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Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population

  • Arnstein Mykletun (a1), Eystein Stordal (a2) and Alv A. Dahl (a3)

The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.


To examine the psychometric properties of the HAD scale in a large population.


All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations.


Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively.


Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.

Corresponding author
Alv A. Dahl, Research Unit, Department of Psychiatry, Aker Hospital, University of Oslo, Sognsvannsveien 21, 0320 Oslo, Norway. Tel: +47 22923400; fax: +47 22923971; e-mail:
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Declaration of interest

The Norwegian Research Council and Novo Nordisk Pharmaceuticals (Norway) supported this study.

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Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population

  • Arnstein Mykletun (a1), Eystein Stordal (a2) and Alv A. Dahl (a3)
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