Revision of the Hospital Anxiety and Depression Scale (HADS) to Produce the Paediatric Index of Emotional Distress (PI–ED) Suzy O’Connor1, PhD, D.Clin.Psych., Terri Carney1, D.Clin.Psych.,Emma House1, D.Clin.Psych., Eamonn Ferguson2, PhD, Fiona Caldwell3, MA(Hons), Rory C O’Connor3, PhD	PDF File
1 NHS Ayrshire and Arran, Scotland 2 University of Nottingham, England 3 University of Stirling, Scotland

This paper describes the development of a paediatric version of the HADS, the PI-ED. Following a three-phase

development, the HADS was revised to render it suitable for children and young people. The revised measure (the PI-ED) was employed in a large-scale standardization school-based study (n=1108) and assessed for diagnostic sensitivity and test-retest reliability in a sample of paediatric out-patients (n=117, data presented elsewhere). Analyses support a

measure of overall emotional distress, with anxiety and depression as sub-factors, which is consistent with literature about co-morbidity. The PI-ED offers a valid, reliable, brief, easily scored, cost-effective method to measure emotional distress in children and young people in primary care / hospital, social work or school settings.

Introduction

The Hospital Anxiety and Depression Scale (HADS)1 was developed as a valid and reliable means of detecting anxiety and /or depression in adult patients in nonpsychiatric hospital departments. Items in the HADS pertain specifically to the “psychic” symptoms of anxiety and depression and items that could be confounded with the symptoms of physical illness, e.g., dizziness or headaches were excluded by the scale authors. This measure has excellent psychometric properties (for
review2); it is brief, easy to score and interpret and has, as a result, been used widely, for clinical and research purposes.
However, to date, no similar measure has been available for use with paediatric populations. This paper outlines the
development and evaluation of a paediatric version of the HADS, (the PI-ED). There are few questionnaire measures that are tailored specifically to the medical paediatric population. Measures such as the Children’s Depression Inventory (CDI)3 contain items that are not necessarily relevant for a screening measure in a paediatric population and can cause children and their parents some distress.