Use of the HADS Hospital Anxiety and Depression Scale in patients with LUTS/BPH and erectile dysfunction

Description of the technique

The scale was developed by Zigmond AS and Snaith RP in 1983 to identify and assess the severity of depression and anxiety in general medical practice.
The advantages of the discussed scale are its ease of use and processing (filling out the scale does not require a long time and does not cause difficulties for the patient), which makes it possible to recommend it for use in general somatic practice for the primary identification of anxiety and depression in patients (screening). The questionnaire has high discriminant validity for two disorders: anxiety and depression. For a more detailed qualification of the condition and tracking its further dynamics, it is recommended to use more sensitive clinical scales (for example, the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Montgomery-Asberg Depression Scale, the Beck Depression Inventory, the Covey Anxiety Scale, the Beck Anxiety Scale. When forming a scale the authors excluded symptoms of anxiety and depression that could be interpreted as a manifestation of a somatic illness (for example, dizziness, headaches, etc.). Items on the depression subscale were selected from the list of the most common complaints and symptoms and reflect predominantly the anhedonic component of depressive disorder. Items on the anxiety subscale compiled on the basis of the corresponding section of the standardized clinical interview Present State Examination and the personal clinical experience of the authors and reflect predominantly psychological manifestations of anxiety.

Hospital Anxiety and Depression Scale ( hads )

The scale, developed by AS Zigmond and RP Snaith in 1983, is subjective and is intended for screening anxiety and depression in somatic hospital patients. It is easy to use and process (filling out the scale does not require a long time and does not cause difficulties for the patient), which allows it to be recommended for use in general medical practice for the primary detection of anxiety and depression in patients (screening).

Recommendations for using the scale

The scale is composed of 14 statements serving 2 subscales:

• subscale A - “anxiety” (from English, “ anxiety ”):

odd numbers 1, 3,

5, 7, 9,11,13;

• subscale D “depression” (from English, “ depression ”):

even points 2, 4,

6; 8,10,12,14.

Each statement corresponds to 4 answer options, reflecting gradations of symptom severity and coded according to the increasing severity of the symptom from 0 points (absence) to 4 (maximum severity).

The distribution of the scale to the patient is accompanied by the following instructions:

“Scientists are confident that emotions play an important role in the occurrence of most diseases. If your doctor knows more about your experiences, he or she will be able to better help you. This questionnaire is designed to help your doctor understand how you are feeling. Ignore the numbers and letters on the left side of the questionnaire. Read each statement carefully and in the blank box on the left, mark with a cross the answer that most closely matches how you felt last week. Don't think too long about each statement. Your first reaction will always be more correct.”

When interpreting the data, the total indicator for each subscale (A and D) is taken into account, and 3 ranges of values ​​are distinguished:

• 0-7 points – normal;

• 8-10 points – subclinically expressed anxiety/depression;

• 11 points and above – clinically significant anxiety/depression.

ZUNG SCALE FOR SELF-ASSESSMENT OF DEPRESSION

The Zung scale is a self-assessment measure of depression. Based on factor analysis, 7 parameters are measured: feelings of mental emptiness, mood changes, somatic and psychomotor symptoms of depression, suicidal thoughts and irritability - indecisiveness.

Recommendations for using the scale

The scale includes 20 items, each of which measures the subjective frequency (“extremely rarely,” “rarely,” “often,” “most of the time or all the time”) of depressive symptoms. When filling out the scale form, the patient marks with a cross the cells of those answer options that most accurately correspond to his condition. Scoring is done as follows:

• points 1, 3, 4, 7,10,13,15 and 19 are scored from 1 to 4 points in direct sequence;

• points 5, b, 11,12,16,17, 18 and 20 (highlighted in background) - in reverse order, i.e. from 4 to 1 points.

ZUNG SCALE

When interpreting data, it is necessary to make an adjustment for the specific gravity of each of the symptoms used in the scale, expressed by a special coefficient (SDS). The latter is calculated as a decimal fraction:

The total score obtained when the patient filled out the scale is ~80 points (the maximum possible total score)

The resulting SDS value is compared with the mean of the standard depression severity score, which is:

• SDS = 0.74 before treatment,

• SDS = 0.39 at end of treatment.

