Anxiety symptoms


Contact: Hannie Comijs

Feeling anxious or nervous is a common emotion for people of all ages and a normal reaction to stress. It can help us handle problems and dangerous situations. It is also normal to feel worried or anxious about illnesses, new situations, and frightening events. But when one feels anxious often, out of proportion and overwhelming and affects daily life, it may be an anxiety disorder. In LASA anxiety symptoms are measured with the anxiety subscale of the  Hospital Anxiety Depression Scale (HADS-A; Zigmund and Snaith, 1983). In the original scale each item has a unique set of response categories. Reliability and validation of the Dutch translation of the HADS has been reported by Spinhoven et al. (1997).

Measurement instrument in LASA
The HADS-A subscale consists of seven items for measuring symptoms of anxiety. The respondent is asked to indicate whether he/she has experienced feelings such as restlessness, tenseness, or panic over the past 4 weeks. In the adaptation for LASA, all items have the same response categories, which are derived from the Center of Epidemiologic Studies Depression Scale (CES-D; Radloff 1977). Thus the HADS-A is composed of Likert type items ranging from 0 (rarely or never) to 3 (mostly or always). The codes of item 4 (see below) must be reversed. The anxiety subscale score is the sum of the scores on the items and therefore has a theoretical range from 0 to 21.

Snaith (2003) introduced two cut-off scores based on analyses of the scores in a clinical setting. A score of 0 to 7 could be regarded as being the normal range, a score of 8 to 10 was suggestive for an anxiety disorder and a score of 11 and higher indicates the presence ('caseness') of an anxiety disorder.

LASAB026 / LASAC026 / LASAD026 / LASAE026 / LASAF026 / LASAG026 / LASAH026 / LAS3B026 / LASMB026 / LASAI026
(main interview, except LASMB026 in medical interview, in English / in Dutch)

Variable information
LASAB026 / LASAC026 / LASAD026 / LASAE026 / LASAF026 / LASAG026 / LASAH026 / LAS3B026 / LASMB026 / LASAI026;
LASAB226 / LASAC226 / LASAD226 / LASAE226 / LASAF226 / LASAG226 / LASAH226 / LAS3B226 / LASMB226 / LASAI226 (scale scores)

Availability of information per wave 1:











MB* I*











Me Ma

1 More information about the LASA data collection waves is available on:

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort (Under Construction);
   I=Under Construction

Ma=data collected in main interview;
Me=data collected in medical interview

Previous use in LASA
Within LASA, several papers have been written using the HADS-A. Subjects were: prevalence and predictors of anxiety, comorbidity, stability and change in symptoms, the association with cognitive decline, benzodiazepine use, mortality and prevention.


  1. Balkom AJ van, Beekman AT, de Beurs E, Deeg DJ, van Dyck R, van Tilburg W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand 2000, 101(1): 37-45.
  2. Beekman, ATF, Bremmer MA, Deeg DJ, Balkom AJ, Smit JH, de Beurs E, van Dyck R and van Tilburg W. Anxiety Disorders in Later Life: a Report From the Longitudinal Aging Study Amsterdam. Int. J. Geriatr. Psychiatry, 1998, 13(10), 717-726.
  3. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R and van Tilburg W. Anxiety and Depression in Later Life: Co-Occurrence and Communality of Risk Factors. Am. J. Psychiatry, 2000, 157 (1), 89-95.
  4. Bierman EJM, Comijs HC, van Leeuwen JEP, Jonker C, & Beekman ATF. Anxiety has a different effect on cognition than depression in later life. Am J Geriatr Psychiatry, 2005, 13(8): 686-693.
  5. Bierman EJ, Comijs HC, Jonker C, & Beekman AT. Symptoms of Anxiety and Depression in the Course of Cognitive Decline. Dem Geriatr Cogn Disord. 2007, 10, 24(3):213-219.
  6. Bierman, E.J.M., Comijs, H.C., Rijmen, F., Jonker, C., Beekman, A.T.F.. Anxiety symptoms and cognitive performance in later life: results from the Longitudinal Aging Study Amsterdam. Aging & Mental Health. 2008, 12, 4, 517-523.
  7. De Beurs E, Comijs HC, Twisk JWR, Sonnenberg C, Beekman ATF, & Deeg DJH. Stability and change in symptoms of depression, anxiety, and general negative affect in late life: modelling of vulnerability profiles. J Affect Disord, 2005, 84: 53-62.
  8. De Beurs E, Beekman AT, Deeg DJ, Dyck R. van, Tilburg W van. Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam. Psycholol Med 2000; 30(3), 515-527.
  9. Hout HPJ van, Beekman ATF, de Beurs E, Comijs H, van Marwijk H, de Haan M, van Tilburg W & Deeg DJH. Anxiety and the risk of death in older men and women, the Longitudinal Aging Study Amsterdam. Br J Psychiatry, 2004, 185, 399-404.
  10. Michielsen, M., Comijs, H.C., Semeijn, E.J., Beekman, A.T.F., Deeg, D.J.H., Kooij, J.J.S. The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: A longitudinal study. Journal of Affective Disorders, 2012, 148, 2-3, 220-227.
  11. Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement, 1977; 1: 385-401.
  12. Smit F, Comijs HC, Schoevers R, Cuijpers P, Deeg D, & Beekman A. Target groups for the prevention of late-life anxiety. British Journal of Psychiatry, 2007, 190: 428-434.
  13. Snaith RP. The hospital anxiety and depression scale. Health Quality Life Outcomes, 2003, 1(29).
  14. Sonnenberg CM, Bierman EJ, Deeg DJ, Comijs HC, van Tilburg W, Beekman AT. Ten-year trends in benzodiazepine use in the Dutch population. Soc Psychiatry Psychiatr Epidemiol, 2012; 47(2):293-301.
  15. Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med, 1997, 27, 363-370.
  16. Van Balkom AJ, Beekman AT, de Beurs E, Deeg DJ, Van Dyck R and Van Tilburg W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand. 2000, 101(1), 37-45.
  17. Zigmund AS and Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983, 67, 361-370.