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

Medically reviewed by April Justice, LICSW
Updated April 28, 2024by 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, a brief questionnaire that can identify whether patients may need mental health support in addition to physical treatments. In many cases, good mental health can contribute to positive physical health outcomes, even when a person isn’t in a hospital setting. You can begin to improve any mental health challenges you may be experiencing (and potentially positively impact your physical health as well) by connecting with a therapist in person or online.

What is the hospital anxiety and depression scale?

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Experiencing symptoms of anxiety or depression?

The Hospital Anxiety and Depression Scale (HADS) 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 generally a short, easy test that usually takes about two to five minutes to complete. It’s also a self-assessment test, meaning you are typically the one who evaluates how much anxiety and depression symptoms impacted you over the past week.

To fill out the HADS questionnaire, you will normally answer several questions 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 tend to ask about that. 

Questions for the depression scale might include the following: 

  • Do you take as much interest in things as you used to? 

  • Do you feel cheerful? 

For the anxiety part of the questionnaire, you may answer questions related to anxiety, such as those below: 

  • Do you worry a lot? 

  • Do you have panic attacks?

You can answer each question on the Hospital Anxiety and Depression Scale by choosing a number from zero to three, indicating how much the question matches your thoughts, feelings, and behaviors. After you take the test, your doctor may add up the score to determine whether they need to address your mental health. In this test, the possible scores range from zero to 21 for depression and the same for anxiety. The scores typically indicate:

  • Zero to seven – Normal range

  • Eight to 10 – Anxiety or depression might be present

  • 11 and above – Depression or anxiety is likely present

In general, 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 typically used for diagnosis, though. If the test shows that you might be experiencing a mental health disorder, 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?

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Going in for medical treatments often involves submitting to a lot of tests. It can be understandable to 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 may be so that your doctor can offer you the best care possible.

Even before HADS existed, doctors generally knew their patients experienced both mental and physical stress during hospital stays. However, they didn’t usually know how to assess their patients’ mental conditions or feel confident in doing so. The Hospital Anxiety and Depression Scale normally offers a quick, concise way to determine whether a patient needs mental health support or special considerations in their medical treatment.

After scoring your HADS responses, your doctor may refer you to a mental health provider for long-term support. In addition, 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 or not, 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, typically reporting that it is valid and effective. A 2022 study on the Hospital Anxiety and Depression Scale stated, “The HADS is a valid and reliable instrument for anxiety and depression screening in adult patients of primary healthcare services.”

When does the scale not work?

Because the Hospital Anxiety and Depression Scale usually relies on the answers you give, it can typically only be effective if you answer it honestly. There may be 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 usually 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 HADS, you might look bad and be treated unfairly by your doctor. However, mental health treatments and assessments are normally kept personal. The only ones who need to know the results are typically 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 HADS can improve your outcomes

While it’s generally 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 except indicate that you might have a mental health condition. However, the scale can prompt you, your doctor, and others to pursue treatments that can 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 tend to be heightened when mental illnesses like anxiety and depression come into play. 

Often, those who believe their physical symptoms will have serious negative consequences on their lives can be at heightened risk for prolonged symptoms. 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 usually to determine how to help you improve your mental health. One reason the Hospital Anxiety and Depression Scale can be so helpful may be because it points out whether 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

Experiencing symptoms of anxiety or depression?
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Whether or not you’re currently going through medical treatments, 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.

Benefits of online therapy

One option may be to talk to a licensed mental health professional online. Online therapy frequently offers many of the same treatment options as an in-person therapist’s office, but with online care, you can receive treatment at a time that’s suitable for you and from any location you choose. All you generally need is a device and an internet connection.

Effectiveness of online therapy

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 typically observed significant improvements in participants’ symptoms after just 12 weeks of treatment.

Takeaway

The Hospital Anxiety and Depression Scale is a test generally 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. Often, seeking psychological support can improve both physical and mental health. One accessible way to receive professional insight and guidance may be through an online therapy platform.
Tests can bring up many emotions
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