Outcome MeasureAnxiety

HADS

Hospital Anxiety and Depression Scale

11 Papers in Blossom

About This Instrument

The Hospital Anxiety and Depression Scale (HADS) is a 14-item self-report questionnaire developed by Zigmond and Snaith in 1983 to detect anxiety and depression in medical outpatient settings. It comprises two 7-item subscales — HADS-A (anxiety) and HADS-D (depression) — each scored 0–21, with a combined total of 0–42. The scale deliberately excludes somatic symptoms (fatigue, insomnia, pain) that could be confounded by physical illness, making it particularly suitable for medically ill populations. In psychedelic research, the HADS has been prominently used in psilocybin trials for cancer-related psychological distress at NYU (Stephen Ross) and Johns Hopkins (Roland Griffiths), where it served as a primary or co-primary endpoint. Subscale scores of 8–10 indicate borderline cases and 11+ indicates clinical caseness. The HADS has strong reliability (α = 0.80–0.93) and is validated in over 25 languages.

Clinical Thresholds

042
Normal
Score 0–7
Borderline
Score 8–10
Clinical
Score 11–21

Outcome Data Across Studies

Reported results for HADS across 6 studies with quantitative data.

Outcome data across 40 study arm–timepoint observations
SD
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Full dose LSD(experimental)0811.73.4—
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Full dose LSD(experimental)6088.13.2—
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Full dose LSD(experimental)36597.64.5—
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Active placebo LSD(active_comparator)0311.32.1—
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Active placebo LSD(active_comparator)60310.73.0—
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases
2014Secondary
Active placebo LSD(active_comparator)6037.02.6—
Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial
2016Secondary
Ketamine(experimental)0209.11.6—
Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial
2016Secondary
Diclofenac(active_comparator)0209.41.5—
Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial
2016Secondary
Ketamine(experimental)212011.2—0.001
Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial
2016Secondary
Diclofenac(active_comparator)212010.5—0.001

Papers Using HADS

Open Accessindividual

Group Retreat Psilocybin Therapy for People with Metastatic Cancer with Symptoms of Anxiety and Depression: Safety and Efficacy Outcomes of a Phase 1/2 Study

This Phase I/II study (n=52) tested a group retreat model of psilocybin therapy for people with metastatic cancer and anxiety or depression, using 25 mg psilocybin in a 3-day retreat format. No unattended distress episodes occurred, and anxiety and depression scores fell over 28 days.

Published
Journal
Psychedelic Medicine
Authors
Back, A. L., McGregor, B. A., Thorn, L. L., Baker, K., Gooley, T., Kaelen, M., Harvey, K., Guy, J. M., Myers, S., Perez, J., Thompson, P., Billingsley, L., Sesnon, C.
Open Accessindividual

An open-label pilot study of psilocybin-assisted therapy for binge eating disorder

This open-label pilot study (n=5) tested a single 25 mg dose of psilocybin with Acceptance and Commitment Therapy-based psychotherapy in adults with binge eating disorder and found the treatment was feasible and well tolerated, with no serious adverse events. Participants reported fewer binge eating episodes, along with improvements in depression, anxiety and psychological flexibility over 14 weeks.

Published
Journal
Journal of Eating Disorders
Authors
Dallery, J., Miller, J. L., Boissoneault, J., Harvey, L., Ives, L., Knerr, A., Blaes, S., Ransom, M. N., Munson, M., Gilligan, J. P., Silverman, M. H., Guzzo, P. R., Loeser, B.
Paywallindividual

Group Retreat Psilocybin Therapy for People with Metastatic Cancer with Anxiety and Depression: A Rite of Passage Facilitation Model for a Phase 1/2 Study

This secondary analysis (n=52) describes a Phase I/II group psilocybin retreat model for people with metastatic cancer and moderate to severe anxiety or depression, using a secular ritual approach based on rites of passage. It describes a model designed for a 3-day in-person retreat and linked to safety and efficacy outcomes in the trial.

Published
Journal
Psychedelic Medicine
Authors
Back, A. L., McGregor, B. A., Billingsley, L., Blom, D., Callan, G., Myers, S., Guy, J., Kumar, S., Layer, M., Levin, J., Perez, J., Thompson, P., Salmonson, K., Whinney, J., Thorn, L. L.
Open Accessindividual

Psilocybin-assisted psychotherapy for depression and anxiety associated with life threatening illness: A phase 2b randomized controlled trial

This double-blind placebo-controlled trial (n=35) found that psilocybin-assisted psychotherapy (25mg) significantly reduced depression and anxiety symptoms in adults with life-threatening illnesses compared to an active placebo (100mg niacin), with benefits sustained at 26 weeks and improvements in spiritual well-being, quality of life, demoralisation, and death anxiety.

Published
Journal
General Hospital Psychiatry
Authors
Ross, M. L., Iyer, R., Williams, M. L., Boughey, M., O'callaghan, C., Hiscock, R., Dwyer, J.
Open Accessindividual

Trial of Ketamine Masked by Surgical Anesthesia in Depressed Patients

This triple-masked, randomised, placebo-controlled trial (n=40) of adults with major depressive disorder (MDD) found no short-term effect on depression severity (measured by MADRS) after a single dose of intravenous ketamine (35mg/70kg) compared to placebo (saline) during anaesthesia for routine surgery.

Published
Journal
Nature Mental Health
Authors
Lii, T. R., Smith, A. E., Flohr, J. R., Okada, R. L., Nyongesa, C. A., Cianfichi, L. J., Hack, L. M., Schatzberg, A. F., Heifets, B. D.
Paywallindividual

Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer

In a 3.2–4.5 year follow-up of cancer patients (n=15) from a prior crossover trial, single-dose psilocybin-assisted psychotherapy produced large, sustained reductions in anxiety, depression, hopelessness, demoralisation and death anxiety, with about 60–80% maintaining clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly reported enduring positive, personally meaningful and spiritually significant life changes.

Published
Journal
Journal of Psychopharmacology
Authors
Agin-Liebes, G. I., Malone, T., Yalch, M. M., Mennenga, S. E., Ponté, K. L., Guss, J., Bossis, A. P., Grigsby, J., Fischer, S., Ross, S.

Quick Facts

Full Name
Hospital Anxiety and Depression Scale
Domain
Anxiety
Papers Indexed
11
Score Range
0–42
Interpretation
Lower = better
Unit
points
All Measures