Psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in individuals with stable chronic obstructive pulmonary disease (COPD): a systematic review

Abstract

Purpose The Hospital Anxiety and Depression Scale (HADS) is used to assess anxiety and depression in individuals with chronic obstructive pulmonary disease (COPD); however, its measurement properties lack critical appraisal. We aimed to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in COPD. Materials and methods Five electronic databases were searched. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines were used to assess the methodological and evidence quality in the selected studies. Results Twelve studies assessed the psychometric properties of the HADS-Total and its subscales HADS-Anxiety and HADS-Depression in COPD. High-quality evidence supported the structural and criterion validity of the HADS-A, the internal consistency of the HADS-T, HADS-A, and HADS-D with Cronbach’s alpha values of 0.73–0.87, and before–after treatment responsiveness of HADS-T and its subscales (minimal clinically important difference = 1.4–2; effect size = 0.45–1.40). Moderate-quality evidence supported the test–retest reliability of the HADS-A and HADS-D with excellent coefficient values of 0.86–0.90. Conclusions The HADS-A is recommended for use in individuals with stable COPD. The lack of high-quality evidence on the validity of the HADS-D and HADS-T prevented drawing robust conclusions about their clinical utility in COPD.