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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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Items 501–600 of 810
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“Both anxiety and depression scores were sorted in four groups: 0–7: none; 8–10: mild; 11–15: moderate; ≥16: serious, using traditional instrument-specific thresholds [22].”
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“[37] provide UK normative data for the HADS.”
BackgroundHinz, A., Kittel, J., Karoff, M., & Schwarz, R. (2004) · PubMed Central · Cited by 16
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“The HADS has good reliability (Crawford et al., 2001), strong convergent validity (Bjelland et al.”
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Téllez, A., Rodríguez-Padilla, C., Martínez-Rodríguez, J. L., García, D. M. J., Cappello, O. S.-A., Sánchez, T. J., Segura, G., & Jaime-Bernal, L. (2017) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2016.1210497 · Cited by 16
“The total HADS score has been recommended as a measure of general distress (Alexander, Palmer, & Stone, 2010; Crawford et al., 2001; Pallant & Tennant, 2007; Singer et al., 2009).”
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“Each question is scored in a simple Likert fashion (0 through 3), yielding a range of scores from 0 to 21 for each item (Crawford et al., 2001).”
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“This scale was originally developed for use in hospital outpatient mental health clinics and shows strong reliability and validity for measuring anxiety and depression for community samples (Crawford et al., 2001), including the present sample.”
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Stool characteristics and colonic transit in irritable bowel syndrome: evaluation at two time points
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“{HADS scores: 0e71⁄4normal; 8e101⁄4borderline abnormal; 11e211⁄4abnormal.(29) CF, cost-free pharmacotherapy; HADS, Hospital Anxiety and Depression Scale; PO, prescription only.”
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“The cutoff value for each subscale is still under discussion but, in accordance with frequent recommendations, we considered that a total score of above 10 was indicative of a clinical diagnosis of moderate-to-severe anxiety or depression.(20)”
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Donnelly, B., Foroughi, N., Williams, M., Touyz, S. W., Madden, S., Kohn, M. R., Clark, S., Sachdev, P. S., Peduto, A. J., Caterson, I. D., et al. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.687849 · Cited by 14
Problem gambling during Covid-19
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“This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. attention to and…”
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“Normative data from nonpatients were used to establish whether patients had experienced improvements of their anxiety and depression symptoms [25].”
MethodWhite, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., McLeod, H. J., & Mitchell, G. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.06.004 · Cited by 13
“HADS normative data obtained by Crawford et al. (2001) from a non-clinical sample broadly representative of the UK general adult population (N = 1792) yielded clinical cut-off scores for the HADS Depression and Anxiety subscales of 8.07 and 8.66 respectively.”
MethodInfluentialvan de Geest-Buit, W. A., Rasing, N. B., Mul, K., Deenen, J. C. W., Vincenten, S. C. C., Siemann, I., Lanser, A., Groothuis, J. T., van Engelen, B. G., Custers, J. A. E., et al. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2092779 · Cited by 13
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Ciaffi, J., Lisi, L., Mari, A., Mancarella, L., Brusi, V., Pignatti, F., Ricci, S., Vitali, G., Stefanelli, N., Assirelli, E., et al. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1219321 · Cited by 15
“A cut-off of >10 has been suggested to distinguish between cases and non-cases in non-clinical populations (40).”
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“However, compared to average normative data within a non-clinical sample (Crawford et al. 2001), there are no indications of more (or less) anxiety complaints in this sample of respondents with an out-of-body experience.”
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Willmer, M., Berglind, D., Thorell, A., Sundbom, M., Uddén, J., Raoof, M., Hedberg, J., Tynelius, P., Ghaderi, A., Näslund, E. B., et al. (2014) · Obesity Surgery · doi:10.1007/s11695-014-1398-4 · Cited by 12
“8 for HADS-D [21, 22].”
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“The scale demonstrates good reliability and validity and is widely used as a measure of anxiety and depression in health care services and there is normative data for comparison (9).”
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“…raised in our survey responses when compared to normative HADS data among other non-clinical prepandemic samples (e.g. Crawford et al. recorded 33.2% within the mild-severe range for anxiety and 11.4% for depression [35]), it was still lower than assessed during the elsewhere during the pandemic.”
InfluentialValidation of an individualised quality of life measure in older day hospital patients
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“Normative scores for the PedsQL-FIM, PSS-10, and HADS were derived from Medrano et al. (2013), Cohen (1988), and Crawford et al. (2001), respectively.”
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“…Scale anxiety and depression (mean 9.04, SD 0.34, and mean 5.49, SD 0.29, respectively) were significantly worse than published UK normative data [33] (anxiety: mean 6.14, SD 3.76; depression: mean 3.68, SD 3.07; anxiety: mean difference 2.896, SE 0.341; t 62011 =8.49; P <.001; depression: mean…”
InfluentialBonafede, M., d’Errico, A., Rugarli, S., Mensi, C., Miligi, L., Calisti, R., Gatta, R., Piro, S., Melis, P. M., Vasselli, D., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1355186 · Cited by 11
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“, the HADS, Although HADS has been found to be appropriate for non-clinical populations (67), the scale covers a limited array of the symptoms characterizing both depression and anxiety.”
