Anxiety symptoms

Anxiety symptoms

LASA filenames:
LASA026 / LASA226

Contact: Almar Kok


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 and it affect 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; Zigmond 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 four weeks. The Likert-type items range from 0 (rarely or never) to 3 (mostly or always). Item four identifies a positive state (see below in pdf) and thus must be reverse coded.  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). 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. A cutoff score for identifying anxious participants is a score equal to or greater than 8. A clinically relevant cutoff, used in longitudinal analyses, is based on two criteria, a score equal to or greater than 8 and and an increase of 0.5 times the standard deviation (SD) of the baseline score.

Scale construction

The HADS-A scale score is computed as the sum of the scores on the 7 items, with a range from 0 to 21. Imputation is performed in the case of one missing item only. The imputed value is calculated by taking the average of the 6 available items (i.e. dividing the scale score by 6 and rounding the result).


LASAB026 / LASAC026 / LASAD026 / LASAE026 / LASAF026 / LASAG026 / LASAH026 / LAS3B026 / LASMB026 / LASAI026 / LASAJ026 / LASAK026
(main interview, except LASMB026 in medical interview, in English / in Dutch)

Interim measurement:

LASEs813 (self-admin. questionnaire, in Dutch)

Variable information

LASAB026 / LASAC026 / LASAD026 / LASAE026 / LASAF026 / LASAG026 / LASAH026 / LAS3B026 / LASMB026 / LASAI026 / LASAJ026 / LASAK026 (K not availabe yet);
LASAB226 / LASAC226 / LASAD226 / LASAE226 / LASAF226 / LASAG226 / LASAH226 / LAS3B226 / LASMB226 / LASAI226 / LASAJ226 / LASAK226 (K not availabe yet) (scale scores)

Interim measurement:


Availability of information per wave




¹ More information about the LASA data collection waves is available here.

* IM=interim measurement between E and F (first cohort only);
2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=not availabe yet

Ma=data collected in main interview;
Sa=data collected in self-admin. questionnaire;
Me=data collected in medical interview

Previous use in LASA

Within LASA, several papers have been written using the HADS-A. Topics were: prevalence and predictors of anxiety, comorbidity, stability and change in symptoms, within-person pain variability in anxious individuals, visual impairment and the association with: cognitive decline, benzodiazepine use, serum 25-hydroxyvitamin D levels, mortality, prevention and sociodemographic characteristics of the neighborhood.


  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.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. Bell ML, Fairclough DL, Fiero MH, Butow PN. Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study. BMC Res Notes. 2016;9(1):479. Published 2016 Oct 22. doi:10.1186/s13104-016-2284-z
  5. Bierman EJM, Comijs HC, Jonker C, & Beekman ATF. Effects of anxiety versus depression on cognition in later life. Am J Geriatr Psychiatry, 2005, 13(8): 686-693.
  6. 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.
  7. 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.
  8. De Beurs E, Comijs HC, Twisk JWR, Sonnenberg C, Beekman ATF, & Deeg DJH. Stability and change of emotional functioning in late life: modelling of vulnerability profiles. J Affect Disord, 2005, 84: 53-62.
  9. 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.
  10. De Koning, E.J., Timmermans, E.J., Van Schoor , N.M., Stubbs, B., Van den Kommer, T.N., Dennison, E.M., Limongi, F., Castell, M.V., Edwards, M.H., Queipo, R., Cooper, C. (2018). Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts. The Journal of Pain, 19, 6, 690-698.
  11. De Koning, E.J., Verweij, L.M., Lips, P.T.A., Beekman, A.T.F., Comijs, H.C., Van Schoor , N.M. (2017). The relationship between serum 25(OH)D levels and anxiety symptoms in older persons: Results from the Longitudinal Aging Study Amsterdam. Journal of Psychosomatic Research, 97, 90-95.
  12. 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. Br J Psychiatry, 2004, 185, 399-404.
  13. 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.
  14. Motoc, I., Timmermans, E.J., Deeg, D.J.H., Penninx, B.W.J.H., Huisman, M. (2019). Associations of neighbourhood sociodemographic characteristics with depressive and anxiety symptoms in older age: Results from a 5-wave study over 15 years. Health and Place, 59, 102172.
  15. Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement, 1977; 1: 385-401.
  16. 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.
  17. Snaith RP. The hospital anxiety and depression scale. Health Quality Life Outcomes, 2003, 1(29).
  18. 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.
  19. 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.
  20. 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.
  21. Van der Aa, H.P.A., Comijs, H.C., Penninx, B.W.J.H., Van Rens, G.H.M.B., Van Nispen, R.M.A. (2015). Major Depressive and Anxiety Disorders in Visually Impaired Older Adults. Investigative Ophthalmology & Visual Science, 56, 849-854.
  22. Zigmond AS and Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983, 67, 361-370.

Date of last update: December, 2019