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BMC Psychiatry
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Research article

A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees

Authors: Christine Bocéréan, Emilie Dupret

Published in: BMC Psychiatry | Issue 1/2014

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Abstract

Background

The Hospital Anxiety and Depression Scale (HADS) is a questionnaire widely used for detecting anxiety and depressive disorders. It is used extensively in France, but has never been the subject of a full study in a population at work. The objectives of this study were to present some psychometric properties of the HADS on a large sample of French employees.

Method

The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination. In 2011, 20992 employees filled in the questionnaire. HADS’s structure was studied first by exploratory, then confirmatory factorial analyses.

Results

The model selected was the original two-factor structure. The two subscales showed good internal consistency. Women scored higher than the men for anxiety and depression; the scores increased with age; engineers and managers had lower average scores than other occupational status (blue- or white-collar workers and technicians).

Conclusion

The results of the analyses are consistent with those in literature relating to other populations studied in other countries. The HADS questionnaire is pertinent for detecting symptoms of anxiety and depression in a population of people at work.
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Literature
1.
Zigmond AS, Snaith P: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67: 361-370. 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed
2.
Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validation of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002, 52: 69-77. 10.1016/S0022-3999(01)00296-3.CrossRefPubMed
3.
Olssøn I, Mykletun A, Dahl AA: The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry. 2005, 5: 46-10.1186/1471-244X-5-46.CrossRefPubMedPubMedCentral
4.
Poole NA, Morgan JF: Validity and reliability of the Hospital Anxiety and Depression Scale in a hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population. Gen Hosp Psychiat. 2006, 28: 55-58. 10.1016/j.genhosppsych.2005.08.004.CrossRef
5.
Hinz A, Brähler E: Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population. J Psychosom Res. 2011, 71: 74-78. 10.1016/j.jpsychores.2011.01.005.CrossRefPubMed
6.
Roberge P, Doré I, Menear M, Chartrand E, Ciampi A, Duhoux A, Fournier L: A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population. J Affect Disord. 2013, 147: 171-179. 10.1016/j.jad.2012.10.029.CrossRefPubMed
7.
Sultan S, Luminet O, Hartemann A: Cognitive and anxiety symptoms in screening for clinical depression in diabetes. A systematic examination of diagnostic of the HADS and BDI-SF. J Affect Disorders. 2010, 123: 332-336. 10.1016/j.jad.2009.09.022.CrossRefPubMed
8.
Michopoulos I, Douzenis A, Kalkavoura C, Christodoulou C, Michalopoulou P, Kalemi G, Fineti K, Patapis P, Protopapas K, Lykouras L: Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Ann Gen Psychiat. 2008, 7: 4-10.1186/1744-859X-7-4.CrossRef
9.
Muszbek K, Szekely A, Balogh EM, Molnar M, Rohansky M, Ruzsa A, Varga K, Szöllosi M, Vadasz P: Validation of the Hungarian translation of hospital anxiety and depression scale. Qual Life Res. 2006, 15: 761-766. 10.1007/s11136-005-3627-8.CrossRefPubMed
10.
Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S: The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual of Life Out. 2003, 1: 14-10.1186/1477-7525-1-14. doi:10.1186/1477-7525-1-14CrossRef
11.
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. 10.1080/09638280110062176.CrossRefPubMed
12.
Schönberger M, Ponsford J: The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiat Res. 2010, 179: 342-349. 10.1016/j.psychres.2009.07.003.CrossRef
13.
Mitchell AJ, Meader N, Symonds P: Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disorders. 2010, 126: 335-348. 10.1016/j.jad.2010.01.067.CrossRefPubMed
14.
Razadi D, Delvaux N, Farvacques C, Robaye E: Validation of the French version of the HADS in a population of inpatients with cancer. Rev Psychol Appl. 1989, 39: 295-307.
15.