MethodArthur, A. R., & Edwards, C. (2005) · European Journal of Psychotherapy & Counselling · doi:10.1080/13642530500249761 · Cited by 11
“Using the cut-off of ten recommended by Crawford et al. (2001) to identify moderate to severe cases identifies 74 per cent (52) as suffering from anxiety and 49 per cent (34) as suffering from depression, suggesting that more people experienced anxiety than depression.”
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“The normative values for HADS were obtained from 1,792 individuals representative of the general adult population of the UK (27).”
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Bosma, H., Sanderman, R., Scaf-Klomp, W., et al. (2004) · Psychology and Health · doi:10.1080/08870440310001594510 · Cited by 11
“and depression (Herrmann, 1997; Spinhoven et al., 1997; Crawford et al., 2001).”
BackgroundFreer, A., Williams, F. R., Durman, S., Hayden, J. K., Armstrong, M. J., & Trivedi, P. J. (2024) · JHEP Reports · doi:10.1016/j.jhepr.2024.101210 · Cited by 12
“62 Whilst we observed an improvement in the HADS over time, scores remained within the ‘ abnormal ’ category at 12 weeks.”
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“Although scores of 8–10 are borderline and >11 indicative of either anxiety or depression ‘caseness’, in view of the recognised high intercorrelation between Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores, we used the sum of scores for the anxiety and depression subscales in our regression…”
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“This 14-item self-report standardised questionnaire was developed to identify cases of anxiety and depression in non-psychiatric samples (Crawford et al. 2001).”
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“Te HADS was originally developed for use in clinical settings; however, it is now widely used in nonclinical populations [52].”
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“This study adopted the more stringent threshold of 10 /21 for defining a case of anxiety for the HADS-A Scale.(19)”
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“Scores on the anxiety and depression components of the HADS were not significantly different between the groups (see Table 1), with mean for both groups within the normal range (<8, Crawford, Henry, Crombie & Taylor, 2001).”
Ciobotaru, D., Jefferies, R., Lispi, L., & Derakshan, N. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103926 · Cited by 9
la Rosa-Cáceres, A. D., Lozano, O. M., Sánchez‐García, M., Fernández‐Calderón, F., Rossi, G. M. P., & Díaz, C. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10008-6 · Cited by 10
“For example, scales such as the Depression Anxiety Stress Scales (DASS; Crawford & Henry, 2003), the Hospital Anxiety and Depression Scale (Crawford et al., 2001; Hinz & Brähler, 2011) or the Inventory of Depression and Anxiety Symptoms (IDAS-II; Nelson et al., 2018; SánchezGarcía et al., 2021) have available reports…”
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Greenway, L., Ahern, D., Leavy, Y., Rawnsley, M., & Duncan, S. (2013) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2013.08.030 · Cited by 9
Ambaw, F. (2011) · Ethiopian Journal of Health Sciences · doi:10.4314/ejhs.v21i1.69041 · Cited by 9
“The observed correlations between the two subscales in both samples of this study were strong similar to reports from other studies (18, 22, 33) showing the significant overlap between the two constructs.”
ResultThe course and impact of family optimism in the post-acute period after acquired brain injury
Riley, G. A., Hough, A., Meader, L. M., & Brennan, A. J. (2015) · Brain Injury · doi:10.3109/02699052.2015.1004754 · Cited by 9
An investigation into the psychometric properties of the CORE‐OM in patients with eating disorders
Jenkins, P. E., & Turner, H. M. (2013) · Counselling and Psychotherapy Research · doi:10.1080/14733145.2013.782057 · Cited by 9
“It is widely used with good internal reliability (Crawford, Henry, Crombie, & Taylor, 2001) as well as good test-retest reliability (Spinhoven et al., 1997), and its use has been supported in a number of different samples (e.g., Bjelland, Dahl, Haug, & Neckelmann, 2002; Mykletun, Stordal, & Dahl,…”
Heald, A., Walther, A., Davis, J. R. E., Moreno, G., Kane, J., Livingston, M., & Fowler, H. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00764 · Cited by 9
“Although Zigmund and Snaith’s original conception of the HADS as measuring independent dimensions of anxiety and depression has been found untenable, it is legitimate to obtain a score on the total scale if a measure of general psychological distress is required (Crawford et al., 2001).”
BackgroundResultHenderson, M., Wittkowski, A., McIntosh, E., McConnachie, A., Buston, K., Wilson, P., Calam, R. M., Minnis, H., Thompson, L. C., O'Dowd, J. J., et al. (2019) · Trials · doi:10.1186/s13063-019-3571-5 · Cited by 9
Beswick, E., Glasmacher, S. A., Dakin, R. S., Newton, J. L., Carson, A. J., Abrahams, S., Chandran, S., & Pal, S. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044996 · Cited by 8
Brown, S. L., Fisher, P., Hope‐Stone, L., Damato, B. E., Heimann, H., Hussain, R. N., & Cherry, M. G. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-021-01036-4 · Cited by 8
“We used Crawford et al’s [23] (n=1,792) UK general population HADS norms of 6.”
