Hospital Anxiety And Depression Scale: How Psychological Tests Can Help Your Outcome

Updated February 6, 2023by BetterHelp Editorial Team

Physical and mental health disorders often go hand in hand. After all, it isn’t always easy to feel calm and positive when you’re experiencing physical pain, discomfort, or illness. And, if you experience symptoms of a mental health disorder, medical problems can seem more overwhelming. For these two reasons, doctors and psychologists worked together to create the Hospital Anxiety and Depression Scale. Here’s what it is, how it helps, and how it can improve your outcome when seeking medical care.

What Is The Hospital Anxiety And Depression Scale?

Experiencing Symptoms Of Anxiety Or Depression?

The Hospital Anxiety and Depression Scale is a test you might be asked to take if you go to the hospital, an outpatient medical treatment center, or a doctor’s office. It’s a short, easy test that takes only about two to five minutes to complete. It’s also a self-assessment test, meaning you are the one who evaluates how much anxiety and depression symptoms were impacting you over the past week.

To fill out the anxiety test and depression scale HADS questionnaire, you answer questions that are relevant to depression and others relevant to anxiety. Because anhedonia, or loss of pleasure, can be a primary feature of depression, most of the questions relating to depression ask about that. 

Questions for the depression scale might include: Do you take as much interest in things you used to? Do you feel cheerful? For the anxiety part of the questionnaire, you answer questions related to anxiety, such as: Do you worry a lot? Do you have panic attacks?

You answer each question on the Hospital Anxiety and Depression Scale by choosing a number from 0 to 3, indicating how much the question matches your thoughts, feelings, and behaviors. After you take the test, your doctor adds up the score to determine if they need to do something further concerning your mental health. In this test, the possible scores range from 0 to 21 for depression and the same for anxiety. The scores indicate:

  • 0 to 7 –normal range

  • 8 to 10 – anxiety or depression might be present

  • 11 and above –depression or anxiety is probably present

HADS is only a screening test done to ensure that your doctor is aware of possible mental health concerns. Neither the depression scale nor the anxiety scale is used for diagnosis, though. If the test shows that you might be experiencing a mental illness, a doctor or psychologist may talk with you, assess your mental health and decide whether a diagnosis of depression or anxiety is appropriate. 

Why Is HADS Needed?

Going in for medical treatments often involves submitting to a lot of tests. So, it’s understandable if you question why you need to take one more. Why do you need to think about the possibility of anxiety or take a depression scale right now? The answer is simple: so that your doctor can offer you the best care possible.

Even before they had an anxiety test and depression scale, like HADS, doctors knew their patients experienced both mental and physical stress during hospital stays. Yet, they didn’t know how to assess their patients’ mental condition or feel confident in doing so. The Hospital Anxiety and Depression Scale gave them a quick, concise way to determine if their patient needs special considerations in their medical treatment or mental health support.

After scoring your depression scale and anxiety questions, your doctor may refer you to a mental health provider for long-term support. Also, knowing the status of your mental health may have a bearing on the medical treatments your doctor provides in the hospital or medical clinic. For example, some medications for physical ailments can also exacerbate anxiety or depression. If your doctor knows one of these concerns is already something to look out for, they can better predict the impact of these medications on your mental health. Whether it changes the treatment you receive not, though, this test can help your doctor ensure that your needs are met. 

Is The Hospital Anxiety And Depression Scale Valid?

Many studies have been done to assess the validity of HADS, and it’s been proven effective time and again. A 2002 review of 747 scientific studies on the Hospital Anxiety and Depression Scale found that the test performed well in:

  • Assessing the severity of symptoms

  • Recognizing anxiety disorders and depression

  • Working well for patients both in medical and psychiatric settings

When Does The Scale Not Work?

Because the Hospital Anxiety and Depression Scale relies on the answers you give, it can typically only be effective if you answer it honestly. There are several reasons you might not feel like you want to be open about feelings of anxiety or depression. For instance, you might worry that if you answer a certain way, you’ll be forced to engage in psychiatric care. But it can be important to remember that no one can make you get mental health treatment unless you are considered a danger to yourself or others. Doctors may strongly suggest it, but the ultimate choice is yours. 

Some people fear the stigma that might come with being seen as “someone with a mental illness.” You might think that if you “fail” the depression scale or anxiety scale, you might look bad and be treated unfairly by your doctor. But mental health treatments and assessments are kept personal. The only ones who need to know the results are your doctor, their helpers, and any mental health professionals who treat you. They all likely have the goal of helping you achieve better mental and physical health outcomes.

How Depression Scales Can Improve Your Outcomes

While it’s good to know whether you have conditions like anxiety and depression, you might be wondering how that will help in the grand scheme of things. Will your physical health improve? What about your mental health? The test itself likely won’t do anything but indicate that you might have a mental health condition. However, the scale can prompt you, your doctor, and others to pursue treatments that can, in fact, improve both your physical and mental health.

Improving Physical Health

If you’re in the hospital for a medical condition, that’s probably going to be your focus right now. Even if you’re just seeing your primary care doctor for medical treatments, you might be more interested in how you’re doing physically than mentally. Still, it’s generally true that physical symptoms can improve at least to some extent when mental healthcare is effective. Many patients feel that their pain, symptoms of illness, and discomfort are heightened when things like anxiety and depression come into play. 

Experiencing Symptoms Of Anxiety Or Depression?

One study, for instance, explored the outcomes of people who had mild head injuries. Psychological tests like the Hospital Anxiety and Depression Scale were used to determine their levels of depression and anxiety. The result was that those who believed their symptoms would have serious negative consequences on their lives were at heightened risk for post-concussion syndrome symptoms. And because psychotherapy can help you choose more realistic and helpful thoughts, it might have a positive impact on your medical outcome.

Improving Mental Health

The ultimate goal of psychological tests is to find out how to help you improve your mental health. One reason the Hospital Anxiety and Depression Scale can be so helpful, then, is because it points out if you may need to receive mental health treatment. In many cases, it’s only once you’re aware of a condition that you can get the treatment you deserve.

Getting Help

Whether you’re having medical treatments currently or not, psychotherapy can help you manage symptoms of mental health disorders that may be impacting other areas of your health. With the right help, you can take steps to feel better both mentally and physically.

One option is to talk to a licensed mental health professional online. Online therapy offers many of the same treatment options you could get at an in-person office, but with online care, you can receive treatment at a time that’s suitable for you and from any location you choose.

In addition to being convenient, online therapy can also be highly effective, especially when it comes to treating common mental health disorders. A 2020 study analyzing the effectiveness of online cognitive behavioral therapy (CBT) for treating depression and anxiety observed significant improvements in participants’ symptoms after just 12 weeks of treatment.


The Hospital Anxiety and Depression Scale is a test meant to help healthcare providers accurately assess the mental health needs of a patient. Because it can be difficult to understand what’s going on beneath the surface, especially if a patient is ill or injured, tools like these can be a huge benefit for doctors as they work to find treatment plans that make sense for each person. Mental and physical health often go together, so better understanding one can enhance our perspective of the other.

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