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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2005

Open Access 01-12-2005 | Research

Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients

Authors: Jürgen Barth, Colin R Martin

Published in: Health and Quality of Life Outcomes | Issue 1/2005

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Abstract

Background

Depression and anxiety in patients with coronary heart disease (CHD) are associated with a poorer prognosis. Therefore the screening for psychological distress is strongly recommended in cardiac rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders.

Methods

We assessed mental distress in in-patient cardiac rehabilitation in Germany. The factor structure of the German language version of the HADS was investigated in 1320 patients with CHD. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument.

Results

Three-factor models were found to offer a superior fit to the data compared to two-factor (anxiety and depression) models. The German language HADS performs similarly to the English language version of the instrument in CHD patients. The German language HADS fundamentally comprises a tri-dimensional underlying factor structure (labelled by Friedman et al. as psychomotor agitation, psychic anxiety and depression).

Conclusion

Despite of clinical usefulness in screening for mental disturbances the construct validity of the HADS is not clear. The resulting scores of the tri-dimensional model can be interpreted as psychomotor agitation, psychic anxiety, and depression in individual patient data or clinical investigations.
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Literature
1.
Ahern DK, Gorkin L, Anderson JL, Tierney C, Hallstrom A, Ewart C, Capone RJ, Schron E, Kornfeld D, Herd A, Richardson DW, Follick MJ: Biobehavioral variables and mortality or cardiac arrest in the cardiac arrhythmia pilot study. Am J Cardiol 1990, 66: 59–62. 10.1016/0002-9149(90)90736-KPubMedCrossRef
2.
Ladwig KH, Roll G, Breithardt G, Budde T, Borggrefe M: Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 1994, 343: 20–23. 10.1016/S0140-6736(94)90877-XPubMedCrossRef
3.
Frasure-Smith N, Lesperance F, Talajic M: The impact of negative emotions on prognosis following myocardial infarction: Is it more than depression? Health Psychology 1995, 14: 388–398. 10.1037//0278-6133.14.5.388PubMedCrossRef
4.
Moser DK, Dragup K: Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhytmic events? Psychosom Med 1996, 58: 395–401.PubMedCrossRef
5.
Thomas SA, Friedmann E, Wimbush F, Schron E: Psychological factors and survival in the cardiac arryhtmia supression trial (CAST): a reexamination. Am J Crit Care 1997, 6: 116–126.PubMed
6.
7.
Franz IW: Herz-Kreislauf-Krankheiten. In Rehabilitationsmedizin: Ambulant, teilstationär, stationär. Edited by: Delbrück H, Haupt E. München: Urban & Schwarzenberg; 1998:238–287.
8.
Rentenversicherungsträger VD: VDR Statistik Rehabilitation. Würzburg: Universitätsdruckerei H. Stürtz; 2003.
9.
Härter M, Woll S, Reuter K, Wunsch A, Bengel J: Recognition and psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients. Arch Phys Med Rehabil 2004, 85: 1192–1197. 10.1016/j.apmr.2003.08.106PubMedCrossRef
10.
Mayou RA, Gill D, Thompson DR, Hicks N, Volmink J, Neil A: Depression and anxiety as predictors of outcome after myocardial infarction. Psychosom Med 2000, 62: 212–219.PubMedCrossRef
11.
Barth J, Schumacher M, Herrmann-Lingen C: Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 2004, 66: 802–813. 10.1097/01.psy.0000146332.53619.b2PubMedCrossRef
12.
Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983, 67: 361–370.PubMedCrossRef
13.
Snaith RP: The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes 2003.,1(29):
14.
Barczak P, Kane N, Andrees S, Congdon AM, Clay JC, Betts T: Patterns of psychiatric morbidity in a genito-urinary clinic. A validation of the Hospital Anxiety Depression Scale (HAD). Br J Psychiatry 1998, 152: 698–700.CrossRef
