HADS: A Quick and Effective Measure of Anxiety and Depression in Acute Pain

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HADS was developed specifically to avoid reliance on confounding factors that are present in depression and anxiety, but also occur as symptoms of illness or treatment side effects.
HADS was developed specifically to avoid reliance on confounding factors that are present in depression and anxiety, but also occur as symptoms of illness or treatment side effects.

The Hospital Anxiety and Depression Scale (HADS) is a valid measure of anxiety and depression in patients with acute lower back pain, according to a study published in The Journal of Pain.1

HADS was developed specifically to avoid reliance on confounding factors that are present in depression and anxiety, but also occur as symptoms of illness or treatment side effects.

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Although several studies have confirmed its validity in the general medical population, including patients with chronic pain, HADS has not previously been studied specifically in patients with acute lower back pain (aLBP) and radicular leg pain.

“The results…suggest that this measure may be an acceptable alternative in analgesic clinical trials to the Beck Depression Inventory (BDI) and Profile of Mood States (POMS), as recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials [IMPAACT],” write Dennis Turk, PhD, director of the Center for Pain Research on Impact, Measurement and Effectiveness (C-PRIME) at the University of Washington, and colleagues.

For the study, researchers conducted a secondary analysis of data from a randomized, double-blind, parallel group study of 666 aLBP patients receiving immediate-release tapentadol immediate release or oxycodone over a 10-day period.

The patient population was 50.6% male; the majority were white (71.5%), and mean age was 45 years. Participants had been diagnosed with aLBP and associated radicular leg pain consistent with Quebec Task Force Classification (QTFC) category 3, 4, or 6.

The 14-item HADS questionnaire (7 for anxiety and 7 for depression) was compared with the Numeric Rating Scale (NRS), Brief Pain Inventory-Short Form (BPI-SF), Short-Form McGill Pain Questionnaire version 2 (SF-MPQ-2), and the Roland and Morris Disability Questionnaire (RMDQ).

Overall responses to the HADS revealed anxiety and depression levels that were on the upper edge of normal, but not pathological; levels were comparable to that of patients with chronic pain and substantially lower than those observed in psychiatric patients.

HADS anxiety and depression subscales both showed good psychometric properties, had high internal consistency, and displayed good convergent validity. They also had no unexpected biases, fit the a priori factor structure, and were highly sensitive to changes as a result of analgesic treatment.

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