Key result
Bifactorial German HADS models fit better than the original two-factor structure in cancer patients.
Why the study?
The optimal factor structure of the HADS in an oncological setting depending on the time of diagnosis remains unclear.
Population
3395 cancer patients receiving psycho-oncological care
Comparison
22 common HADS factor models from the literature
Design
Secondary data analysis using confirmatory factor analysis
Authors
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Supports bifactorial German HADS scoring in cancer patients; leaves open prospective validation of clinical utility.
Cross-Sectional (n=3,395)
The German version of the HADS in cancer patients is best represented by a bifactorial structure that supports the use of a total sum score alongside anxiety and depression subscales.
Dietz et al. (2026) conducted a cross-sectional in Cancer (n=3,395). Bifactorial models of the HADS vs. Original two-factorial structure was evaluated on Model fit (CFI, TLI, RMSEA). Bifactorial models of the German HADS demonstrated better model fit (e.g., CFI 0.987-0.991; RMSEA 0.053-0.065) compared to the original two-factorial structure in cancer patients.
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