Abstract
Depression and anxiety are common complaints in patients with multiple sclerosis (MS). The study objective was to investigate the factor structure, internal consistency, and correlates of the Croatian version of the Hospital Anxiety and Depression Scale (HADS) in patients with MS. A total of 179 patients with MS and 999 controls were included in the online survey. All subjects completed the HADS and self-administered questionnaires capturing information of demographic, education level, disease-related variables, and the Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the HADS in patients with MS. The two HADS subscales (anxiety and depression) had excellent internal consistencies (Cronbach’s α value 0.82–0.83), and factor analysis confirmed a two-factor structure. The convergent validity of the HADS subscales appeared to be good due to the significant correlations between HADS and MSIS-29. Receiver operating characteristic (ROC) analysis indicates that the HADS subscales have a significant diagnostic validity for group differentiation. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the incremental validity of the HADS. The HADS is a reliable and valid self-assessment scale in patients with MS and is suggested to be used in clinical monitoring of the psychiatric and psychological status of patients with MS.
Highlights
Multiple sclerosis (MS) has a high prevalence of depression, anxiety, and stress comorbidities (Marrie et al, 2018; Karimi et al, 2020)
In previous studies conducted in Croatia, the Hospital Anxiety and Depression Scale (HADS) has been used in medical conditions other than multiple sclerosis (MS) (Filipovic-Grcic et al, 2010; Vuleticet al., 2011; Ostojicet al., 2014; Pokrajac-Bulian et al, 2015; Miljanovicet al., 2017), but no study determined psychometric properties for the Croatian version of the HADS in people with MS (pwMS)
The sex differences were found in pwMS in achievement on the HADS depression subscale, indicating that the male participants have a higher depression score than females with MS (t = −2.10, df = 177, p < 0.05)
Summary
Multiple sclerosis (MS) has a high prevalence of depression, anxiety, and stress comorbidities (Marrie et al, 2018; Karimi et al, 2020). The HADS is one of the most commonly used scales for assessing anxiety and depression among patients in a general hospital setting (Zigmond and Snaith, 1983; Mitchell et al, 2010). The normative data for the HADS in pwMS were provided in pwMS in different languages (Honarmand and Feinstein, 2009; Atkins et al, 2012; Watson et al, 2014; Marrie et al, 2018; Pais-Ribeiro et al, 2018). Two studies conducted in Croatia with HADS stated the origin of the Croatian version of HADS (Miljanovicet al., 2017; Galicet al., 2020), and so far, only Miljanovicet al. (2017) investigated metric properties of HADS in terminal cancer patients but having relatively smaller convenient sample size without a control group
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