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The validity and clinical utility of the Hospital Anxiety and Depression Scale (HADS) with older adult New Zealanders

Published online by Cambridge University Press:  22 November 2013

Margaret H. Roberts ,
Richard B. Fletcher  and
Paul L. Merrick
Margaret H. Roberts*
Affiliation:
Centre for Psychology, Massey University, Albany, Auckland, New Zealand
Richard B. Fletcher
Affiliation:
School of Psychology, Massey University, Auckland, New Zealand
Paul L. Merrick
Affiliation:
School of Psychology, Massey University, Auckland, New Zealand
*
Correspondence should be addressed to: Margaret H. Roberts, Centre for Psychology, Massey University, Private Bag 102904, North Shore, Albany, Auckland 0745, New Zealand. Phone: +649-414-0800; ext. 41232. Email: m.h.roberts@massey.ac.nz.
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Abstract

Background:

The Hospital Anxiety and Depression Scale (HADS) has established use with older adult populations in New Zealand but few studies have evaluated its psychometric properties. Research with the psychometric properties of the HADS in elderly populations has primarily used correlational methods that do not allow for the effects of measurement error to be observed. The hypothesized tripartite model of anxiety and depression within the HADS was evaluated using confirmatory factor analysis (CFA) methods.

Methods:

Overall, 203 community-dwelling older adults who were recruited from older adult community groups completed the HADS. Competing two- and three-factor structures were trialled using CFA.

Results:

A three-factor model indicated a lack of differentiation between factors and poor clinical utility and was rejected in favor of a two-factor model. Significant correlations were observed between the anxiety and depression factors on the two-factor model, but it was considered to have validity for older adult samples. Good internal consistency was found for the HADS.

Conclusions:

A two-factor model of the HADS was favored due to the lack of differentiation between factors on the three-factor model, and the higher clinical utility of a two-factor solution. The validity of the HADS may be limited by over-diagnosing anxiety in non-clinical populations. It is recommended that the HADS be used to measure change over time through treatment and not be used as a diagnostic tool until future research establishes appropriate norms and cut-offs.

Keywords

anxietydepressionolder adultsHospital Anxiety and Depression Scaletripartite modelpsychometricsconfirmatory factor analysis
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 2 , February 2014 , pp. 325 - 333
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

Arbuckle, J. L. (2006). AMOS. Chicago, IL: SPSS.Google Scholar
Bjelland, I., Dahl, A. and Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 67–99.Google Scholar
Brown, T. (2006). Confirmatory Factor Analysis for Applied Research. London: Guilford Press.Google Scholar
Bryant, C., Jackson, H. and Ames, D. (2009). Depression and anxiety in medically unwell older adults: prevalence and short-term course. International Psychogeriatrics, 21, 754–763.Google Scholar
Cheung, G. W. and Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modelling, 9, 233–255.Google Scholar
Clark, L. A. and Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.CrossRefGoogle ScholarPubMed
Clark, D., Steer, R. and Beck, A. (1994). Common and specific dimensions of self-reported anxiety and depression: implications for the cognitive and tripartite models. Journal of Abnormal Psychology, 103, 645–654.CrossRefGoogle ScholarPubMed
Desmond, D. M. and MacLachlan, (2005). The factor structure of the Hospital Anxiety and Depression Scale in older individuals with acquired amputations: a comparison of four models using confirmatory factor analysis. International Journal of Geriatric Psychiatry, 20, 344–349.Google Scholar
Diefenbach, G. J.et al. (2003). “Minor GAD”: characteristics of subsyndromal GAD in older adults. Behaviour Research and Therapy, 41, 481–487.Google Scholar
Dunbar, M., Ford, G., Hunt, K. and Der, G. (2000). A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. British Journal of Clinical Psychology, 39, 79–94.Google Scholar
Fan, X., Thompson, B. and Wang, L. (1999). Effects of sample size, estimation methods, and model specification on structural equation modelling fit indexes. Structural Equation Modelling: A Multidisciplinary Journal, 6, 56–83.Google Scholar
Gale, C. R.et al. (2010). The structure of the Hospital Anxiety and Depression Scale in four cohorts of community-based, healthy older people: the HALCyon program. International Psychogeriatrics, 22, 559–571.Google Scholar
Helvik, A.-S. (2011). A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly. Nordic Journal of Psychiatry, 65, 338–344.Google Scholar
Hu, L. and Bentler, P. M. (1999). Cut-off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modelling, 6, 1–55.CrossRefGoogle Scholar
Johnston, M., Pollard, B. and Hennessey, P. (2000). Construct validation of the Hospital Anxiety and Depression Scale. Journal of Psychosomatic Research, 48, 579–584.Google Scholar
Knight, B. and Poon, C. (2008). The socio-cultural context in understanding older adults: contextual adult lifespan theory for adapting psychotherapy. In Woods, R. and Clare, L. (eds.), Handbook of the Clinical Psychology of Ageing. Chichester: Wiley.Google Scholar
MacCallum, R. C., Browne, M. W. and Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modelling. Psychological Methods, 1, 130–149.Google Scholar
Moorey, S.et al. (1991). The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. British Journal of Psychiatry, 158, 255–259.Google Scholar
Oakley Browne, M. A., Wells, J. E., Scott, K. M., McGee, M. A. and New Zealand Mental Health Survey Research Team (2006). Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry, 40, 865–874.CrossRefGoogle ScholarPubMed
Palmer, B. W., Jeste, D. V. and Sheikh, J. I. (1997). Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment. Journal of Affective Disorders, 46, 183–190.Google Scholar
Rodriguez-Blazquez, C., Frades-Payo, B., Forjaz, M. J., de Pedro-Cuesta, J., Martinez-Martin, P. and Longitudinal Parkinson's Disease Patient Study Group (2009). Psychometric attributes of the Hospital Anxiety and Depression Scale in Parkinson's disease. Movement Disorders, 24, 519–525.Google Scholar
Snaith, P. and Zigmond, A. S. (1994). The Hospital Anxiety and Depression Scale with the Irritability-Depression-Anxiety Scale and the Leeds Situational Anxiety Scale. London: NFER-Nelson.Google Scholar
Spinhoven, P., Ormel, J., Sloekers, P. P. , Kempen, G. I., Speckens, A. E. and Van Hemert, A. M. (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363–370.CrossRefGoogle ScholarPubMed
SPSS Inc. (2008). SPSS for Windows. Chicago, IL: SPSS Inc.Google Scholar
Stanley, M., Beck, J. and Zebb, B. (2000). Anxiety disorders. Clinical Psychology Review, 20, 731–754.Google Scholar
Wetherell, J. L., Birchler, G. D., Ramsdell, J. and Unützer, J. (2007). Screening for generalized anxiety disorder in geriatric primary care patients. International Journal of Geriatric Psychiatry, 22, 115–123.Google Scholar
Wilk, J. E.et al. (2006). Comorbidity patterns in routine psychiatric practice: is there evidence of underdetection and underdiagnosis? Comprehensive Psychiatry, 47, 258–264.Google Scholar
Wolitzky-Taylor, K., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190–211.Google Scholar
Zigmond, A. and Snaith, R. (1983). The Hospital and Anxiety Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar