Hospital Anxiety and Depression Scale (HADS)

DESCRIPTION:
The Hospital Anxiety and Depression Scale is a simple, easy-to-use questionnaire designed for screening anxiety and depression in at-risk patients.^1,2 Atopic dermatitis (AD), especially moderate-to-severe AD, can significantly impact a patent’s psychological well-being and is associated with decreased health-related quality of life (HRQoL) measures.^3-6 The HADS scale helps clinicians evaluate and quantify the psychological impact of AD on their patients.⁷

DISEASE STATES: 
Atopic dermatitis

VALIDATED USES: 
Treatment monitoring in clinical trials, clinical assessment

ADMINISTRATION METHOD:
Patient, clinician

COMMONLY USED IN:
Clinical trials, clinical practice

DETAILED DESCRIPTION:
Studies have shown that AD patients often experience higher HADS scores compared to individuals without AD.⁶ The HADS questionnaire was developed by Zigmond and Snaith in 1983 to identify probable anxiety disorders and depression among patients in nonpsychiatric hospital clinics. It only takes about 2–5 minutes to complete.²

HADS consists of 14 questions divided into 2 subscales: 7 for anxiety (HADS-A) and 7 for depression (HADS-D). Each question is scored on a 4-point Likert-type scale that ranges from 0 to 3. The total score for each subscale ranges from 0 to 21, with higher scores indicating more severe symptoms. The recommended cutoff scores are 8 or above for possible cases and 11 or above for probable cases of anxiety or depression.^1,2

VALIDITY:
HADS has been extensively studied and validated; Cronbach's alpha for anxiety (0.68–0.93 [mean 0.83]) and Cronbach’s alpha for depression (0.67–0.90 [mean 0.82]).¹ Adults with AD have higher mean HADS scores compared to those without AD across both anxiety and depression subscales, (7.7 vs 5.6) and (6.0 vs 4.3) respectively. Prevenance rates for both anxiety and depression are also higher in the AD population compared to those without AD, (28.6% vs 15.5%) and (13.5% vs 9.0%) respectively.⁷ Sleep disturbances are positively correlated with depression scores.⁵

LIMITATIONS:
No significant correlation between disease severity and psychological parameters.⁵

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.

References: 1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69-77. doi:10.1016/s0022-3999(01)00296-3 2. Snaith RP. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes. 2003;1:29. doi:10.1186/1477-7525-1-29 3. Silverberg JI, Gelfand JM, Margolis DJ, et al. Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340-347. doi:10.1016/j.anai.2018.07.006 4. Sánchez-Pérez J, Daudén-Tello E, Mora AM, Surinyac NL. Impact of atopic dermatitis on health-related quality of life in Spanish children and adults: the PSEDA study. Actas Dermosifiliogr. 2013;104:44-52. doi:10.1016/j.ad.2012.03.008 5. Talamonti M, Galluzzo M, Silvaggio D, Lombardo P, Tartaglia C, Bianchi L. Quality of life and psychological impact in patients with atopic dermatitis. J Clin Med. 2021;10(6):1298. doi:10.3390/jcm10061298 6. Rønnstad ATM, Halling-Overgaard AS, Hamann CR, Skov L, Egeberg A, Thyssen JP. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;79(3):448-456.e30. doi:10.1016/j.jaad.2018.03.017 7. Silverberg JI, Gelfand JM, Margolis DJ, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554-565. doi:10.1111/bjd.17683