InfluentialWalter, S., Jones, M. P., Sjödahl, J., Stjernman, H., Hjortswang, H., & Andréasson, A. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1974087 · Cited by 8
“For example, Crawford et al. found a mean anxiety score of 6.1 (SD ¼ 3.76) and depression score of 3.7 (SD ¼ 3.07) in a non-clinical sample, broadly representative of the general adult UK population [71].”
InfluentialPsychological Time during the COVID-19 Lockdown: Canadian Data
Rioux, P.-A., Chaumon, M., Demers, A., Fitzback-Fortin, H., Kübel, S. L., Lebrun, C., Mendoza-Durán, E., Micillo, L., Racine, C., Thibault, N., et al. (2022) · Timing & Time Perception · doi:10.1163/22134468-bja10063 · Cited by 8
Price, A., Sumner, P., & Powell, G. (2025) · Vision Research · doi:10.1016/j.visres.2025.108610 · Cited by 8
“The HADS-A subscale shows adequate internal consistency (Cronbach ’ s α = 0.82; Crawford et al., 2001).”
InfluentialPsychological Characteristics and Outcomes of Elective Cosmetic Surgery Patients
Dowling, N. A., Jackson, A. C., Honigman, R. J., & Francis, K. L. (2011) · Plastic and Aesthetic Nursing · doi:10.1097/psn.0b013e31823ef115 · Cited by 8
“The HADS has shown consistently good psychometric properties (Bjelland, Dahl, Haug, & Neckelmann, 2002; Crawford, Henry, Crombie, & Taylor, 2001; Herrmann, 1997), with adequate to high internal consistency reliabilities ( .82 for anxiety and .77 for depression; Crawford et al., 2001).”
BackgroundHowarth, A., Perkins-Porras, L., Smith, J. G., Subramaniam, J., Copland, C., Hurley, M. V., Beith, I. D., Riaz, M. A., & USSHER, M. H. (2016) · Trials · doi:10.1186/s13063-016-1405-2 · Cited by 8
“A score of 0–21 is calculated for each disorder with total scores between 11–21 indicating abnormal levels of anxiety/depression [38].”
BackgroundStreamlining screening of emotional function in Veterans with traumatic brain injury
Flaherty, J. M., Spencer, R. J., Drag, L. L., Pangilinan, P. H., & Bieliauskas, L. A. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22595 · Cited by 8
Development and Pilot Testing of a Coping Kit for Parents of Hospitalized Children
Hill, D. L., Carroll, K. W., Snyder, K. J., Mascarenhas, M. R., Erlichman, J., Patterson, C. A., Barakat, L. P., & Feudtner, C. (2018) · Academic Pediatrics · doi:10.1016/j.acap.2018.11.001 · Cited by 8
Sousa, C., Jacques, T., Sá, M. J., & Alves, R. A. (2022) · Applied Neuropsychology Adult · doi:10.1080/23279095.2022.2112681 · Cited by 11
“Anxiety and depression were assessed with the Hospital Anxiety Depression Scale (HADS), a validated self-report screening scale used to investigate the prevalence of emotional distress among patients in general medical clinics (Crawford et al., 2001).”
MethodSherwood, A., Paynter, J. M., & Emerson, L. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02571-7 · Cited by 13
Anxiety, depression, and brain overwork in the general population of Mongolia
Lkhagvasuren, B., Hiramoto, T., Bat-Erdene, E., Tumurbaatar, E., Tumur-Ochir, G., Amartuvshin, T., Dashtseren, M., Lai, E., Viswanath, V., Oka, T., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-52779-w · Cited by 8
“The normative scores were higher or similar compared with those of other countries 25–30 (Supplementary Table S4).”
ResultGillanders, S., & Gillanders, D. T. (2018) · Routledge eBooks · doi:10.4324/9780429466618-3 · Cited by 8
Ellis, G., Pridgeon, S. W., Lamb, B. W., Awsare, N., Osaghae, S., Smith, S. G., McNicholas, T., & Green, J. (2014) · Journal of Clinical Urology · doi:10.1177/2051415814551821 · Cited by 8
Attentional biases in patients with alcohol dependence: influence of coexisting psychopathology
Sinclair, J., Garner, M. J., Pasche, S. C., Wood, T. B., & Baldwin, D. S. (2016) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2549 · Cited by 8
Ensari, I., Pilutti, L. A., & Motl, R. W. (2017) · Acta Neurologica Scandinavica · doi:10.1111/ane.12748 · Cited by 9
Ritz, T., Rosenfield, D., Laurent, C. D. S., Trueba, A. F., Werchan, C. A., Vogel, P. D., Auchus, R. J., Reyes‐Serratos, E., & Befus, A. D. (2017) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00393.2016 · Cited by 8
Praz, C., Ducki, J., Connaissa, M.-L., Terrier, P., Vuistiner, P., Léger, B., & Lüthi, F. (2018) · Pain Research and Management · doi:10.1155/2018/4128913 · Cited by 8
“)is selfadministrated questionnaire was originally designed for hospitalized patients but has been also validated for the general population [45].”
Background
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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