Cosco and colleagues [this issue] provide a well done and transparently reported systematic review of the Hospital and Anxiety Depression Scale (HADS) literature of the past decade. They conclude that the underlying structure of the HADS is inconsistent across samples and highly dependent on the statistical methods used to establish that structure. The implication is that the HADS is not a dependable means of differentiating anxiety and depression for the purposes of assessing the absolute or relative levels of these variables. These results can also go far in explaining the confusing difficulties that have arisen in research concerning use of the HADS as the first stage of two-stage screening procedures for depression and anxiety disorders or case identification purposes.