personality in patients with coronary artery disease.
Vuković, O., Toševski, D. L., Jašović‐Gašić, M., Damjanović, A., Zebić, M., Britvić, D., Stepanović, J., Djordjevic‐Dikic, A., Beleslin, B., & Ostojić, M. (2014) · PubMed · Cited by 26
Parker, H. L., Tucker, E., Blackshaw, E., et al. (2017) · Neurogastroenterology & Motility · doi:10.1111/nmo.13122 · Cited by 26
Swendeman, D. T., Fehrenbacher, A. E., Roy, S., Das, R., Ray, P., Sumstine, S., Ghose, T., & Jana, S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207055 · Cited by 26
Jones, C. J., & Bryant‐Waugh, R. (2012) · Appetite · doi:10.1016/j.appet.2011.12.017 · Cited by 26
Lodovico, L. D., & Gorwood, P. A. P. M. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112703 · Cited by 31
Demarzo, M., García‐Campayo, J., Martínez‐Rubio, D., Pérez‐Aranda, A., Miraglia, J. L., Hirayama, M. S., Salvo, V., Cicuto, K. M., Favarato, M. L., Terra, V. D. S., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17031081 · Cited by 34
Yang, Y., Wang, R., Zhang, D., Zhao, X., & Su, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105472 · Cited by 33
“Despite the wide application in psychiatric patients, HDS has been found to be applicable for the assessment of depressive symptoms in nonclinical settings such as nursing homes [49,50].”
BackgroundBurfield, L., Rutter, K. J., Thompson, B. S., Marjanovic, E. J., Neale, R. Ε., & Rhodes, L. E. (2022) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.18772 · Cited by 26
“Photodermatoses have a considerable negative impact on quality of life and psychological wellbeing.(4,5) A recent systematic review found one- third of patients with photodermatoses experienced a ‘very large’ or ‘extremely large’ impact on quality of life; that is, with a Dermatology Life Quality Index (DLQI) score >…”
BackgroundAnxiety and Depression in Patients Undergoing Mitral Valve Surgery: A Prospective Clinical Study
Botzet, K., Dalyanoĝlu, H., Schäfer, R., Lichtenberg, A., Schipke, J., & Korbmacher, B. (2017) · The thoracic and cardiovascular surgeon · doi:10.1055/s-0037-1604461 · Cited by 23
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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