McCue, P, Martin, Cr, Buchanan, T et al. · Psychology, health & medicine · 2003 · DOI
Researchers tested a questionnaire called the Hospital Anxiety and Depression Scale (HADS) to see if it accurately measures anxiety and depression in people with ME/CFS. They found that while the questionnaire seems reliable overall, it doesn't work exactly as doctors expected—it measures three separate things rather than two. This means the tool may not be the best choice for screening anxiety and depression in ME/CFS patients without some changes.
Many clinicians use the HADS to screen for anxiety and depression in ME/CFS patients, but this study reveals the tool may not function as intended in this population. Understanding these limitations is important for ensuring patients receive accurate assessments and appropriate mental health support without relying on potentially flawed screening tools.
This study does not prove that anxiety and depression are absent in ME/CFS or that they are caused by the illness itself. It also does not establish which screening tools should replace the HADS, nor does it demonstrate that the underlying psychological experiences of patients differ—only that this particular questionnaire's structure doesn't fit CFS populations well.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
McCue, P, Martin, Cr, Buchanan, T, Rodgers, J, & Scholey, Ab (2003). An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in individuals with chronic fatigue syndrome.. Psychology, health & medicine. https://doi.org/10.1080/1354850310001604568
BibTeX
@article{mecfsatlas-mccue-2003-investigation-into,
author = {McCue, P and Martin, Cr and Buchanan, T and Rodgers, J and Scholey, Ab},
title = {An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in individuals with chronic fatigue syndrome.},
journal = {Psychology, health & medicine},
year = {2003},
doi = {10.1080/1354850310001604568},
note = {PubMed: 21974733},
url = {https://www.mecfsatlas.com/evidence/mccue-2003-investigation-into},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/mccue-2003-investigation-into
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