Excessive negative affect and deficient positive affect in anxiety and depression: balancing the valences in the Hospital Anxiety and Depression Scale (HADS)

In the widely used Hospital Anxiety and Depression Scale (HADS) most of the items forming the Depression subscale use terms for a pleasant state of mind, whereas most of the items in the Anxiety subscale mention aversive states. Thus the constructs assessed may relate respectively to absence of positive affect and presence of negative affect, rather than to the different sorts of affect intended. In the present study this hypothesis was partly supported by factor analyses of responses to the HADS in a healthy group and in a group with the rheumatic disease Sjögren’s syndrome. Re-analysis showed that it may be feasible to create an 8-item instrument that distinguishes anxiety items from depression items while having items with positive valence in equal number to items with negative valence in each subscale. Patients’ own descriptions and categorisations of such items should be used to develop an affect-balanced and somatic-free inventory that then may be able to separate anxiety from depression among healthy and physically ill populations.