HAMILTON DEPRESSION RATING SCALE ( HDRS )

The Hamilton Depression Rating Scale is one of the most widely used instruments in affective pathology clinics. Several versions of the scale are used (17, 21 and 23 points). The original version contains 23 points, 2 of which (16th and 18th) consist of two parts - A and B, filled out alternatively. The scale provides a simple way to assess the severity of depression over time.

Recommendations for using the scale

The severity of depressive symptoms over time is assessed objectively through repeated testing. Accordingly, the researcher must be a qualified and experienced psychiatrist or have received the necessary training. For assessment, you should choose the answer option that most accurately characterizes the patient’s condition, who should be given the opportunity to answer the questions asked in detail. Place a mark in the box highlighted in background.

When interpreting the data, it must be remembered that the point values ​​of items 4-6,12-14,16-18, in which variables cannot be expressed quantitatively, are assessed qualitatively (from 0 to 2 points). Items 18–21 do not measure depression severity.

severity of depression is assessed using the HDRS as follows [ Guelfi
G. D. _
Devaluation clinique standardis its en psychiatric, psycho-pathologie denerale. Depression, anxiete, et anxiodepression. Editions Medi-cales Pierre Fabre, 1993]:

• a score from 0 to 7 indicates the absence of depression;

• total values ​​for minor depressive episode are

7-16 points;

• lower limit value for major depressive episode -

over 16 points;

• the maximum possible total score is 52 and corresponds to the extreme severity of depressive syndrome.

MONTGOMERY-ASBERG DEPRESSION RATING SCALE ( MADRS )

Montgomery-Asberg scale [ Montgomery S. A .,
Asberg M
., 1979] was developed for quick and accurate assessment of the severity of depression and its dynamics during therapy. This scale, along with the Hamilton scale, is one of the standardized objective clinical instruments widely used in modern psychiatry.

The MADRS is equivalent to the HDRS in that it takes into account the core symptoms of depression (excluding motor inhibition). Moreover, the scale contains fewer items than the HDRS. It is believed that MADRS allows a more accurate assessment of the dynamics of the condition.

Recommendations for using the scale

The recommendations are the same as for the Hamilton scale. The assessment should be based on a clinical interview from the least direct to clarifying questions about the condition and its severity.

The researcher must decide whether the severity of the symptom corresponds to the main points - 0, 2,4,6 or intermediate - 1, 3, 5. If it is not possible to obtain accurate answers from the patient himself, it is recommended to use other sources of information (medical documentation, information from relatives etc.).

To assess the condition over time, repeated testing is carried out at fixed intervals.

The researcher puts down his notes in the column marked with a background.

MONTGOMERY-ASBERG DEPRESSION RATING SCALE (MADRS)

When interpreting the data, scores are calculated as follows: each item on the scale is scored from 0 to 6 according to the increasing severity of the symptom. The maximum total score is 60 points. The sum of points corresponds to:

• 0-15 points – absence of a depressive episode;

• 16-25 points – minor depressive episode;

• 26-30 points – moderate depressive episode;

• over 30 points – major depressive episode.

Psychometric scales for assessing depression

UKU Side Effect Rating Scale
The
scale was developed in 1987 by Scandinavian researchers 0. Lingia-erde, UG Ahlfots and P. Bech to assess the tolerability of drugs in clinical trials (full name “Udvald for Kliniske Undersogelser Scale” ) .

The UKU scale contains a list of 26 side effects and a separate

"Other side effects" column.

The presence and severity of each of them is assessed in points from 0 to 3:

• 0—absence,

• 1—mild degree,

• 2—moderate,

• 3—heavy.

The severity of symptoms is assessed objectively through questioning, which is recommended to be supplemented by clinical observations and information obtained from medical staff and from medical records.

Recommendations for using the scale

Most symptoms require assessment at the time of examination, but the patient's condition over the past three days is taken into account. For some individually specified symptoms, the time period assessed exceeds 72 hours (eg, weight, menstrual irregularities, cramps, physical and psychological dependence).

When assessing psychopathological side effects, discrepancies may arise between subjective complaints and clinical signs detected objectively. Priority goes to clinical

observations.

Ratings are entered in the column indicated by the background.

If assessment of a symptom is not possible, an “x” is placed in the corresponding column on the left (“symptom not assessed”).

