A Validation of the Hospital Anxiety and Depression Scale (HADS) in the Medically-Ill

Ma. Lourdes Rosanna E. de Guzman

Department of Psychiatry and Behavioral Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila


The underdiagnosis of depression and anxiety in the medical complications, improve compliance to treatment, and facilitate the "appropriate" use of health care resources.

Objectives. To determine the prevalence of depression and/or anxiety in the in-patient medically ill and to validate the Hospital Anxiety and Depression Scale (HADS) for Filipinos.

Methods. To aid clinicians, the Hospital Anxiety and Depression Scale (HADS), a 14-item self-report questionnaire was validated in this cross-sectional study of 710 medically ill in-patients, to be able to determine how well it identified depression and anxiety against the criterion of a diagnostic psychiatric interview and to determine the optimal cut-off score of the HADS for Filipinos with the use of the Receiver Operating Characteristics (ROC).

Results. The prevalence of depression was 26.9% anxiety was 14.3%, and the 'mixed diagnosis' of both was 13.7% among the medically-ill. The overall prevalence was 54.9%. The results showed that the optimal cut-off score for the HADS/ HADS-P is a score of 11, with a sensitivity of 75%, specificity of 70% and PPV of 75%.

Conclusion. The HADS/ HADS-P will provide clinicians with a reliable, valid and practical screening tool for identifying the two most common clinical problems in the medically ill, depression and anxiety. The HADS/ HADS-P can serve as a guide for clinicians towards the diagnosis of depression and anxiety, but it cannot be the sole basis for diagnosis.

Key Words: HADS, depression, anxiety