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

By BetterHelp Editorial Team|Updated August 9, 2022

Physical and mental health disorders often go hand in hand. After all, it isn’t easy to feel calm and positive when you’re going through a medical problem. And, if you start out with depression or anxiety, 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.

What Is the Hospital Anxiety and Depression Scale?

The Relationship Between Physical and Mental Health is Complex

The Hospital Anxiety and Depression Scale is a test you might be asked to take if you go to the hospital or even an outpatient medical treatment center or 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 bothering 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, is a primary feature in 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 issues. Neither the depression scale nor the anxiety scale is used for diagnosis, though. If the test shows that you might have some mental health issues, a doctor or psychologist talks with you, assesses your mental health condition and decides whether a diagnosis of depression or anxiety is appropriate. If so, they determine what specific type of depression or anxiety you have.

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? Why do you need to take the Hospital and Anxiety Depression Scale? The answer is simple. You need to take it so that your doctor can offer you the best help.

Even before they had an anxiety test and depression scale, like HADS, doctors knew their patients experienced both mentally and physically 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 and mental health treatments as well.

After scoring your depression scale and anxiety questions, your doctor may refer you to a mental health provider or suggest that you start psychotherapy. Also, knowing your mental state may have a bearing on the medical treatments your doctor provides in the hospital or medical clinic. For example, some medications for physical problems can also increase anxiety or depression. If your doctor knows one of these issues is already a problem for you, they can better predict the impact of these medications on your mental health. This might change their mind about what medication or combination of meds to give you. Whether it changes the meds you take or not, though, your doctor will be more alert to mental health issues that may arise.

Is the Hospital Anxiety and Depression Scale Valid?

Another question you might be wondering is, how reliable is this test? 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 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 have psychiatric care. But it’s important to remember that no one can make you get mental health treatment unless you are a danger to yourself or others. They can strongly suggest it, but the ultimate choice is yours. Even more important, getting psychological treatment may help you get through your medical problems more easily and create a better life for yourself.

Some people fear the stigma of being seen as someone with mental health issues. 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 are always private. The only ones who need to know are your doctor, their helpers, and any mental health professionals who treat you. And they’re all on your side. They all share the goal of helping you achieve better mental and physical health outcomes.

How Depression Scales 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 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. If so, you might be interested to know that several studies have shown that physical symptoms also improve after mental health disorders are discovered using HADS and other psychological tests. After psychological treatments and possibly psychiatric meds are added to the regimen, patients saw improvement in their physical conditions after taking anxiety tests and depression scales.

The Relationship Between Physical and Mental Health is Complex

For example, the thoughts you have about your bodily symptoms can have an impact on your physical health. One study 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. Then, your mental health conditions can be reduced, no matter how your medical treatments go. One reason the Hospital Anxiety and Depression Scale is so helpful is that it points out if you need to receive mental health treatment. And that’s important because once you know you have a problem, you can get the treatment you need.

What’s more, people who discover they have anxiety and depression are more likely to get that treatment. For instance, one research project studied cardiac patients to see if a collaborative care program would help people with cardiovascular diseases get into treatment for their depression. The collaboration would be between medical and mental health professionals. The study found that cardiac patients who had a psychological screening in a hospital were more likely to get appropriate mental health treatment after they were discharged.

Getting Help


Whether you’re having medical treatments currently or not, psychotherapy can help you deal with your physical pains and other symptoms better. With the right help, you can improve both your physical and mental health. You can find therapists to help you both in your local community and online. One option is to talk to a licensed mental health counselor at BetterHelp. Online therapy offers many of the same treatments you could get at a psychologist’s office in your area. Yet, with online care, you can often get treatment at a time that’s more suitable for you and from any location you choose. Whatever you do, consider the possibility that mental health treatment may ease your condition in many ways. Then, with the right help, you can enjoy your life more fully and feel calmer and more relaxed as you do it.

For Additional Help & Support With Your Concerns
Speak with a Licensed Therapist
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.