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Understanding Your Mood: The Hospital Anxiety and Depression Scale (HADS)

Article | Depression

Feeling anxious or down is something everyone experiences at times. But how do you know if these feelings are just a passing phase or something more significant? The Hospital Anxiety and Depression Scale (HADS) is a simple and reliable tool designed to help you check for signs of anxiety and depression. It’s not about applying a label—it’s about understanding your emotional state better. This article includes a version of the HADS test you can take yourself, along with clear explanations of what your results mean.

The HADS was created in 1983 by British researchers Anthony S. Zigmond and R. Philip Snaith. They originally designed it for use in general hospital settings to spot anxiety and depression in people with physical health issues, but its usefulness has led to its widespread adoption in many other contexts. What makes the HADS particularly effective is its focus on the emotional signs of anxiety and depression, deliberately avoiding physical symptoms like fatigue or sleep problems, which could be confused with underlying medical conditions. In psychology, tools like HADS are invaluable because they help people recognize patterns in their emotions, which is the first essential step toward addressing them. Importantly, studies show that early awareness of anxiety or depression can significantly improve outcomes, as it encourages individuals to seek support sooner.

This test is straightforward and designed for anyone to use. It contains 14 questions in total—7 for anxiety and 7 for depression. Each question asks how you’ve felt over the past week and provides four answer options. Simply pick the one that best matches your experience. The test is not a diagnostic tool but rather a way to reflect on your current mood. Ready to begin?

HADS Test: Checking for Anxiety and Depression

Answer each question based on how you have felt over the past week. Choose the option that feels closest to your experience.

  1. I feel tense or wound up:
    • Most of the time (3)
    • A lot of the time (2)
    • From time to time, occasionally (1)
    • Not at all (0)
  2. I get a sort of frightened feeling as if something awful is about to happen:
    • Very definitely and quite badly (3)
    • Yes, but not too badly (2)
    • A little, but it doesn’t worry me (1)
    • Not at all (0)
  3. Worrying thoughts go through my mind:
    • A great deal of the time (3)
    • A lot of the time (2)
    • From time to time, but not too often (1)
    • Only occasionally (0)
  4. I can sit at ease and feel relaxed:
    • Definitely (0)
    • Usually (1)
    • Not often (2)
    • Not at all (3)
  5. I get a sort of frightened feeling, like butterflies in the stomach:
    • Not at all (0)
    • Occasionally (1)
    • Quite often (2)
    • Very often (3)
  6. I feel restless, as if I have to be on the move:
    • Very much indeed (3)
    • Quite a lot (2)
    • Not very much (1)
    • Not at all (0)
  7. I get sudden feelings of panic:
    • Very often indeed (3)
    • Quite often (2)
    • Not very often (1)
    • Not at all (0)
  8. I still enjoy the things I used to enjoy:
    • Definitely as much (0)
    • Not quite so much (1)
    • Only a little (2)
    • Hardly at all (3)
  9. I can laugh and see the funny side of things:
    • As much as I always could (0)
    • Not quite so much now (1)
    • Definitely not so much now (2)
    • Not at all (3)
  10. I feel cheerful:
    • Most of the time (0)
    • Sometimes (1)
    • Not often (2)
    • Not at all (3)
  11. I feel as if I am slowed down:
    • Nearly all the time (3)
    • Very often (2)
    • Sometimes (1)
    • Not at all (0)
  12. I have lost interest in my appearance:
    • Definitely (3)
    • I don’t take as much care as I should (2)
    • I may not take quite as much care (1)
    • I take just as much care as ever (0)
  13. I look forward with enjoyment to things:
    • As much as I ever did (0)
    • Rather less than I used to (1)
    • Definitely less than I used to (2)
    • Hardly at all (3)
  14. I can enjoy a good book or radio or TV program:
    • Often (0)
    • Sometimes (1)
    • Not often (2)
    • Seldom (3)

Calculating Your Results

Each answer has a point value shown in parentheses (0, 1, 2, or 3). Add up your points for the two sections separately:

  • Anxiety Score: Sum the points from questions 1, 3, 5, 7, 9, 11, and 13.
  • Depression Score: Sum the points from questions 2, 4, 6, 8, 10, 12, and 14.

Each score will range from 0 to 21. Check your scores against the ranges below to understand what they might suggest.

Understanding Your Results

The HADS provides two separate scores—one for anxiety and one for depression. Here’s a guide to interpreting them:

  • 0–7 (Normal): Your score suggests no significant signs of anxiety or depression. You are likely feeling emotionally balanced, but remember that everyone has tough days. It's still wise to monitor your mood if circumstances change.
  • 8–10 (Borderline): You might be experiencing some mild symptoms of anxiety or depression. This does not mean you have a clinical condition, but it is worth paying closer attention to how you feel over time. Factors like stress or major life changes could be playing a role.
  • 11–21 (Possible Concern): Your score indicates that you may be experiencing noticeable symptoms of anxiety or depression. This is not a diagnosis, but it serves as a strong signal to consider talking to a professional, such as a counselor, therapist, or doctor, for further evaluation and support.

Important: This test is a screening tool, not a medical diagnosis. If your scores are in the borderline or possible concern range, or if you simply feel overwhelmed, it is highly recommended that you reach out to a healthcare provider or a mental health professional. In psychology, early awareness is crucial—research consistently shows that addressing emotional challenges early can lead to better long-term mental health outcomes.

Why HADS Is Unique

The HADS stands out because it is brief, clear, and focuses purely on emotional experiences. By omitting physical symptoms, it remains a useful tool for people with or without co-existing physical health conditions. It is widely used in hospitals, clinics, and research because it is easy to administer and understand. Psychology research highlights that anxiety and depression often overlap, but the HADS's design separates the two constructs to give you a clearer picture of your specific emotional state.

It's also worth noting that anxiety and depression can manifest differently for everyone. For instance, anxiety might feel like constant worry or restlessness, while depression may present as a persistent lack of joy or energy. The HADS helps you identify these specific patterns, which is a key step toward self-awareness. In psychology, this practice is known as “self-monitoring,” which can empower you to take a more active role in managing your mental health.

If your scores suggest you are doing okay, that’s excellent—continue to nurture your well-being. If they are higher than you expected, try not to worry. Instead, view it as a sign to pause and reflect. You could explore relaxation techniques, talk to someone you trust, or seek professional advice. The HADS, created by Zigmond and Snaith, has served for decades as a valuable guide to help people navigate their emotional landscape.

Reference

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. This is the original paper that introduced the HADS, describing its development, validation, and intended use as a screening tool in clinical settings.
Author: Helena Abernethy
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