Psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults

Objectives The Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city. Methods In total, 1190 inhabitants ≥ 70 (range 70 – 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed “HUNT4 70 + ” in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity. Results The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6 D ( “I feel cheerful” ) along with a correlated error term between item 2 D ( “I still enjoy the things I used to enjoy” ) and 12 D ( “I look forward with enjoyment to things ”) improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable. Conclusions The HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.