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Abstract
The population of people living with HIV (PLWH) is growing in number and usually results in mental health problems that impact their quality of life. Therefore, valid instruments and screening methods for psychological disorders are of great significance. The Hospital Anxiety and Depression Scale (HADS) reveals good psychometric properties, but shows ambiguous results in factor structure. This study aims to evaluate psychometric properties in terms of the internal reliability and structure validity of the Chinese version of the HADS (C-HADS) in a large sample of PLWH in China. The C-HADS was administered to 4,102 HIV-infected adults at an HIV clinic in China. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure. Measurement invariance was assessed across gender and course of infection. Internal reliability was also assessed. A bifactor model with anomalous loadings of items 7, 8, and 10 fits the data best and holds measurement invariance across gender and course of infection. Internal reliability was good with all Cronbach’s alphas > 0.70 and Spearman’s ρ between 0.30 and 0.70. The C-HADS has good psychometric properties in terms of internal reliability and structure validity of a bifactor model. The C-HADS is recommended to be used as a total scale that measures general psychological distress, instead of anxiety and depression separately, when applied to PLWH. Further studies are needed to evaluate criterion validity, the cutoff score, and the effect of wording and scoring of the HADS.
Highlights
As reported by the World Health Organization (WHO), HIV has been a constant major public health concern worldwide during the past few decades
This study aimed to present an evaluation of the psychometric properties of the Chinese version of Hospital Anxiety and Depression Scale (HADS) (C-HADS) in terms of internal reliability and structure validity in a large sample of people living with HIV (PLWH) in China
We found that the internal reliability of the HADS was satisfactory, which is similar to previous findings using the Chinese version of the test [27, 28, 31] and in PLWH [26]
Summary
As reported by the World Health Organization (WHO), HIV has been a constant major public health concern worldwide during the past few decades. The number of people living with HIV (PLWH) was reported to be around 36.7 million at the end of 2016, with 1.8 million newly infected cases in 2016 globally [1]. A systematic review and meta-analysis showed that the prevalence of depression and/or anxiety in PLWH was about one-third, higher than for patients living with other chronic medical conditions and the general population [2]. A recent systematic review in China revealed a higher prevalence of depression (greater than 60%) and anxiety (greater than 40%) in a sample of PLWH [3], which is associated with higher odds of HIV-related outcomes, such as poor adherence to antiviral therapy (ART), suboptimal engagement with HIV services, and worse HIV clinical outcomes [4, 5]. It is critical for clinicians to develop a reliable and valid instrument to screen for mental disorders among this population
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