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)00216-4.CrossRefPubMed
16.
Krespi Boothby MR, Cases A, Carrington K, Mulholland I, Bolger T: The accuracy of HADS in detecting emotional distress in male prisoners. Procedia S+BS. 2010, 5: 95-98. 10.1016/j.proeng.2010.09.056.CrossRef
17.
Andersson E: The Hospital and Depression Scale. Homogeneity of the subscales. Soc Behav Personal. 1993, 21: 197-204. 10.2224/sbp.1993.21.3.197.CrossRef
18.
Martin CR, Thompson DR: A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychology, Health & Medecine. 2000, 5: 193-201. 10.1080/713690189.CrossRef
19.
Cosco T, Doyle F, Ward M, McGee H: Latent structure of the The Hospital Anxiety and Depression Scale: A 10 year systematic review. J Psychosom Res. 2012, 72: 180-184. 10.1016/j.jpsychores.2011.06.008.CrossRefPubMed
20.
Martin CR: What does the Hospital Anxiety and Depression Scale (HADS) really measure in liaison psychiatry settings?. Curr Psychiat Rev. 2005, 1: 69-73. 10.2174/1573400052953510.CrossRef
21.
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.100.3.316.CrossRefPubMed
22.
Watson D, Clark LA: Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. J Abnorm Psychol. 1995, 104: 15-25. 10.1037/0021-843X.104.1.15.CrossRefPubMed
23.
Leung CM, Ho S, Kan CS, Hung CH, Chen CN: Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom. 1993, 40: 29-34.PubMed
24.
Dunbar M, Ford G, Hunt K, Der G: A confirmatory factor analysis of the Hospital Anxiety and Depression scale: Comparing empirically and theoretically derived structures. Brit J Clin Psychol. 2000, 39: 79-94. 10.1348/014466500163121.CrossRef
25.
Friedman S, Samuelian JC, Lancrenon S, Even C, Chiarelli P: Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiat Res. 2001, 104: 247-257. 10.1016/S0165-1781(01)00309-2.CrossRef
26.
Caci H, Baylé FJ, Mattei V, Dossios C, Robert P, Boyer P: How does the Hospital Anxiety and Depression Scale measure anxiety and depression in healthy subjects?. Psychiat Res. 2002, 118: 89-99. 10.1016/S0165-1781(03)00044-1.CrossRef
27.
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. Psychiat Res. 2003, 120: 85-94. 10.1016/S0165-1781(03)00162-8.CrossRef
28.
Martin CR, Bonner A, Brook A, Luscombe C: Factor structure and use of the Hospital Anxiety and Depression Scale in the homeless and socially marginalized. Psychology, Health & Medicine. 2006, 2: 190-197. 10.1080/13548500500155883.CrossRef
29.
Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertson B, Bliss J: The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Brit J Psychiat. 1991, 158: 255-259. 10.1192/bjp.158.2.255.CrossRefPubMed
30.
Spinhoven PH, Ormel J, Sloekers PP, Kempen GIJ, Speckens AE, Van Hermerts AM: A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997, 27: 363-370. 10.1017/S0033291796004382.CrossRefPubMed
31.
Lisspers J, Nygren A, Söderman E: Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiat Scan. 1997, 96: 281-286. 10.1111/j.1600-0447.1997.tb10164.x.CrossRef
32.
Bedford A, De Pauw K, Grant E: The structure of the hospital anxiety and depression scale (HAD): an appraisal with normal, psychiatric and medical patient subjects. Pers Indiv Differ. 1997, 23: 473-478. 10.1016/S0191-8869(97)80013-X.CrossRef
33.
Crawford JR, Henry JD, Crombie C, Taylor EP: Normative data for the HADS from a large non-clinical sample. Brit J Clin Psychol. 2001, 40: 429-434. 10.1348/014466501163904.CrossRef
34.
Mykletun A, Stordal E, Dahl AA: Hospital Anxiety and Depression (HAD) scale: factor structure, items analyses and internal consistency in a large population. Brit J Psychiat. 2001, 179: 540-544. 10.1192/bjp.179.6.540.CrossRefPubMed
35.
Flint AJ, Rifat SL: Factor structure of the hospital anxiety and depression scale in older patients with major depression. Int J of Geriatr Psych. 2002, 17: 117-123. 10.1002/gps.535.CrossRef
36.
Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, Cull A: Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother-T. 2002, 75: 165-176. 10.1348/147608302169625.CrossRef
37.
Herrero ML, Blanch J, Peri JM, De Pablo J, Pintor L, Bulbena A: A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiat. 2003, 25: 277-283. 10.1016/S0163-8343(03)00043-4.CrossRef
38.
Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M: Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine. 2007, 12: 225-237. 10.1080/13548500500524088.CrossRef
