What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary heart disease (n=1320). Intervention: Hospital Anxiety and Depression Scale (HADS). Primary outcome: Factor structure of the German language version of the HADS.

March 16, 2005Open Access

Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients

Key Result

A three-factor model comprising psychomotor agitation, psychic anxiety, and depression provided a superior fit for the German language HADS in coronary heart disease patients compared to traditional two-factor models.

Study Design

Type

Cross-Sectional (n=1,320)

Multicenter

Yes

Structured PICO

Population

1,320 patients (mean age 60.3 years, 21.6% female) with a confirmed diagnosis of coronary heart disease and a recent cardiac event undergoing in-patient cardiac rehabilitation in Germany.

Outcome

Underlying factor structure of the German language version of the Hospital Anxiety and Depression Scale (HADS) assessed via exploratory and confirmatory factor analysispatient reported

The German version of the HADS demonstrates a tri-dimensional factor structure (psychomotor agitation, psychic anxiety, and depression) in CHD patients, suggesting that a three-factor interpretation may provide more precise psychological screening in cardiac rehabilitation.

Limitations

The assessment of the efficacy of interventions in evaluation studies by the HADS may be biased by problems in construct validity.
Agitation might be more likely biased by the medical status of the patients.

Abstract

BACKGROUND: Depression and anxiety in patients with coronary heart disease (CHD) are associated with a poorer prognosis. Therefore the screening for psychological distress is strongly recommended in cardiac rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. METHODS: We assessed mental distress in in-patient cardiac rehabilitation in Germany. The factor structure of the German language version of the HADS was investigated in 1320 patients with CHD. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. RESULTS: Three-factor models were found to offer a superior fit to the data compared to two-factor (anxiety and depression) models. The German language HADS performs similarly to the English language version of the instrument in CHD patients. The German language HADS fundamentally comprises a tri-dimensional underlying factor structure (labelled by Friedman et al. as psychomotor agitation, psychic anxiety and depression). CONCLUSION: Despite of clinical usefulness in screening for mental disturbances the construct validity of the HADS is not clear. The resulting scores of the tri-dimensional model can be interpreted as psychomotor agitation, psychic anxiety, and depression in individual patient data or clinical investigations.

Mark Helpful

Bookmark

Relay

View Full Paper