Abstract

BackgroundThe HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. There is also a lack of psychometric evaluations of the HADS in non-clinical samples of older people. The aim of the study was to evaluate the factor structure of the HADS in a general population 65–80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex.MethodsThis study was based on data from a Swedish sample, randomized from the total population in the age group 65–80 years (n = 6659). Confirmatory factor analyses (CFA) were performed to examine the factor structure. Ordinal regression analyses were conducted to detect DIF for sex. Reliability was examined by both ordinal as well as traditional Cronbach’s alpha.ResultsThe CFA showed a two-factor model with cross-loadings for two items (7 and 8) had excellent model fit. Internal consistency was good in both subscales, measured with ordinal and traditional alpha. Floor effects were presented for all items. No indication for meaningful DIF regarding sex was found for any of the subscales.ConclusionsHADS Anxiety and HADS Depression are unidimensional measures with acceptable internal consistency and are invariant with regard to sex. Despite pronounced ceiling effects and cross-loadings for item 7 and 8, the hypothesized two-factor model of HADS can be recommended to assess psychological distress among a general population 65–80 years old.

Highlights

  • The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression)

  • Floor and/or ceiling effects are marked in bold, defined if more than 20% of the participants used the lowest and/or highest possible scores HADS Hospital Anxiety and Depression Scale

  • Problems with floor effects were shown for all items

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Summary

Introduction

The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. The aim of the study was to evaluate the factor structure of the HADS in a general population 65–80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex. Psychological distress in terms of depression and anxiety is a growing problem among older people, with a prevalence of depression in European countries at 12% for people aged 65 years or over [1]. The Hospital Anxiety and Depression Scale (HADS) is a frequently used self-rating scale developed to assess psychological distress in non-psychiatric patients. It consists of two subscales, Anxiety and Depression [5]. It has demonstrated satisfactory psychometric properties in different groups; in primary care patients [6], cognitively intact nursing home patients [7], cancer

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