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Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample

Ioannis Michopoulos1, Athanasios Douzenis1, Christina Kalkavoura1, Christos Christodoulou1, Panayiota Michalopoulou1, Georgia Kalemi1, Katerina Fineti1, Paulos Patapis2, Konstantinos Protopapas3 and Lefteris Lykouras1*

Author Affiliations

1 Second Department of Psychiatry, Athens University Medical School, 'Attikon' General Hospital, Athens, Greece

2 Third Department of Surgery, University of Athens, School of Medicine, 'Attikon' University Hospital, Athens, Greece

3 Fourth Department of Internal Medicine, University General Hospital 'Attikon', Athens, Greece

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Annals of General Psychiatry 2008, 7:4  doi:10.1186/1744-859X-7-4

Published: 6 March 2008



The Hospital Anxiety and Depression Scale (HADS) has been used in several languages to assess anxiety and depression in general hospital patients with good results.


The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens). The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were used as 'gold standards' for depression and anxiety respectively.


The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression) and stability (test-retest intraclass correlation coefficient 0.944). Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749).


The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.