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Quality of Life Research
Published in: Quality of Life Research 11/2019

Open Access 01-11-2019 | Anxiety

Prevalence of anxiety in patients with an implantable cardioverter defibrillator: measurement equivalence of the HADS-A and the STAI-S

Authors: W. H. Emons, M. Habibović, S. S. Pedersen

Published in: Quality of Life Research | Issue 11/2019

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Abstract

Purpose

The Hospital Anxiety and Depression Scale (HADS-A) and State-Trait Anxiety Inventory (STAI-S) are popular instruments for assessing anxiety and are considered interchangeable, although little is known about their equivalence. Hence, we examined whether the two instruments are (i) equivalent with respect to determining the prevalence of probable clinical anxiety levels and (ii) reflect variation on a common anxiety attribute.

Methods

Score and construct concordance were evaluated using equipercentile equating and bifactor modeling, respectively. Secondary data from the WEBCARE trial and the MIDAS study were used for the current study, where patients implanted with a first-time implantable cardioverter defibrillator completed both the HADS-A and the STAI-S within 10 days post implant.

Results

Data from 710 patients were included in the analyses. Results showed that the STAI-S produced a higher prevalence rate than the HADS-A (39% vs. 23%). A crosswalk table was generated with equivalent scores and cutoffs for the HADS-A and STAI-S, respectively. Bifactoring suggested that HADS-A and STAI-S largely tapped into the same generic anxiety attributes.

