Quality of Life Research

, Volume 24, Issue 2, pp 391–398 | Cite as

Normative data for the Hospital Anxiety and Depression Scale

  • Suzanne Breeman
  • Seonaidh Cotton
  • Shona Fielding
  • Gareth T. Jones



The Hospital Anxiety and Depression Scale (HADS) is widely used in both research and clinical contexts. However, UK normative data from HADS remain limited. In our recent review of the literature, only six reports from four studies were identified as reporting UK normative data and all had limitations. The aim of our study was to use a large population-based dataset to address this.


The Epidemiology of Functional Disorders Study is a large longitudinal population-based study carried out in Northwest England. All adults aged between 25 and 65 years registered with three general practices were sent a self-completion questionnaire which contained the HADS and other health-related instruments. Scores were calculated for participants completing all items on each sub-scale (anxiety 6,189 participants and depression 6,198 participants). Scores are presented by gender and by 5-year age groups. Percentile scores were also generated.


The median anxiety score was higher in women [6, interquartile range (IQR) 4–9] than in men (5, IQR 2–8) and increased with age in both groups. The median depression score for both women and men was 3 (IQR 1–6).


Our study is the largest population-based study providing UK normative data from the HADS. While our data confirm some of the normative data reported previously, subtle and important differences emerged, particularly at the upper end of the percentile scores. Due to the nature of our study design and the number of participants sampled, we believe that our data are likely to be more representative of the UK population than existing published normative values.


Hospital Anxiety and Depression Scale Normative data Population-based study Percentile scores 



The authors would like to thank all those involved in the EpiFunD study for their role in collecting the data used in this study, particularly the principal investigators Gary Macfarlane (University of Aberdeen) and John McBeth (Keele University, and the University of Manchester) who allowed use of the EpiFunD dataset. The EpiFunD study was funded by Arthritis Research UK (formerly the Arthritis Research Campaign), Grant Number: 17552.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Suzanne Breeman
    • 1
  • Seonaidh Cotton
    • 1
  • Shona Fielding
    • 2
  • Gareth T. Jones
    • 3
  1. 1.Health Services Research Unit, Division of Applied Health SciencesUniversity of AberdeenForesterhill, AberdeenUK
  2. 2.Medical Statistics Team, Division of Applied Health SciencesUniversity of AberdeenForesterhill, AberdeenUK
  3. 3.Epidemiology Group, Division of Applied Health SciencesUniversity of AberdeenForesterhill, AberdeenUK

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