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The structure of the Hospital Anxiety and Depression Scale in four cohorts of community-based, healthy older people: the HALCyon program

Published online by Cambridge University Press:  10 March 2010

Catharine R. Gale*
Affiliation:
MRC Epidemiology Resource Centre, University of Southampton, U.K.
Michael Allerhand
Affiliation:
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, U.K.
Avan Aihie Sayer
Affiliation:
MRC Epidemiology Resource Centre, University of Southampton, U.K.
Cyrus Cooper
Affiliation:
MRC Epidemiology Resource Centre, University of Southampton, U.K.
Elaine M. Dennison
Affiliation:
MRC Epidemiology Resource Centre, University of Southampton, U.K.
John M. Starr
Affiliation:
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, U.K. Geriatric Medicine Unit, University of Edinburgh, Royal Victoria Hospital, Edinburgh, U.K.
Yoav Ben-Shlomo
Affiliation:
Department of Social Medicine, University of Bristol, U.K.
John E Gallacher
Affiliation:
Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Cardiff University, U.K.
Diana Kuh
Affiliation:
MRC Unit for Lifelong Health and Ageing, University College London, U.K.
Ian J. Deary
Affiliation:
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, U.K.
*
Correspondence should be addressed to: Dr. Catharine Gale, MRC Epidemiology Resource Centre (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, U.K. Phone: +44 (0)23 80764080; Fax: +44 (0)23 80704021. Email: crg@mrc.soton.ac.uk.

Abstract

Background: The Hospital Anxiety and Depression Scale (HADS) is widely used but evaluation of its psychometric properties has produced equivocal results. Little is known about its structure in non-clinical samples of older people.

Methods: We used data from four cohorts in the HALCyon collaborative research program into healthy aging: the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study, and the Lothian Birth Cohort 1921. We used exploratory factor analysis and confirmatory factor analysis with multi-group comparisons to establish the structure of the HADS and test for factorial invariance between samples.

Results: Exploratory factor analysis showed a bi-dimensional structure (anxiety and depression) of the scale in men and women in each cohort. We tested a hypothesized three-factor model but high correlations between two of the factors made a two-factor model more psychologically plausible. Multi-group confirmatory factor analysis revealed that the sizes of the respective item loadings on the two factors were effectively identical in men and women from the same cohort. There was more variation between cohorts, particularly those from different parts of the U.K. and in whom the HADS was administered differently. Differences in social-class distribution accounted for part of this variation.

Conclusions: Scoring the HADS as two subscales of anxiety and depression is appropriate in non-clinical populations of older men and women. However, there were differences between cohorts in the way that individual items were linked with the constructs of anxiety and depression, perhaps due to differences in sociocultural factors and/or in the administration of the scale.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2010

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