Conclusions

STAI-S and HADS-A reflect a common anxiety attribute, but using the recommended cutoff scores on the respective measures show very different prevalence rates and would classify patients as anxious with the STAI-S who would not be identified as such with the HADS-A. Clinicians and researchers should be aware of the inequivalence when using these measures for screening and determining the prevalence of probable clinical anxiety levels.
Literature
1.
Antiarrhythmics versus Implantable Defibrillators I. (1997). A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. New England Journal of Medicine, 337(22), 1576–1583.
2.
Bardy, G. H., Lee, K. L., Mark, D. B., Poole, J. E., Packer, D. L., Boineau, R., et al. (2005). Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. New England Journal of Medicine, 352(3), 225–237.PubMed
3.
Moss, A. J., Zareba, W., Hall, W. J., Klein, H., Wilber, D. J., Cannom, D. S., et al. (2002). Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. New England Journal of Medicine, 346(12), 877–883.PubMed
4.
Pedersen, S. S., Hoogwegt, M. T., Jordaens, L., & Theuns, D. A. (2013). Pre-implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation. International Journal of Cardiology, 166(1), 215–220.PubMed
5.
Magyar-Russell, G., Thombs, B. D., Cai, J. X., Baveja, T., Kuhl, E. A., Singh, P. P., et al. (2011). The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: A systematic review. Journal of Psychosomatic Research, 71(4), 223–231.PubMed
6.
Habibovic, M., van den Broek, K. C., Alings, M., Van der Voort, P. H., & Denollet, J. (2012). Posttraumatic stress 18 months following cardioverter defibrillator implantation: Shocks, anxiety, and personality. Health Psychology, 31(2), 186–193.PubMed
7.
Versteeg, H., Theuns, D. A., Erdman, R. A., Jordaens, L., & Pedersen, S. S. (2011). Posttraumatic stress in implantable cardioverter defibrillator patients: The role of pre-implantation distress and shocks. International Journal of Cardiology, 146(3), 438–439.PubMed
8.
von Kanel, R., Baumert, J., Kolb, C., Cho, E. Y., & Ladwig, K. H. (2011). Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator. Journal of Affective Disorders, 131(1–3), 344–352.
9.
Mastenbroek, M. H., Versteeg, H., Jordaens, L., Theuns, D. A., & Pedersen, S. S. (2014). Ventricular tachyarrhythmias and mortality in patients with an implantable cardioverter defibrillator: Impact of depression in the MIDAS cohort. Psychosomatic Medicine, 76(1), 58–65.PubMed
10.
Pedersen, S. S., Brouwers, C., & Versteeg, H. (2012). Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: Is there a link? Expert Review of Medical Devices, 9(4), 377–388.PubMed
11.
Morken, I. M., Isaksen, K., Karlsen, B., Norekval, T. M., Bru, E., & Larsen, A. I. (2012). Shock anxiety among implantable cardioverter defibrillator recipients with recent tachyarrhythmia. Pacing and Clinical Electrophysiology, 35(11), 1369–1376.PubMed
12.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.PubMed
13.
Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press Inc.
14.
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597.PubMed
15.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.PubMed
16.
Ford, J., Finch, J. F., Woodrow, L. K., Cutitta, K. E., Shea, J., Fischer, A., et al. (2012). The Florida Shock Anxiety Scale (FSAS) for patients with implantable cardioverter defibrillators: Testing factor structure, reliability, and validity of a previously established measure. Pacing and Clinical Electrophysiology, 35(9), 1146–1153.PubMed
17.
Kuhl, E. A., Dixit, N. K., Walker, R. L., Conti, J. B., & Sears, S. F. (2006). Measurement of patient fears about implantable cardioverter defibrillator shock: An initial evaluation of the Florida Shock Anxiety Scale. Pacing and Clinical Electrophysiology, 29(6), 614–618.PubMed
18.
Pedersen, S. S., van Domburg, R. T., Theuns, D. A., Jordaens, L., & Erdman, R. A. (2005). Concerns about the implantable cardioverter defibrillator: A determinant of anxiety and depressive symptoms independent of experienced shocks. Amerian Heart Journal, 149, 6.
19.
Emons, W. H., Sijtsma, K., & Pedersen, S. S. (2012). Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients: Comparison of Mokken scale analysis and factor analysis. Assessment, 19(3), 337–353.PubMed
20.
Vigneau, F., & Cormier, S. (2008). The factor structure of the State-Trait Anxiety Inventory: An alternative view. Journal of Personality Assessment, 90(3), 280–285.PubMed
21.
Hoogwegt, M. T., Kupper, N., Theuns, D. A., Zijlstra, W. P., Jordaens, L., & Pedersen, S. S. (2012). Undertreatment of anxiety and depression in patients with an implantable cardioverter-defibrillator: Impact on health status. Health Psychology, 31(6), 745–753.PubMed
22.
Pedersen, S. S., Tekle, F. B., Hoogwegt, M. T., Jordaens, L., & Theuns, D. A. (2012). Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator. Cardiovascular Quality and Outcomes, 5(3), 373–380.PubMed
23.
Habibovic, M., Denollet, J., Cuijpers, P., Spek, V. R., van den Broek, K. C., Warmerdam, L., et al. (2014). E-health to manage distress in patients with an implantable cardioverter-defibrillator: Primary results of the WEBCARE trial. Psychosomatic Medicine, 76(8), 593–602.PubMed
24.
Bernaards, C. A., & Sijtsma, K. (2000). Influence of simple imputation and EM methods on factor analysis when item nonresponse in questionnaire data is nonignorable. Multivariate Behavioral Research, 35, 43.
25.
van Ginkel, J. R., & van der Ark, L. A. (2005). SPSS syntax for missing value imputation in test and questionnaire data. Applied Psychological Measurement, 29, 2.
26.
Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001). Normative data for the HADS from a large non-clinical sample. British Journal of Clinical Psychology, 40(Pt 4), 429–434.PubMed
27.
Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis. Journal of Psychosomatic Research, 74(1), 74–81.PubMed
28.
Roalf, D. R., Moore, T. M., Mechanic-Hamilton, D., Wolk, D. A., Arnold, S. E., Weintraub, D. A., et al. (2017). Bridging cognitive screening tests in neurologic disorders: A crosswalk between the short Montreal Cognitive Assessment and Mini-Mental State Examination. Alzheimer’s & Dementia, 13(8), 947–952.
29.
von Davier, A., Holland, P. W., & Thayler, D. T. (2003). The kernel method of test equating. New York: Springer.
30.
Pommerich, M. (2007). Concordance: The good, the bad, and the ugly. In M. Dorans & M. Pommerich (Eds.), Linking and aligning scores and scales (p. 2007). New York: Springer.
31.
Pommerich, M., Hanson, B. A., Harris, D. J., & Sconing, J. A. (2004). Issues in conducting linkages between distinct tests. Applied Psychological Measurement, 28, 26.
32.
Andersson, B., Bränberg, K., & Wiberg, M. (2013). Performing the Kernel method of test equiting with package equate. Journal of Statistical Software, 55, 25.
33.
Reise, S. P., Bonifay, W. E., & Haviland, M. G. (2013). Scoring and modeling psychological measures in the presence of multidimensionality. Journal of Personality Assessment, 95(2), 129–140.PubMed
34.
Reise, S. P., Morizot, J., & Hays, R. D. (2007). The role of the bifactor model in resolving dimensionality issues in health outcomes measures. Quality of Life Research, 16(Suppl 1), 19–31.PubMed
35.
Muthen, L. K., & Muthen, B. O. (2003–2008) Mplus user’s guide (5th ed.). Los Angeles: Muthen & Muthen.
36.
McNemar, Q. (1947). Note on the sample error for the difference between correlated proportions or percentages. Psychometrika, 12, 5.
37.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 16.
38.
Coyne, J. C., & van Sonderen, E. (2012). No further research needed: Abandoning the Hospital Anxiety and Depression Scale (HADS). Journal of Psychosomatic Research, 72, 2.
39.
Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent structure of the Hospital Anxiety and Depression Scale: A 10-year systematic review. Journal of Psychosomatic Research, 72(3), 180–184.PubMed
40.
Doyle, F., Cosco, T., & Conroy, R. (2012). Why the HADS is still important: Reply to Coyne & van Sonderen. The Journal of Psychosomatic Research, 73(1), 74. (Author reply 7–8).PubMed
41.
Norton, S., Sacker, A., Done, J., & Calse, J. (2012). Further research needed: A comment on Coyne and van Sonderen’s call to abandon the Hospital Anxiety and Depression Scale. Journal of Psychosomatic Research, 73, 2.
42.
Tesio, V., Molinaro, S., Castelli, L., Andriani, M., Fanelli, A. L., Marra, S., et al. (2014). Screening of depression in cardiac patients: Is the HADS an effective tool? International Journal of Cardiology, 172(2), e344–e345.PubMed
43.
Luciano, J. V., Barrada, J. R., Aguado, J., Osma, J., & Garcia-Campayo, J. (2014). Bifactor analysis and construct validity of the HADS: A cross-sectional and longitudinal study in fibromyalgia patients. Psychological Assessment, 26(2), 395–406.PubMed
44.
Straat, J. H., van der Ark, L. A., & Sijtsma, K. (2013). Methodological artifacts in dimensionality assessment of the hospital anxiety and depression scale (HADS). Journal of Psychosomatic Research, 74(2), 116–121.PubMed
Metadata
Title
Prevalence of anxiety in patients with an implantable cardioverter defibrillator: measurement equivalence of the HADS-A and the STAI-S
Authors
W. H. Emons
M. Habibović
S. S. Pedersen
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
Quality of Life Research / Issue 11/2019
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-019-02237-2

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