The structure of the Hospital Anxiety and Depression Scale: Theoretical and methodological considerations.

The Hospital Anxiety and Depression Scale (HADS; Zigmond ‐ Snaith, 1983) is widely used; however, its factor structure is unclear, with studies reporting differing unidimensional, two‐factor and three‐factor models. We aimed to address some key theoretical and methodological issues contributing to i...

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Publicado en:British Journal of Psychology Vol. 114; no. 2; pp. 457 - 476
Autores principales: Lloyd, Maddison, Sugden, Nicole, Thomas, Matt, McGrath, Andrew, Skilbeck, Clive
Formato: Artículo
Publicado: Wiley-Blackwell May2023
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Acceso en línea:Ver este registro en EBSCOhost
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      dt: May2023
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        atl: The structure of the Hospital Anxiety and Depression Scale: Theoretical and methodological considerations.
      aug:
        au:
          Lloyd, Maddison
          Sugden, Nicole
          Thomas, Matt
          McGrath, Andrew
          Skilbeck, Clive
        affil:
          School of Psychology, Charles Sturt University, Bathurst New South Wales,, Australia
          Western New South Wales Local Health District, Bathurst New South Wales,, Australia
          Marathon Health, Bathurst New South Wales,, Australia
          School of Psychology, University of Tasmania, Sandy Bay Tasmania,, Australia
      su:
        Psychometrics
        Psychological tests
        Mental depression
        Anxiety
        Medical research
        Statistics
        Mathematical models
        Comparative studies
        Theory
        Factor analysis
        Statistical models
        Data analysis
        Evaluation
      sug:
        subj:
          Psychometrics
          Psychological tests
          Mental depression
          Anxiety
          Medical research
          Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology)
          Statistics
          Mathematical models
          Comparative studies
          Theory
          Factor analysis
          Statistical models
          Data analysis
          Evaluation
      keyword:
        anxiety
        depression
        factor analysis
        Hospital Anxiety and Depression Scale
        psychological assessment
        anxiety
        depression
        factor analysis
        Hospital Anxiety and Depression Scale
        psychological assessment
      ab: The Hospital Anxiety and Depression Scale (HADS; Zigmond ‐ Snaith, 1983) is widely used; however, its factor structure is unclear, with studies reporting differing unidimensional, two‐factor and three‐factor models. We aimed to address some key theoretical and methodological issues contributing to inconsistencies in HADS structures across samples. We reviewed existing HADS models and compared their fit using confirmatory factor analysis (CFA). We also investigated methodological effects by comparing factor structures derived from Rasch and Principal Components Analysis (PCA) methods, as well as effects of a negative wording factor. An Australian community‐dwelling sample consisting of 189 females and 158 males aged 17–86 (M = 35.73, SD = 17.41) completed the 14‐item HADS. The Rasch Analysis, PCA and CFA all supported the original two‐factor structure. Although some three‐factor models had good fit, they had unacceptable reliability. In the CFA, a hierarchical bifactor model with a general distress factor and uncorrelated depression and anxiety subscales produced the best fit, but the general factor was not unidimensional. The addition of a negative wording factor improved model fit. These findings highlight the effects of differing methodologies in producing inconsistent HADS factor structures across studies. Further replication of model fit across samples and refinement of the HADS items is warranted.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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