A Validation Study of the Hospital Anxiety and Depression Scale (HADS) in a Large Sample of French Employees

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2014 Dec 17

PMID 25511175

Citations 113

Authors

Christine Bocerean

Emilie Dupret

Affiliations

Soon will be listed here.

Abstract

Background: The Hospital Anxiety and Depression Scale (HADS) is a questionnaire widely used for detecting anxiety and depressive disorders. It is used extensively in France, but has never been the subject of a full study in a population at work. The objectives of this study were to present some psychometric properties of the HADS on a large sample of French employees.

Method: The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination. In 2011, 20992 employees filled in the questionnaire. HADS's structure was studied first by exploratory, then confirmatory factorial analyses.

Results: The model selected was the original two-factor structure. The two subscales showed good internal consistency. Women scored higher than the men for anxiety and depression; the scores increased with age; engineers and managers had lower average scores than other occupational status (blue- or white-collar workers and technicians).

Conclusion: The results of the analyses are consistent with those in literature relating to other populations studied in other countries. The HADS questionnaire is pertinent for detecting symptoms of anxiety and depression in a population of people at work.

Citing Articles

Determinants of health-related quality of life among patients with Ischemic heart disease.

Jlassi O, Omrane A, Ben Massoud M, Khalfallah T, Bouzgarrou L, Gamra H Health Syst (Basingstoke). 2025; 13(4):322-331.

PMID: 39839496 PMC: 11750061. DOI: 10.1080/20476965.2023.2275799.

Correlates of mental health of people living with HIV co-infected with SARS-CoV-2: findings from the COVIDHIV study in France.

Yaya I, Amboise Y, Roucoux G, Yombo-Kokule L, Marcellin F, Duvivier C Front Psychiatry. 2025; 15():1437362.

PMID: 39831057 PMC: 11739155. DOI: 10.3389/fpsyt.2024.1437362.

Validation of visual analog scales of mood and anxiety at the workplace.

Dutheil F, Palgen C, Brousse G, Cornet T, Mermillod M, Lakbar I PLoS One. 2024; 19(12):e0316159.

PMID: 39739967 PMC: 11687878. DOI: 10.1371/journal.pone.0316159.

IROND-L: study protocol for a French prospective, quasi-experimental, multicentre trial to examine the impact of a coordinated multidisciplinary approach for women victims of violence.

El-Khoury F, Ben Ghezala I, Hatem G, Jaffal Z, Soares A, Yacini L BMJ Open. 2024; 14(11):e086143.

PMID: 39566954 PMC: 11580272. DOI: 10.1136/bmjopen-2024-086143.

Cluster analysis identifies long COVID subtypes in Belgian patients.

Mfouth Kemajou P, Besse-Hammer T, Lebouc C, Coppieters Y Biol Methods Protoc. 2024; 9(1):bpae076.

PMID: 39478809 PMC: 11522879. DOI: 10.1093/biomethods/bpae076.

References

Dunbar M, Ford G, Hunt K, Der G . A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. Br J Clin Psychol. 2000; 39(1):79-94. DOI: 10.1348/014466500163121. View

Stordal E, Bjartveit Kruger M, Dahl N, Kruger O, Mykletun A, Dahl A . Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT). Acta Psychiatr Scand. 2001; 104(3):210-6. DOI: 10.1034/j.1600-0447.2001.00130.x. View

Friedman S, Samuelian J, Lancrenon S, Even C, Chiarelli P . Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Res. 2001; 104(3):247-57. DOI: 10.1016/s0165-1781(01)00309-2. View

Mykletun A, Stordal E, Dahl A . Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry. 2001; 179:540-4. DOI: 10.1192/bjp.179.6.540. View

Harter M, Reuter K, Bengel J . Screening for anxiety, depressive and somatoform disorders in rehabilitation--validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disabil Rehabil. 2001; 23(16):737-44. DOI: 10.1080/09638280110062176. View

Crawford J, Henry J, Crombie C, TAYLOR E . Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol. 2002; 40(4):429-34. DOI: 10.1348/014466501163904. View

Flint A, Rifat S . Factor structure of the hospital anxiety and depression scale in older patients with major depression. Int J Geriatr Psychiatry. 2002; 17(2):117-23. DOI: 10.1002/gps.535. View

Bjelland I, Dahl A, Haug T, 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. View

Friedman S, Even C, Samuelian J, Guelfi J . Factor structure of the Hospital Anxiety and Depression (HAD) scale. Br J Psychiatry. 2002; 181:165-6; author reply 166. DOI: 10.1017/s0007125000161975. View

10.

Smith A, Selby P, Velikova G, Stark D, Wright E, Gould A . Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother. 2002; 75(Pt 2):165-76. DOI: 10.1348/147608302169625. View

11.

Caci H, Bayle F, Mattei V, Dossios C, Robert P, Boyer P . How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects?. Psychiatry Res. 2003; 118(1):89-99. DOI: 10.1016/s0165-1781(03)00044-1. View

12.

Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S . The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003; 1:14. PMC: 161819. DOI: 10.1186/1477-7525-1-14. View

13.

Herrero M, Blanch J, Peri J, de Pablo J, Pintor L, Bulbena A . A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiatry. 2003; 25(4):277-83. DOI: 10.1016/s0163-8343(03)00043-4. View

14.

Martin C, Lewin R, Thompson D . A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Res. 2003; 120(1):85-94. DOI: 10.1016/s0165-1781(03)00162-8. View

15.

Olsson I, Mykletun A, Dahl A . The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry. 2005; 5:46. PMC: 1343544. DOI: 10.1186/1471-244X-5-46. View

16.

Poole N, Morgan J . Validity and reliability of the Hospital Anxiety and Depression Scale in a hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population. Gen Hosp Psychiatry. 2005; 28(1):55-8. DOI: 10.1016/j.genhosppsych.2005.08.004. View

17.

Muszbek K, Szekely A, Balogh E, Molnar M, Rohanszky M, Ruzsa A . Validation of the Hungarian translation of Hospital Anxiety and Depression Scale. Qual Life Res. 2006; 15(4):761-6. DOI: 10.1007/s11136-005-3627-8. View

18.

Martin C, Bonner A, Brook A, Luscombe C . Factor structure and use of the hospital anxiety and depression scale in the homeless and socially marginalized. Psychol Health Med. 2006; 11(2):190-7. DOI: 10.1080/13548500500155883. View

19.

Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M . Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007; 12(2):225-35. DOI: 10.1080/13548500500524088. View

20.

Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R . The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiatry. 1991; 158:255-9. DOI: 10.1192/bjp.158.2.255. View