It is important that the assessment be made regardless of whether the symptom is considered to be caused by the drug or not. The likelihood of a relationship between the occurrence of a symptom and the therapy being given is indicated by a “T” in a separate column (“symptom probably related to therapy”).

UKU
SIDE EFFECTS RATING SCALE Column “x” - the symptom is not assessed; Column “T”—symptom likely related to therapy.

When interpreting the data, it must be remembered that the scale is not intended for a summary rating, but for ascertaining side effects, assessing their severity and connection with the therapy. Each item is rated on a 4-point scale. As a rule, a score of “O” means “absent or not bothered” and corresponds to the average idea of ​​a “normal” or “conditionally healthy” individual. Exceptions to this rule are legitimate in cases where the reference to the usual state, i.e., habitual for the patient before the illness, becomes more clinically significant. This applies to items assessing sleep (items 1.7 and 1.8), dream intensity (items 1.9), body weight (items 4.5 and 4.6), menstrual disorders (items 4.7 and 4.8), and manifestations of sexual dysfunction (items 4.1.1- 4.16). Scores of “1,” “2,” and “3” assess mild, moderate, and severe symptom severity, respectively. For some items, examples are provided to illustrate the assessment of relevant symptoms. These examples should not be considered as a guide to action, but only as a recommendation.

The assessment of the likelihood of an association between a symptom and the drug (column “T”) is based on prior knowledge of the patient and clinical judgment for all symptoms scored “1”, “2” or “3”.

Purpose of the scale

The Hospital Anxiety and Depression Scale is a special psychological test designed to determine the level of severity of these conditions. More often referred to by the English abbreviation HADS. The goal is the primary identification of signs in general medical practice.

The test was compiled in the mid-80s of the 20th century. In 1983 A.S. Zsigmond and R.P. Snaith published a special work, “Hospital Anxiety and Depression Scale,” where the test was presented and commented on.

At the present stage of studying the problem of assessing ailments, experts continue to pay close attention to HADS - they study it and analyze its structure. Some researchers accept the existing two-block structure, calling it optimal.

A number of experts offer options that consist of three or four blocks, since the test created by Zsigmond and Snaith, in their opinion, is only suitable for a one-dimensional assessment of psychological stress.

When compiling the Hospital Depression and Anxiety Scale, the following factors were taken into account:

• symptoms that can be perceived as somatic diseases are excluded - dizziness, headache, fatigue, insomnia, hypersomnia (daytime sleepiness);
• the items in Part A (anxiety) were compiled based on baseline interviews and the personal experiences of the authors;
• for Part D (depression), statements were selected based on the most common complaints and symptoms.

Benefits of HADS:

• recognized reliability of the results during the initial examination - the assessment results have minimal error, given the simplicity of the method;
• speed of completion - only 14 questions;
• simplicity - understandable and vital questions;
• ease of calculating results;
• The assessment method has an international distribution and is used by doctors and specialists in more than one hundred countries around the world.

For more accurate diagnosis, several more tests have been developed today:

• HARS;
• HDRS;
• MADRS;
• BDI;
• BAI;
• CAS.

Special hospital self-assessment programs have been developed that provide primary data regarding the patient’s self-assessment.

Test form

“Scientists are confident that emotions play an important role in the occurrence of most diseases. If your doctor knows more about your experiences, he or she will be able to better help you. This questionnaire is designed to help your doctor understand how you are feeling. Ignore the numbers and letters on the left side of the questionnaire. Read each statement carefully, and in the blank space on the left, mark with a cross the answer that most closely matches how you felt last week. Don't think too long about each statement. Your first reaction will always be more correct.”

The HADS form consists of 14 items, divided into two parts:

• 7 points are devoted to anxiety - block A;
• 7 points are aimed at determining the degree of depression - block D.

Each statement in the test is scored from zero to three. Zero is the complete absence of the proposed sensations and desires. Three - coincidence of the proposed sensations and feelings with your state. Intermediate grades - one and two.

When taking the test, you can score from 0 to 21 points in each group of points. Anxiety and depression are assessed separately.

