Always use the subscale scores (HADS-A and HADS-D separately, each 0-21) for clinical decisions. The total score (0-42) reflects overall distress but does not guide treatment, which differs substantially for anxiety vs depression. Positive subscale thresholds (≥8) determine which disorder needs clinical attention.

No. HADS does not contain suicidality assessment items by design (Zigmond and Snaith intentionally excluded them). When administering HADS to patients with elevated depression scores (HADS-D ≥8), always additionally assess for suicidal ideation using direct clinical inquiry or a dedicated tool (PHQ-9 item 9, C-SSRS).

HADS can be used in primary care but is not the first-line choice. PHQ-9 and GAD-7 are more widely validated in primary care, require less time, and are more familiar to primary care teams. HADS is preferred when somatic symptom contamination is a specific concern (cancer patients, COPD, cardiac disease).

A HADS subscale score ≥8 indicates a possible case requiring clinical follow-up interview to assess whether DSM-5 criteria for anxiety or depressive disorder are met. It does not diagnose a disorder — it identifies patients who warrant focused clinical attention, referral for formal assessment, and potentially treatment.