15.
Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002, 52: 69–77. 10.1016/S0022-3999(01)00296-3PubMedCrossRef
16.
Härter M, Reuter K, Gross-Hardt K, Bengel J: Screening for anxiety, depressive and somatoform disorders in rehabilitation – validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disabil Rehabil 2001, 23: 737–744. 10.1080/09638280110062176PubMedCrossRef
17.
Herrmann C: International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res 1997, 42: 17–41. 10.1016/S0022-3999(96)00216-4PubMedCrossRef
18.
Johnston M, Pollard B, Hennessey P: Construct validation of the Hospital Anxiety and Depression Scale with clinical populations. J Psychosom Res 2000, 48: 579–584. 10.1016/S0022-3999(00)00102-1PubMedCrossRef
19.
Jomeen J, Martin CR: Is the Hospital Anxiety and Depression Scale (HADS) a reliable screening tool in early pregnancy? Psychology and Health 2004, 19: 787–800. 10.1080/0887044042000272895CrossRef
20.
Martin CR, Bonner AB: A pilot investigation of the effect of trytophan manipulation on affective state in male chronic alcoholics. Alcohol Alcohol 2000, 35: 49–51.PubMedCrossRef
21.
Martin CR, Thompson DR: Prediction of quality of life in patients with end-stage renal disease. British Journal of Health Psychology 2000, 5: 41–55. 10.1348/135910700168757CrossRef
22.
Martin CR, Thompson DR: A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychology, Health and Medicine 2000, 5: 193–201.CrossRef
23.
Martin CR, Thompson DR, Chan DS: An examination of the psychometric properties of the Hospital Anxiety and Depression Scale in Chinese patients with acute coronary syndrome. Psychiatry Research 2004, 129: 279–288. 10.1016/j.psychres.2004.06.012PubMedCrossRef
24.
Martin CR, Tweed AE, Metcalfe MS: A psychometric evaluation of the Hospital Anxiety and Depression Scale in patients diagnosed with end-stage renal disease. Br J Clin Psychol 2004, 43: 51–64. 10.1348/014466504772812968PubMedCrossRef
25.
Lewin RJP, Thompson DR, Martin CR, Stuckey N, Devlen J, Michaelson S, Maguire P: Validation of the Cardiovascular Limitations and Symptoms Profile (CLASP) in chronic stable angina. Journal of Cardiopulmonary Rehabilitation 2002, 22: 184–191. 10.1097/00008483-200205000-00010PubMedCrossRef
26.
Martin CR, Lewin RJP, Thompson DR: A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Research 2003, 120: 85–94. 10.1016/S0165-1781(03)00162-8PubMedCrossRef
27.
Mayou R, Springings D, Birkhead J, Price J: A randomized controlled trial of a brief educational and psychological intervention for patients presenting to a cardiac clinic with palpitation. Psychological Medicine 2002, 32: 699–706. 10.1017/S0033291702005536PubMed
28.
Snaith RP, Zigmond AS: The Hospital Anxiety and Depression Scale Manual. NFER: Nelson, Windsor; 1994.
29.
Martin CR, Thompson DR: Utility of the Hospital Anxiety and Depression Scale in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Psychology, Health and Medicine 1999, 4: 369–376. 10.1080/135485099106117CrossRef
30.
McCue P, Martin CR, Buchanan T, Rodgers J, Scholey AB: An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in individuals with Chronic Fatigue Syndrome. Psychology, Health and Medicine 2003, 8: 425–440. 10.1080/1354850310001604568PubMedCrossRef
31.
Caci LA, Bayle FJ, Mattel V, Dossios C, Robert P, Boyer P: How does the Hospital Anxiety and Depression Scale measure anxiety and depression in healthy subjects? Psychiatry Report 2003, 118: 89–99. 10.1016/S0165-1781(03)00044-1CrossRef
32.
Dunbar M, Ford D, Hunt K, Der G: A confirmatory factor analysis of the Hospital Anxiety and Depression Scale: comparing empirically and theoretically derived structures. Br J Clin Psychol 2000, 39: 79–94. 10.1348/014466500163121PubMedCrossRef
33.
Friedmann S, Samuelian JC, Lancrenon S, Even C, Chiarelly P: Three-dimesional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Research 2001, 104: 247–357. 10.1016/S0165-1781(01)00309-2CrossRef
34.
