Symptoms of depression and anxiety can

significantly impact a patient's health status and quality of life. The APPROACH-IS study

administered the Hospital Anxiety and Depression Scale (HADS) to assess the prevalence of

depression and anxiety symptoms among adults with congenital heart disease and their

potential impact on health status and quality of life. The following table from Kovaks, et al.

2023 publication includes the associated score ranges indicating elevated symptoms of

depression and anxiety.

Table 1.

HADS Score Depression and Anxiety Symptoms

8-10 Mildly elevated

11-13 Moderately elevated

14 or greater Severely elevated

Assume the HADS scores in the study sample are normally distributed with a mean of 5.6 and a

standard deviation of 4.75. If 19 study participants complete the HADS, what would be the 99%

confidence interval around this estimate of the mean?

What is the standard error?

a. 0.025

b. 1.09

c. 1.12

d. 2.50