Confirmatory factor analysis of the Hospital Anxiety and Depression Scale in 1,793 patients with coronary heart disease showed that three-factor models offered a superior fit to two-factor models.
Cross-Sectional (n=1,793)
Yes
What is the underlying factor structure of the Hospital Anxiety and Depression Scale (HADS) in patients with coronary heart disease?
The HADS instrument in CHD patients is better represented by a three-factor model rather than the originally proposed two-factor model, suggesting more precise scales should be used in outcome studies to reduce measurement errors.
BACKGROUND: Depression and anxiety in patients with coronary heart disease (CHD) is associated with a poorer prognosis. Therefore, the screening for psychological distress is strongly recommended in cardiac care and rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. The factor structure of the HADS was investigated in CHD populations across three countries (Germany, Hong Kong, United Kingdom). METHODS: In total, HADS data from 1793 patients with CHD were explored using confirmatory factor analysis to establish the underlying factor structure of the instrument. RESULTS: Three-factor models were found to offer a superior fit to the data compared with two-factor (anxiety and depression) models in all countries. The anxiety items can be separated in a factor labelled autonomic anxiety and negative affectivity. CONCLUSIONS: The HADS offers good possibilities to detect distressed patients with somatic illnesses, but the construct validity of the originally proposed two factors (depression, anxiety) remains unclear. In outcome studies, more precise scales should be used to reduce measurement errors based on the scales used.
Martin et al. (Mon,) conducted a cross-sectional in coronary heart disease (n=1,793). Hospital Anxiety and Depression Scale (HADS) three-factor model vs. Two-factor model was evaluated on Factor structure fit. Confirmatory factor analysis of the Hospital Anxiety and Depression Scale in 1,793 patients with coronary heart disease showed that three-factor models offered a superior fit to two-factor models.