The hospital anxiety and depression scale consists of 14 items
pertaining to anxiety and depression, which are measured on a fourpoint
scale. Scores for the anxiety and depression subscale range from
0–21, and values for the total score range from 0–42. Higher scores
indicate more severe anxiety or depression (16). A total score of 13 or
more was considered increased. Dutch reference values of the general
population were derived from the study by Spinhoven et al.