Contact: Hannie Comijs
The Hospital Anxiety Depression Scale (Zigmund and Snaith, 1983) consists of 14 items, seven for measuring feelings of depression and seven for measuring symptoms of anxiety. The respondent is asked to indicate whether he/she has experienced feelings such as restlessness, tenseness, or panic over the past 4 weeks. In the original scale each item has a unique set of response categories. Reliability and validation of the Dutch translation of the HADS has been reported by Spinhoven et al. (1997).
Measurement instrument in LASA
In LASA only the seven items measuring anxiety were included; therefore we use the term HADS-A subscale. In the adaptation for LASA, all items have the same response categories, which are derived from the Center of Epidemiologic Studies Depression Scale (CES-D; Radloff 1977). Thus the HADS-A is composed of Likert type items ranging from 0 (rarely or never) to 3 (mostly or always). The codes of item 4 (see below) must be reversed. The anxiety subscale score is the sum of the scores on the items and therefore has a theoretical range from 0 to 21.
In the first cycle of LASA the mean score for men was 2.1, and 3.0 for woman. Since no threshold score for the Dutch version of the HADS-A was available to delineate clinical anxiety, a cut-off score halfway between the mean score for the entire sample and the mean score of subjects with an anxiety disorder (based on the diagnosis from the CIDI) was chosen. Thus defined, the cut-off point was a score between 3 and 4. Subjects with a score beyond 3 are deemed to suffer from anxiety symptoms. Recently, Snaith (2003) introduced two cut-off scores based on analyses of the scores in a clinical setting. A score of 0 to 7 could be regarded as being the normal range, a score of 8 to 10 was suggestive for an anxiety disorder and a score of 11 and higher indicates the presence ('caseness') of an anxiety disorder.
In LASA the HADS-A is part of the main interview. The HADS is not administered in the baseline cycle of the cohort recruited in 2002.
1. I feel tense or wound up lately.
2. I get a sort of frightened feeling as if something awful is about to happen lately.
3. Worrying thoughts go through my mind.
4. I can sit at ease and feel relaxed lately.
5. I get a sort of frightened feeling like ‘butterflies’ in the stomach lately.
6. I feel restless as if I have to be on the move, lately.
7. I get sudden feelings of panic lately.
Previous use in LASA
Within LASA, numerous papers have been written using the HADS-A. Subjects were: prevalence and predictors of anxiety, comorbidity, stability and change in symptoms, the association with cognitive decline, mortality and prevention.
Balkom AJ van, Beekman AT, de Beurs E, Deeg DJ, van Dyck R, van Tilburg W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand 2000, 101(1): 37-45.
Beekman, ATF, Bremmer MA, Deeg DJ, Balkom AJ, Smit JH, de Beurs E, van Dyck R and van Tilburg W. Anxiety Disorders in Later Life: a Report From the Longitudinal Aging Study Amsterdam. Int. J. Geriatr. Psychiatry, 1998, 13(10), 717-726.
Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R and van Tilburg W. Anxiety and Depression in Later Life: Co-Occurrence and Communality of Risk Factors. Am. J. Psychiatry, 2000, 157 (1), 89-95.
Bierman EJM, Comijs HC, van Leeuwen JEP, Jonker C, & Beekman ATF. Anxiety has a different effect on cognition than depression in later life. Am J Geriatr Psychiatry, 2005, 13(8): 686-693.
Bierman EJ, Comijs HC, Jonker C, & Beekman AT. Symptoms of Anxiety and Depression in the Course of Cognitive Decline. Dem Geriatr Cogn Disord. 2007, 10, 24(3):213-219.
Beurs E de, Comijs HC, Twisk JWR, Sonnenberg C, Beekman ATF, & Deeg DJH. Stability and change in symptoms of depression, anxiety, and general negative affect in late life: modelling of vulnerability profiles. J Affect Disord, 2005, 84: 53-62.
Beurs E de, Beekman AT, Deeg DJ, Dyck R. van, Tilburg W van. Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam. Psycholol Med 2000; 30(3), 515-527.
Hout HPJ van, Beekman ATF, de Beurs E, Comijs H, van Marwijk H, de Haan M, van Tilburg W & Deeg DJH. Anxiety and the risk of death in older men and women, the Longitudinal Aging Study Amsterdam. Br J Psychiatry, 2004, 185, 399-404.
Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement, 1977; 1: 385-401.
Smit F, Comijs HC, Schoevers R, Cuijpers P, Deeg D, & Beekman A. Target groups for the prevention of late-life anxiety. British Journal of Psychiatry, 2007, 190: 428-434.
Snaith RP. The hospital anxiety and depression scale. Health Quality Life Outcomes, 2003, 1(29).
Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med, 1997, 27, 363-370.
Van Balkom AJ, Beekman AT, de Beurs E, Deeg DJ, Van Dyck R and Van Tilburg W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand 2000, 101(1), 37-45.
Zigmund AS and Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983, 67, 361-370.