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During the time of conducting our study, the reliability of the HADS as a clinical screening
tool was critically questioned noting that although the HADS was used in TIDES, different measures were recommended from that international study.36 These measures were the PHQ - 9 for depression and the GAD - 7 for anxiety.4 36 Both these measures are recommended in the international guidelines for mental
health screening of patients with CF, 11 which are since being used in CF clinical settings.15 31 Because of the current shift away from using HADS as a screening
tool for depression and anxiety in CF, and because of the small sample sizes in each group (online and paper - based), we did not test
measurement invariance to determine if the online version of HADS is equivalent to the paper based version.