Colin R. Martin

A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test-retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups.

A psychometric evaluation of the Hospital Anxiety and Depression Scale in patients diagnosed with end-stage renal disease

OBJECTIVES To determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with end-stage renal disease (ESRD) and determine the suitability of the instrument for use with this clinical group. DESIGN Between-subjects and cross-sectional design. The independent variable was type of treatment for ESRD. The dependent variables were HADS total (all items) and HADS anxiety and depression subscale scores. METHODS Group differences in HADS scores were determined using between-subjects one-way analysis of variance (ANOVA). Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 160 patients with ESRD. Seven models were tested to determine model fit to the data. RESULTS None of the seven models tested proved to be an adequate fit to the data. Treatment modality was found to have a significant impact on HADS-assessed levels of anxiety and depression. CONCLSIONS: The clinical utility of the HADS in the assessment of anxiety and depression in ESRD patients may be enhanced by using the HADS total (all items) score as an index of psychological distress. Further research is required to establish the appropriateness of using the HADS to screen ESRD patients.

An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in patients with breast cancer

BackgroundTo determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer and determine the suitability of the instrument for use with this clinical group.MethodsA cross-sectional design was used. The study used a pooled data set from three breast cancer clinical groups. The dependent variables were HADS anxiety and depression sub-scale scores. Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 110 patients with breast cancer. Seven models were tested to determine model fit to the data.ResultsBoth factor analysis methods indicated that three-factor models provided a better fit to the data compared to two-factor (anxiety and depression) models for breast cancer patients. Clark and Watsons three factor tripartite and three factor hierarchical models provided the best fit.ConclusionThe underlying factor structure of the HADS in breast cancer patients comprises three distinct, but correlated factors, negative affectivity, autonomic anxiety and anhedonic depression. The clinical utility of the HADS in screening for anxiety and depression in breast cancer patients may be enhanced by using a modified scoring procedure based on a three-factor model of psychological distress. This proposed alternate scoring method involving regressing autonomic anxiety and anhedonic depression factors onto the third factor (negative affectivity) requires further investigation in order to establish its efficacy.

Is the hospital anxiety and depression scale (HADS) a reliable screening tool in early pregnancy

The factor structure and internal reliability of the Hospital Anxiety and Depression Scale (HADS) was investigated to determine the suitability of the instrument for screening during early pregnancy. The study used a cross-sectional design with all observations taken at the antenatal booking clinic. Confirmatory factor analysis (CFA) of the HADS revealed that a three-factor solution offered the most parsimonious account of the data. However, the CFA further revealed that none of the factor models tested provided a consistent and good fit to the data. It was concluded that the HADS does not reliably assess distinct domains of anxiety and depression in early pregnancy. These findings suggest that the HADS is not a suitable screening tool for symptoms of anxiety and depression in this clinical group.

A psychometric evaluation of the Hospital Anxiety and Depression Scale during pregnancy

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression during pregnancy was investigated. A maximum likelihood factor analysis was conducted on the HADS to determine its psychometric properties and utility in 100 women from two culturally diverse populations (UK and Uzbekistan) at 12-weeks and 34-weeks pregnancy. The findings suggest that the HADS lacks the internal reliability requirements of a clinical assessment tool in this population. There was little evidence found to suggest that the HADS measures two dimensions of anxiety and depression consistently and reliably. The findings from this study suggest that the HADS could not be recommended as a clinical screening tool for anxiety and depression in pregnant women. Further research in this area is both desirable and required.

An examination of the psychometric properties of the Hospital Anxiety and Depression Scale in Chinese patients with acute coronary syndrome

The psychometric properties of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for patients with acute coronary syndrome (ACS) were investigated in a translated Chinese version of the instrument. A confirmatory factor analysis (CFA) was conducted on the HADS to establish its psychometric properties in 138 ACS patients over two observation points (within 1 week and 6 months post-admission for ACS). Internal and test-retest reliability values for the HADS total and HADS anxiety sub-scales were found to be acceptable. The HADS depression sub-scale lacked acceptable internal reliability. The underlying factor structure of the HADS comprised three distinct factors, though inconsistency between the best three-factor model fit was observed between observation points. The HADS was confirmed to be a useful screening instrument to assess symptoms of psychological distress in ACS patients. Further research is required to determine the most appropriate use of HADS sub-scale structures in clinical populations.

