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Psychometric properties and factor structures

The beauty of the HADS score is its simplicity, speed and ease of use. Very few (literate) people have difficulty completing it, on paper or electronically. It assesses both anxiety and depression, which commonly coexist [2]. Anxiety is poorly recognized by clinicians, so should be actively sought [3]. Anxiety often precedes depression in response to stressors, and identifying the employee with high or rising anxiety before depression allows occupational health practitioners to advise on early intervention measures while the employee is still at work and potentially avoid sickness absence. This would be missed using a depression only questionnaire such as the Patient Health Questionnaire (PHQ9). HADS focuses on non-physical symptoms so that it can be used to diagnose depression in people with significant physical ill-health. Any overlap, for instance impaired concentration secondary to pain rather than depression, is usually easy to separate on an individual basis. HADS does not include all of the diagnostic criteria of depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth/Fifth Edition (DSM IV/V)) or all those required by the Health and Work Development Unit (HWDU) National Depression and Long Term Sickness Absence Screening Audit [4]. For this, additional questions on appetite, sleep and self-harm/suicidal thoughts have to be asked. A risk assessment for self-harm or suicide should of course be carried out in appropriate cases.