The Hospital Anxiety and Depression Scale

A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of seventy of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments. Received December 3,1982; accepted for publication December 12, 1982 The prevalence of psychiatric disorder in non-psychiatric hospital clinics is certainly high (1, 2, 3). Sometimes emotional disorder is a result of the stress caused by physical disability but somatic symptoms which lead to referral to medical and surgical departments may be a manifestation of anxiety or depressive states and have no basis in organic pathology; finally a neurosis may coexist with a physical illness causing the patient to be more distressed by the symptoms of the illness which may lead to a complicated clinical presentation, a poor response to treatment and, frequently, unnecessary investigation and referral to other departments of the hospital. Physicians and surgeons are usually aware of the emotional components of their patients’ illnesses but, under pressure of work in busy hospital clinics, they have little time to sort out’how the neurosis contributes to the disorder or from just what form of neurosis the patient is suffering. It is therefore probable that clinicians would be helped by a reliable screening test for psychiatric disorder. The development and refinement of questionnaires whereby patients themselves assess their symptoms is leading to an increasing use of such instruments (4) and, in the field of psychiatric epidemiology, the many issues related to case definition and identification have been reviewed by Williams et al. (5). The instrument which has been studied most widely in a variety of contexts is the General Health Questionnaire (6) but this has two main disadvantages: it is rather long and it detects a ‘case’ but gives no information about the nature of the psychiatric disorder. These objections have been partly overcome in a modification of the original questionnaire (7) but we considered that