Key result
Mokken scaling of HADS in CVD patients reveals a unidimensional structure capturing general psychological distress.
Cross-Sectional (n=893)
Yes
In patients with cardiovascular disease, the HADS scale measures a single dimension of general psychological distress rather than distinct anxiety and depression constructs.
Supports total HADS scoring for distress in CVD; leaves open incremental value of anxiety/depression subscales.
OBJECTIVE: The Hospital Anxiety and Depression Scale (HADS) is a prolifically used scale of anxiety and depression. The original bidimensional anxiety-depression latent structure of the HADS has come under significant scrutiny, with previous studies revealing one-, two-, three- and four-dimensional structures. The current study examines the latent structure of the HADS using a non-parametric item response theory method. METHOD: Using data conglomerated from four independent studies of cardiovascular disease employing the HADS (n=893), Mokken scaling procedure was conducted to assess the latent structure of the HADS. RESULTS: A single scale consisting of 12 of 14 HADS items was revealed, indicating a unidimensional latent HADS structure. DISCUSSION: The HADS was initially intended to measure mutually exclusive levels of anxiety and depression; however, the current study indicates that a single dimension of general psychological distress is captured.
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Cosco et al. (2011) conducted a cross-sectional in cardiovascular disease (n=893). Hospital Anxiety and Depression Scale (HADS) was evaluated on Latent structure of the HADS assessed via Mokken scaling procedure. Mokken scaling analysis of the Hospital Anxiety and Depression Scale in 893 patients with cardiovascular disease revealed a unidimensional latent structure capturing general psychological distress.
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