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Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population

  • Arnstein Mykletun (a1), Eystein Stordal (a2) and Alv A. Dahl (a3)
Abstract
Background

The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.

Aims

To examine the psychometric properties of the HAD scale in a large population.

Method

All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations.

Results

Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively.

Conclusions

Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.

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Copyright
Corresponding author
Alv A. Dahl, Research Unit, Department of Psychiatry, Aker Hospital, University of Oslo, Sognsvannsveien 21, 0320 Oslo, Norway. Tel: +47 22923400; fax: +47 22923971; e-mail: a.a.dahl@psykiatri.uio.no
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Declaration of interest

The Norwegian Research Council and Novo Nordisk Pharmaceuticals (Norway) supported this study.

Footnotes
References
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Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population

  • Arnstein Mykletun (a1), Eystein Stordal (a2) and Alv A. Dahl (a3)
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