SET #3 HADS - Hospital Anxiety and Depression Survey

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Instructions: Check the box beside the reply that is closest to how you have been feeling in the past week. Don't take too long over your replies; your immediate response is best.

To maintain the confidentiality of your responses, please enter the last 5 digits of your driver's license number. When you complete the sets of assessment forms (Set #1 = pretest, Set #2 = last day tests, Set #3 = one month follow-up) please carefully input these 5 digits on each form. Thank you! *

1. In the past week, I feel tense or "wound up": *

3 = Most of the time

2 = A lot of the time

1 = From time to time, occasionally

0 = Not at all

Required

2. I still enjoy the things I used to enjoy: *

0 = Definitely as much

1 = Not quite so much

2 = Only a little

3 = Hardly at all

Required

3. I get a sort of frightened feeling as if something awful is about to happen: *

3 = Very definitely and quite badly

2 = Yes, but not too badly

1 = A little, but it doesn't worry me

0 = Not at all

Required

4. I can laugh and see the funny side of things: *

0 = as much as I always could

1 = Not quite so much now

2 = Definitely not so much now

3 = Not at all

Required

5.Worrying thoughts go through my mind: *

3 = Quite a bit

2 = A lot of the time

3 = From time to time, but not too often

0 = only occasionally

Required

6. I feel cheerful: *

3 = not at all

2 = Not often

1 = Sometimes

0 = Most of the time

Required

7. I can sit still and feel relaxed: *

0 = definitely

1 = Usually

2 = Not often

3 = Not at all

Required

8. I feel as if I am slowed down: *

3 = Nearly all the time

2 = Very often

1 = Sometimes

0 = Not at all

Required

9. I get a sort of frightened feeling like "butterflies" in the stomach: *

0 = Not at all

1 = Occasionally

2 = Quite often

3 = Very often

Required

10. I have lost interest in my appearance: *

3 = Definitely

2 = I don't take as much care as I should

1 = I may not take quite as much care

0 = I take just as much care as ever

Required

11. I feel restless as I have to be on the move: *

3 = Very much indeed

2 = Quite a lot

1 = Not very much

0 = Not at all

Required

12. I look forward with enjoyment to things: *

0 = As much as I ever did

1 = Rather less than I used to

2 = Definitely less than I used to

3 = Hardly at all

Required

13. I get sudden feelings of panic: *

3 = Very often indeed

2 = Quite often

1= Not very often

0 = Not at all

Required

14. I can enjoy a good book or radio or TV program *

0 = Often

1 = Sometimes

2 = Not often

3 = Very seldom

Required

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