Handbook of behavior, food and nutrition

1. General, normative aspects and overviews.- 1.1 General and normative aspects: evolutionary and genetic.- 1.2 General and normative aspects: sensory.- 1.3 General and normative: endocrine and neuroendocrine.- 1.4 General and normative aspects: neurological.- 1.5 General and normative aspects: behavioural and psychological.- 1.6 General and normative aspects: physiological.- 1.7 General and normative aspects: feeding and eating.- 1.8 General and normative aspects: food choice, selection and preferences .- 1.9 General and normative aspects: appetite.- 1.10 General and normative aspects: fatty acids .- 2. Pathological and abnormal aspects.- 2.1 Pathology and abnormal aspects: genetic.- 2.2 Pathology and abnormal aspects: sensory.- 2.3 Pathology and abnormal aspects: endocrine and neuroendocrine.- 2.4 Pathology and abnormal aspects: neurological.- 2.5 Pathology and abnormal aspects: behavioural and psychological.- 2.6 Pathology and abnormal aspects: physiological.- 2.7 Pathology and abnormal aspects: feeding and eating.- 2.8 Pathology and abnormal aspects: food choice, selection and preferences .- 2.9 Pathology and abnormal aspects: appetite .- 2.10 Pathology and abnormal aspects: lipids.- 2.11 Pathology and abnormal aspects: miscellaneous topics .- 3. Specific conditions and diseases.- 3.1 Pregnancy.- 3.2 Developmental, children and adolescents.- 3.3 Starvation and nutrient deficiency .- 3.4 Anorexia nervosa.- 3.5 Bulimia nervosa and night eating syndrome.- 3.6 Metabolic syndrome and non-obese-overweight.- 3.7 Obesity .- 3.8 Diabetes.- 3.9 Nutrient excess and toxicity .- 3.10 Ageing and Dementia.- 3.11 Alcohol.- 3.12 Quality of Life.- 3.13 Body image.- 4. Changing eating behaviour and attitudes.- 4.1 The young and adolescents.- 4.2 Adults and the elderly.- 4.3 Other general or specific conditions .- 5. Selective methods

Factor structure of the Hospital Anxiety and Depression Scale in individuals with facial disfigurement

The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool.

Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome.

OBJECTIVES To investigate the factor structure and internal consistency of the Hospital Anxiety and Depression Scale (HADS) in individuals with Chronic Fatigue Syndrome (CFS) using an Internet administered version of the instrument. DESIGN Between subjects. METHOD Confirmatory factor analysis (CFA) and internal consistency analysis of the HADS was used to determine the psychometric characteristics of the instrument in individuals with CFS and a control group with data captured via an Internet data collection protocol. RESULTS CFA revealed that a 3-factor solution offered the most parsimonious account of the data. Internal consistency estimations of the anxiety and depression subscales were found to be acceptable for both groups. The CFS group was found to have significantly higher HADS-assessed anxiety and depression scores compared with controls, however, there was also evidence found that Internet administration of the instrument may inflate HADS subscale scores as an artifact of testing medium. CONCLUSIONS The HADS is suitable for use for screening individuals with CFS in terms of the factor structure of the instrument, however, clinicians should be aware that this instrument assesses 3 domains of affective disturbance rather than 2 as is interpreted within the current HADS anxiety and depression subscale scoring system. Researchers need also be aware that Internet administration of negative affective state measures such as the HADS is likely to inflate scores and need to ensure that comparisons between clinical groups are made with control group data gathered using the same collection methodology.

Factor structure of the Chinese version of the Geriatric Depression Scale

Abstract Depression is common in patients following stroke and has been found to be related to the degree of functional disability, recovery and engagement in rehabilitation. Consequently, screening for depression is crucial in this group in order to facilitate the delivery of appropriate psychological support. The current study sought to determine key psychometric properties of the Chinese version of the Geriatric Depression Scale (GDS) in this group. Three versions of the GDS were evaluated, these being the 30-item original measure (GDS-30), the short-form version comprising 15 items (GDS-SF) and a recently developed innovative four-item version (GDS-4). Confirmatory factor analysis revealed the GDS-30 and GDS-SF to offer an acceptable fit to data suggesting utility of these measures for screening. However, the GDS-4 offered a poor fit to the data, suggesting this measure was an inadequate measure of depression in this clinical group. Further, though GDS-30 and GDS-SF measures revealed good internal consistency, the performance of the GDS-4 was marginal. However, all GDS-derived measures demonstrated excellent convergent and divergent validity. It is concluded that the GDS-30 is a useful and appropriate screening instrument in this group. Further, the GDS-SF shows promise in terms of development as a multidimensional measure of depression that may have predictive and outcome monitoring potential. The psychometric shortcomings of the GDS-4 strongly suggest that this measure is unsuitable for screening in this clinical group.