Named types of testing

Testing is used in many areas. The field of psychology and psychotherapy is no exception. Various specialists have created methods for identifying depression in the form of tests, which subsequently showed high effectiveness. To determine different forms of psychological problems, tests are used today:

1. Rorschach. Examines the human condition using symmetrical ink spots, which are applied to 5 color and 5 black and white cards. While taking the test, a person describes his associations with ink blots of various shapes.
2. Luscher. A well-known method for diagnosing depression is based on the use of cards of different colors. During the testing process, a person will have to choose the least pleasant colors. It is noteworthy that the same people taking the Luscher test at different periods of life choose different colors. With its help, hidden psychological problems, the degree of anxiety are identified and the general condition of a person is assessed.
3. Sondi. The technique is based on eight different portraits, from which you should choose the most attractive and unpleasant options. The test not only helps to identify common problems that occur in most people, but also provides recommendations for personal self-realization.
4. Rosenzweig. The test, which became a kind of result of Saul Rosenzweig's theory of frustration, looks like a set of pictures, 16 of which demonstrate a psychological obstacle (disorienting, discouraging, offending, etc.), and 8 of which are accusing. There is a testing method for children and adults. The first is used from 4 to 13 years of age, the second - from 15 years of age. In the interim period, either option can be used. The decision remains with the specialist performing the testing.

Another popular research method in the field of psychology is the Ammon test, which has a self-structure.

More than 200 points help to identify destructive, deficient and constructive signs. With its help, character traits such as fear, anxiety, aggression, external and internal limitations, sexuality and narcissism are accurately identified.

Instructions for the HADS Anxiety and Depression Test

Practical recommendations. The scale must be completed in 10-15 minutes independently, without discussion with anyone. Answers must be selected for all items. Each statement on the HADS scale has four response options. Select and mark the answer that corresponds to your condition over the past 7 days. Don't think too long about answering the question. Your first reaction will be the most correct.

Part I (Anxiety Assessment)

1. I feel tense and uneasy

• 3 - all the time
• 2 - often
• 1 - from time to time, sometimes
• 0 - I don’t feel it at all

2. I feel afraid, it feels like something terrible is about to happen.

• 3 - this is definitely true, and the fear is very great
• 2 - yes, this is true, but the fear is not very great
• 1 - sometimes, but it doesn't bother me
• 0 - I don’t feel it at all

3. Worrying thoughts are running through my head.

• 3 - constantly
• 2 - most of the time
• 1 - from time to time and not so often
• 0 - only sometimes

4. I can easily sit down and relax.

• 0 - definitely so
• 1 - this is probably true
• 2 - only rarely is this true
• 3 - I can’t do it at all

5. I experience internal tension or tremors.

• 0 - I don’t feel it at all
• 1 - sometimes
• 2 - often
• 3 - very often

6. I feel restless and constantly need to move.

• 3 - definitely so
• 2 - this is probably true
• 1 - only to some extent this is true
• 0 - I don’t feel it at all

7. I have sudden feelings of panic.

• 3 - very often
• 2 - quite often
• 1 - not so often
• 0 - never happens at all

NUMBER OF POINTS _______

Part II (assessment of depression level)

1. Something that brought me great pleasure still gives me the same feeling.

• 0 - definitely true
• 1 - this is probably true
• 2 - only to a very small extent this is true
• 3 - this is not true at all

2. I am able to laugh and see the funny in this or that event.

• 0 - definitely so
• 1 - this is probably true
• 2 - only to a very small extent this is true
• 3 - not at all capable

3. I feel energized

• 3 - I don’t feel it at all
• 2 - very rarely
• 1 - sometimes
• 0 - almost all the time

4. It seems to me that I began to do everything very slowly

• 3 - almost all the time
• 2 - often
• 1 - sometimes
• 0 - not at all

5. I don't take care of my appearance.

• 3 - definitely so
• 2 - I don't spend as much time on this as I need
• 1 - maybe I started devoting less time to this
• 0 - I take care of myself the same way as before

6. I believe that my activities (activities, hobbies) can bring me a sense of satisfaction.

• 0 - exactly the same as usual
• 1 - yes, but not to the same extent as before
• 2 - significantly less than usual
• 3 - I don’t think so at all

7. I can enjoy a good book, radio or television program.

• 0 - often
• 1 - sometimes
• 2 - rarely
• 3 - very rarely

NUMBER OF POINTS _______

Main advantages of the test

Compared to other similar meters, the HADS scale has certain advantages. They are in the following aspects:

1. Fast and easy to use. It contains only 14 questions, which will take no more than 5 minutes to answer. There will be no particular difficulty in answering or determining the results.
2. Widespread. The HADS scale has been translated into more than 100 languages, which makes it easy to use as an international test.

