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Comparison of Two Versions of the Hospital Anxiety and Depression Scale in Assessing Depression in a Neurologic Setting

Patel, Viral P. MSc*; Feinstein, Anthony MD, PhD*,†

Cognitive And Behavioral Neurology: December 2017 - Volume 30 - Issue 4 - p 145–149
doi: 10.1097/WNN.0000000000000138
Original Studies

Background: The Hospital Anxiety and Depression Scale–Depression Subscale (HADS-D) is widely used to assess depression in people with multiple sclerosis (MS). Developed specifically for use in a medical setting, the scale has one item, “I feel as if I am slowed down,” that might represent a significant somatic confounder, possibly biasing the assessment.

Objective: We sought to determine whether inclusion or exclusion of the “slowed down” item in the HADS-D affects the detection of depression and the scale’s associations with impaired cognition, fatigue, and employment status.

Methods: A sample of 193 people with confirmed MS completed the HADS. To identify depressed participants, we used previously established cutoff scores for the HADS-D with (≥8) and without (≥6) the “slowed down” item. Linear and logistic regression models were used to determine predictors of cognition and employment status.

Results: The HADS-D with and without the “slowed down” item detected similar rates of depression: 30.6% and 31.6%, respectively. Both versions of the HADS-D predicted processing speed and executive functioning, but not memory. Neither version predicted employment status.

Conclusions: The HADS-D is an easy-to-use and clinically relevant self-report psychometric scale for detecting depression in MS. Removing the “slowed down” item from the HADS-D does not influence its internal consistency, and both versions have similar associations with clinical outcomes.

*Department of Psychiatry, Sunnybrook Health Sciences Center

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Supported in part by the Multiple Sclerosis Society of Canada.

The authors declare no conflicts of interest.

Correspondence: Anthony Feinstein, MD, PhD, 2075 Bayview Ave., Toronto, Ontario, Canada M4N 3M5 (e-mail:

Received August 30, 2017

Accepted October 3, 2017

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