Bifactorial models of the German HADS demonstrated better model fit (e.g., CFI 0.987-0.991; RMSEA 0.053-0.065) compared to the original two-factorial structure in cancer patients.
Cross-Sectional (n=3,395)
The German version of the HADS in cancer patients is best represented by a bifactorial structure that supports the use of a total sum score alongside anxiety and depression subscales.
BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument for assessing anxiety and depression in cancer patients. However, the best factor structure for an oncological setting depending on the time of diagnosis is still unclear. AIM: The objective of this study was to investigate the factor structure of the German-language version of the HADS in order to review the use of the HADS subscales and the HADS total scale in standard psycho-oncological care for cancer patients. METHOD: A secondary data analysis of N = 3395 cancer patients receiving psycho-oncological care was conducted to analyze 22 of the most common HADS factor models from the literature using confirmatory factor analysis. Confirmatory factor analysis was performed using weighted least squares with mean and variance adjustment (WLSMV). Additionally, measurement invariance (MI) analysis was conducted. RESULTS: The results indicate that two bifactorial models (Bifactor Model 1: higher-order factor + Anxiety and Depression subscale; Bifactor Model 2: higher-order factor + Restlessness, Anxiety, and Depression subscale) exhibit better quality than the original two-factorial structure (independent anxiety and depression scales) of the HADS (CFI: original structure = 0.970-0.971; Bifactor Model 1 = 0.987-0.988; Bifactor Model 2 = 0.990-0.991; TLI: original structure = 0.964-0.966; Bifactor Model 1 = 0.982; Bifactor Model 2 = 0.985-0.986; RMSEA: original structure = 0.082-0.086; Bifactor Model 1 = 0.065; Bifactor Model 2 = 0.053-0.054). The MI analysis revealed significant differences in performance between configural, metric, and scalar invariance for all three models. CONCLUSION: The results support the use of a bifactorial factor structure for the HADS-D, with the original Anxiety and Depression factors/scales operationalized, as well as an overarching factor in the form of the total sum score.
Dietz et al. (Mon,) conducted a cross-sectional in Cancer (n=3,395). Bifactorial models of the HADS vs. Original two-factorial structure was evaluated on Model fit (CFI, TLI, RMSEA). Bifactorial models of the German HADS demonstrated better model fit (e.g., CFI 0.987-0.991; RMSEA 0.053-0.065) compared to the original two-factorial structure in cancer patients.
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