Stroke liaison nurse visits following MDT meeting

Hospital Anxiety and Depression Scale (HADS)

Reference: Zigmond, A.S., & Snaith, R.P. ( 1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370. Current Publisher: GL Assessments. (Previously NFER-NELSON)

Patients have to rate how they have felt over the last week on 7 items of depression and 7 items of anxiety.

Forced choice answers are provided and items are scored on a 0-3 scale. The total scores range from 0-21 for the anxiety subscale and for the depression subscale and a higher score indicates a greater severity of anxiety or depression.

The scale can be self-administered or with help. It should take about 10 minutes to complete.

It was designed as a brief screening measure for anxiety and depression for use with medical out-patients with a low emphasis on physical symptoms. However, it is non-stroke specific and there is some overlap with physical and cognitive symptoms (e.g., someone may score highly on “I feel as if I am slowed down” due to physical problems after a stroke; likewise someone may not think that “I can enjoy a good book or radio or TV programme” due to concentration or memory difficulties after a stroke rather than due to depressed mood).

Although potentially suitable as a screening tool it should not be used diagnostically (Aben et al. 2002).

Standard cut-off scores are 8-10 for possible mood disorder and 11 or above for probable mood disorder for each subscale. However, a lower cut-off with stroke patients (6/7 for each scale) has been suggested (O’Rourke et al., 1998).

This tool is copyrighted by GL Assessment and unauthorised versions should not be used. A scored version is used in this case as an illustrative example.

References:

Aben, I., Verhey, F., Lousberg, R., Lodder, J., Honig, A. (2002). Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients. Psychosomatics, 43, 386-393.

O’Rourke, S., McHale, S., Signorini, D., & Dennis, M. (1998). Detecting psychiatric co-morbidity after stroke: Comparison of the GHQ and the HAD Scale. Stroke, 29(5), 980-985.