Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population

• Published in: Journal of psychosomatic research Vol. 71; no. 2; pp. 74 - 78
• Main Authors: Hinz, Andreas, Brähler, Elmar
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2011; Elsevier
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Anxiety; Anxiety - diagnosis; Anxiety - psychology; Anxiety disorders; Anxiety-Depression; Biological and medical sciences; Depression; Depression - diagnosis; Depression - psychology; Female; Gender; Germany; Hospitals; Humans; Male; Medical sciences; Middle Aged; Normative values; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Reference Values; Sex Factors; Techniques and methods; Europe; Germany; Normative values; Depression; Anxiety; Gender; Age; Reference values; Social environment; Mood disorder; Human; Hospital Anxiety and Depression Scale Zigmond Snaith; Affect affectivity; Reference value; Sex; Psychometrics; Sociodemographic factor; Cutoff note; Psychometric standardization
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2011.01.005

The aim of this study was to present normative values for the Hospital Anxiety and Depression Scale (HADS). A representative sample of the German general population (N=4410) was tested with the HADS. Females are more anxious than males, and older subjects are more depressed than younger subjects. The mean scores for anxiety / depression are 4.4 / 4.8 (males) and 5.0 / 4.7 (females). Using the cut-off 8+, the percentages of elevated anxiety and depression in the total sample are 21 % and 23 %, respectively. Regression analyses proved a linear but not a curvilinear age trend of anxiety and depression. Percentile rank norms are given for anxiety, depression, and the HADS total score. The regression coefficients allow the calculation of expected mean scores for each age and gender distribution of any sample of patients. HADS mean scores are better suited to describe the degree of anxiety and depression in patient samples compared to percentages of subjects with elevated values.