Factor structure of the Hospital Anxiety and Depression Scale in individuals with facial disfigurement

Abstract The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool. Acknowledgments We would like to thank all those individuals who participated in the study. We are also grateful to the very helpful comments we received from anonymous reviewers on an earlier version of this manuscript.