Abstract
PurposeTo analyze the validity of the Hospital Anxiety and Depression Scale (HADS) among Chinese cataract population.MethodsA total of 275 participants with unilateral or bilateral cataract were recruited to complete the Chinese version of HADS. The patients' demographic and ophthalmic characteristics were documented. Rasch analysis was conducted to examine the model fit statistics, the thresholds ordering of the polytomous items, targeting, person separation index and reliability, local dependency, unidimentionality, differential item functioning (DIF) and construct validity of the HADS individual and summary measures.ResultsRasch analysis was performed on anxiety and depression subscales as well as HADS-Total score respectively. The items of original HADS-Anxiety, HADS-Depression and HADS-Total demonstrated evidence of misfit of the Rasch model. Removing items A7 for anxiety subscale and rescoring items D14 for depression subscale significantly improved Rasch model fit. A 12-item higher order total scale with further removal of D12 was found to fit the Rasch model. The modified items had ordered response thresholds. No uniform DIF was detected, whereas notable non-uniform DIF in high-ability group was found. The revised cut-off points were given for the modified anxiety and depression subscales.ConclusionThe modified version of HADS with HADS-A and HADS-D as subscale and HADS-T as a higher-order measure is a reliable and valid instrument that may be useful for assessing anxiety and depression states in Chinese cataract population.
Highlights
Cataract is the most common cause of visual impairment in China[1,2,3]
Rasch analysis was performed on anxiety and depression subscales as well as Hospital Anxiety and Depression Scale (HADS)-Total score respectively
Analysis of the initial HADS- Anxiety (HADS-A) items shows the mean infit mean square (MNSQ) value for items A7 (I can sit at ease and feel relaxed) was 1.44, indicating misfit the Rasch model(infit MNSQ = 1.44 and outfit MNSQ = 1.37), outside an ideal MNSQ value ranges between 0.7 and 1.3
Summary
Cataract is the most common cause of visual impairment in China[1,2,3]. Visual loss and visual disability significantly impact mental health and affect the quality of life in the aging population[4,5,6]. Depression and anxiety are among the major mental health problems in the elderly, especially in visually impaired older adults[5]. The prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%) among patients is twice as high as the prevalence in general elderly populations[5]. Vision impairment due to cataract has been significantly associated with depression and anxiety in older adults[8,9,10]. A study of 662 individuals aged over 70 years in Australia using the Goldberg scales (GADS) found anxiety and depression symptoms were associated with cataract[9]. Several studies have examined the impact of cataract surgery on depression and anxiety [11,12,13]. Few studies have evaluated the association of anxiety and depression with cataract in Chinese population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
