Is the Hospital Anxiety and Depression Scale (HADS) an appropriate screening tool for use in an alcohol-dependent population?

Aims. To examine the psychometric properties of the Hospital Anxiety and Depression Scale in selected research to determine the suitability of this instrument for use in an alcohol-dependent population. Background. Anxiety and depression represent a significant comorbid problem encountered with alcohol dependency. Effective screening for clinically relevant anxiety and depression is crucial for tailoring effective treatment intervention. However, no guidance exists to suggest the most appropriate screening measure in this clinical group. Design. Narrative review. Methods. Three criteria were used: factor analysis, test-retest reliability and internal consistency reliability. Results. Factor analysis studies highlighted a mostly bi-dimensional model or a tripartite model, with only a couple of exceptions. Test-retest reliability came from only five studies, and while they all showed significantly positive correlated scores, only one study fulfilled criteria for a good or efficient reliability measure. The last evaluation, internal consistency reliability, faired much better in terms of recommended scores for reliability. Nearly all the studies showed a high level of internal consistency reliability. Conclusion. It is concluded that the Hospital Anxiety and Depression Scale is likely to be a suitable screening tool for use in an alcohol-dependent population. Relevance to clinical practice. Effective screening for anxiety and depression can significantly enhance treatment efficacy when working with those patients presenting with alcohol dependency. This review suggests that the Hospital Anxiety and Depression Scale may be an appropriate instrument to use in this group based on observation of the tools measurement characteristics.