Despite the small number of questions, this technique is distinguished by a very accurate level of disease assessment. It is how accurately the degree of the disease is determined that determines which regimen is suitable for treatment and what effectiveness it will show.

Interpretation of results

When interpreting the results, the total indicator for each subscale is taken into account, and 3 areas of its values ​​are distinguished:

• 0-7 - normal (absence of significantly expressed symptoms of anxiety and depression),
• 8-10 - subclinically expressed anxiety/depression,
• 11 and above - clinically significant anxiety/depression.

If the total score for any part of the scale is 8 points or more, a consultation with a neurologist or a consultation with a psychotherapist is necessary to prescribe the necessary treatment.

A modern effective method for treating panic attacks, depression and anxiety is transcranial magnetic stimulation.

Part II (assessing the level of DEPRESSION)

The scale is made up of 14 statements and includes two parts: anxiety (Part I) and depression (Part II)

For interpretation, it is necessary to sum up the scores for each part separately:

• 0-7 points is normal (absence of significantly expressed symptoms of anxiety and depression)
• 8-10 points subclinical anxiety/depression
• 11 points and above clinically significant anxiety/depression For example: on the anxiety scale it turned out to be 11 points, on the depression scale - 3 points. It can be concluded that there is clinically significant anxiety, and the level of depression is within normal limits.

Or: on the anxiety scale it turned out to be 15 points, on the depression scale - 9 points. We can conclude that there is clinically pronounced anxiety and subclinically expressed depression.

Or: on the anxiety scale it was 6 points, on the depression scale 7 points. We can conclude that the levels of both anxiety and depression are within normal limits (i.e., there is no need to sum the scores of each part together!)

Each statement has 4 answer options. Choose the answer that matches your condition, and then add up the points.

Zang scale (adapted by T.I. Balashova)

The Zang Self-Rating Depression Scale helps detect early psychological deterioration. The scale covers all the main aspects of human life. It is also called the Zung Depression Scale. This is the same questionnaire for identifying psychological problems. Since the author’s surname is foreign, you can sometimes come across the name Zung Depression Scale. It was developed at an American university in 1965.

The Zung Depression Test has translations into many languages. In addition to translation, the questionnaire needs some adaptation to the country where the diagnosis will be carried out. In Russia, this work with a depression scale was carried out by T. I. Balashova.

There are only 20 questions and they can be conditionally divided into two groups - positive and negative statements. Answers are scored from one to four and then added together. All answers are differentiated into 4 categories: 1) occasionally or not, 2) sometimes, 3) often, 4) always or constantly.

You can take the Zang Self-Rating Depression Scale online:

1. I'm depressed and sad

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

2. I feel better in the morning.

• occasionally or not – 4;
• sometimes – 3;
• often – 2;
• always – 1.

3. I'm on the verge of tears or whiny.

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

4. I have trouble sleeping

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

5. My appetite has not changed

• yes, has not changed – 1 point;
• changed a little – 2;
• I have a poor appetite – 3;
• no appetite – 4.

6. I am attracted to the opposite sex.

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

7. I'm losing weight

• occasionally or not – 1 point;
• sometimes – 2;
• I’m noticeably losing weight – 3;
• lost a lot of weight – 4.

8. I suffer from constipation

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

9. I have tachycardia

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

10. I get tired for no reason

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

11. My mind is as clear as ever

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

12. I find it easy to cope with work

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

13. I am restless and restless

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

14. I am full of hope for the future

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

15. I get irritated faster than before

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

16. I make decisions easily

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

17. I feel like I’m useful and needed by people.

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

18. My life is full and interesting

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

19. I think everyone will be better off if I disappear from this world.

• occasionally or not – 1 point;
• sometimes – 2;
• often – 3;
• constantly – 4.

20. I now rejoice in what has always made me happy before.

• occasionally or not – 4 points;
• sometimes – 3;
• often – 2;
• constantly – 1.

Interpretation of the depression test:

• 20-49 is normal;
• 50-59 – mild depression;
• 60-69 – moderate degree;
• 70 and more – heavy.