Clark LA, Watson D: Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 1991, 100: 316–336. 10.1037//0021-843X.100.3.316PubMedCrossRef
35.
Martin CR, Newell RJ: Factor structure of the Hospital Anxiety and Depression Scale in individuals with facial disfigurement. Psychology, Health and Medicine 2004, 9: 327–336. 10.1080/13548500410001721891CrossRef
36.
Karimova G, Martin CR: A psychometric evaluation of the Hospital Anxiety and Depression Scale during pregnancy. Psychology, Health and Medicine 2003, 8: 89–103. 10.1080/1354850021000059296PubMedCrossRef
37.
Herrmann C, Buss U, Snaith RP: HADS-D: Hospital Anxiety and Depression Scale – Deutsche Version. Testdokumentation und Handanweisung. Bern: Huber; 1993.
38.
Herrmann C, Buss U: Vorstellung und Validierung einer deutschen Version der "Hospital Anxiety and Depression Scale" (HAD-Skala). Diagnostica 1994,40(2):143–154.
39.
Hinz A, Schwarz R: Angst und Depression in der Allgemeinbevölkerung. Psychother Psychosom Med Psychol 2001,51(5):193–200. 10.1055/s-2001-13279PubMedCrossRef
40.
West R: Computing for Psychologists. Char: Harwood Academic; 1991.
41.
Meadows K, Steen N, McColl E, Eccles M, Shiels C, Hewison J, Hutchinson A: The Diabetes Health Profile (DHP): a new instrument for assessing the psychosocial profile of insulin requiring patients: development and psychometric evaluation. Quality of Life Research 1996, 5: 242–254. 10.1007/BF00434746PubMedCrossRef
42.
Arbuckle JL, Wothke W: AMOS 4.0 Users Guide. Chicago: Smallwaters; 1999.
43.
Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertsond B, Bliss J: The factor structure and factor stability of the Hospital Anxiety and Depression Scale in patients with cancer. Br J Psychiatry 1991, 158: 255–259.PubMedCrossRef
44.
Razavi D, Delvaux N, Farvacques C, Robaye E: Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry 1990, 156: 79–83.PubMedCrossRef
45.
Bentler PM, Bonett DG: Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 1980, 88: 588–606. 10.1037//0033-2909.88.3.588CrossRef
46.
Bentler PM: Comparative fit indexes in structural models. Psychol Bull 1988, 107: 238–246.CrossRef
47.
48.
Bozdogan H: Model selection and Akaike's information criterion (AIC): the general theory and its analytical extensions. Psychometrika 1987, 52: 345–370.CrossRef
49.
Joreskog KG, Sorbom D: LISREL 8 User's Reference Guide. Chicago: Scientific Software International; 1993.
50.
Kline RB: Principles and Practice of Structural Equation Modeling. New York: Guilford; 1998.
51.
Marsh HW, Balla JR, McDonald RP: Goodness-of-fit indices in confirmatory factor analysis: the effect of sample size. Psychol Bull 1988, 103: 391–410. 10.1037//0033-2909.103.3.391CrossRef
52.
Browne MW, Cudeck R: Alternative ways of assessing model fit. Testing structural equation models. 1993, 136–162.
53.
Barth J, Paul J, Englert N, Härter M, Bengel J: Brief psychotherapy for patients with coronary heart disease and co-morbid depression. In Research in Rehabilitation – Results from a Rehabilitation Network in Southwest Germany. Edited by: Jäckel WH, Bengel J, Herdt J. Stuttgart: Thieme; in press.
54.
Fabrigar IW, Wegener DT, Maccallum RC, Strahan EJ: Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods 1999, 3: 272–299.CrossRef
55.
Dagnan D, Chadwick P, Trower P: Psychometric properties of the Hospital Anxiety and Depression Scale with a population of members of a depression self-help group. Br J Med Psychol 2000, 73: 129–137. 10.1348/000711200160255PubMedCrossRef
56.
Mykletun A, Stordal E, Dahl AA: Hospital Anxiety and Depression (HAD) Scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry 2001, 179: 540–544. 10.1192/bjp.179.6.540PubMedCrossRef
Metadata
Title
Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients
Authors
Jürgen Barth
Colin R Martin
Publication date
01-12-2005
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2005
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-3-15

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