39.
Gough K, Hudson P: Psychometric properties of the Hospital and Depression Scale in family caregivers of palliative care patients. J Pain Symptom Manag. 2009, 37: 797-806. 10.1016/j.jpainsymman.2008.04.012.CrossRef
40.
Untas A, Aguirrezabal M, Chauveau P, Leguen E, Combe C, Rascle N: Anxiété et dépression en hémodialyse : validation de l'Hospital Anxiety and Depression Scale (HADS). Nephrol Ther. 2009, 5: 193-200. 10.1016/j.nephro.2009.01.007.CrossRefPubMed
41.
Friedmann S, Even C, Samuelian JC, Guelfi JD: Factor structure of the Hospital Anxiety and Depression (HAD) scale. Brit J Psychiat. 2002, 181: 165-166.
42.
Straat JH, Van der Ark LA, Sijtsma K: Methodological artifacts in dimensionality assessment of the hospital anxiety and depression scale (HADS). J Psychosom Res. 2013, 74: 116-121. 10.1016/j.jpsychores.2012.11.012.CrossRefPubMed
43.
Norton S, Cosco T, Doyle F, Done J, Sacker A: The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis. J Psychosom Res. 2013, 74: 74-81. 10.1016/j.jpsychores.2012.10.010.CrossRefPubMed
44.
Lépine JP, Godchau M, Brun P: Anxiety and depression in inpatients. Lancet. 1985, 28: 1425-1426. 10.1016/S0140-6736(85)92589-9.CrossRef
45.
Lepine JP, Godchau M, Brun P, Lemperière T: Evaluation de l'anxiété et de la dépression chez des patients hospitalisés dans un service de médecine interne. Ann Med-Psychol. 1985, 2: 175-189.
46.
Lépine JP: L'échelle HAD. L'évaluation clinique standardisée en psychiatrie. Edited by: Guelfi JD. 1996, Editions Médicales Pierre Fabre, Paris, 367-374.
47.
Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav. 1983, 24: 385-396. 10.2307/2136404.CrossRefPubMed
48.
Dupret E, Bocéréan C, Teherani M, Feltrin M, Petersen J: Psychosocial risks evaluation : French validation of the Copenhagen Psychosocial Questionnaire (COPSOQ). Scand J Public Health. 2012, 40: 482-490. 10.1177/1403494812453888.CrossRefPubMed
49.
Hu L, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999, 6: 1-55. 10.1080/10705519909540118.CrossRef
50.
Steiger JH: Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res. 1990, 25: 173-180. 10.1207/s15327906mbr2502_4.CrossRef
51.
Browne MW, Cudeck R: Alternative ways of assessing model fit. Testing structural equation models. Edited by: Bollen KA, Long JS, Newbury CA. 1993, Sage, Newbury Park, CA, 132-162.
52.
Bentler PM, Bonett DG: Significance tests and goodness-of-fit in the analysis of covariance structures. Psychol Bull. 1980, 88: 588-606. 10.1037/0033-2909.88.3.588.CrossRef
53.
Costello AB, Osborne J: Best practices in exploratory factor analysis: four recommendations for getting the most from yours analysis. Pract Asses Res & Eval. 2005, 10 (7): ᅟ-Available online: http://​pareonline.​net/​getvn.​asp?​v=​10&​n=​7,
54.
Stordal E, Bjartveit Krüger M, Dahl NH, Mykletun A, Dahl AA: Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT). Acta Psychiat Scan. 2001, 104: 210-216. 10.1034/j.1600-0447.2001.00130.x.CrossRef
55.
Stellman J: Encyclopédie de sécurité et de santé au travail. 2000, Genève, Bureau International du Travail
56.
Besançon G: Manuel de Psychopathologie. 2005, Dunot, Paris
57.
Cohidon C: Prévalence des troubles de santé mentale et conséquences sur l’activité professionnelle en France dans l’enquête « Santé mentale en population générale ». Bulletin épidémiologique hebdomadaire. 2007, ᅟ: 1-6.
58.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59: 34-57.
59.
Cases C, Salines E: Statistiques en psychiatrie en France: données de cadrage. Revue Française des Affaires Sociales. 2004, 1: 181-204.
60.
Legros M, Bauer D, Goyaux D: Pour un accès aux soins plus égal et facilité à la santé et aux soins. 2012, Ministère des affaires sociales, de la Santé et des droits des femmes, Paris
61.
Askenazy P, Baudelot C, Brochard P, Brun JP, Cases C, Davezie P, Falissard B, Gallie D, Gollac M, Griffiths A, Grignon M, Imbernon E, Leclerc A, Molinier P, Niedhammer I, Parent-Thirion A, Verger D, Vézina M, Volkoff S, Weill-Fassina A: Mesurer les facteurs psychosociaux de risque au travail pour les maîtriser. ᅟ. 2011, ᅟ: ᅟ-Available online: http://​www.​college-risquespsychosoc​iaux-travail.​fr,
Metadata
Title
A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees
Authors
Christine Bocéréan
Emilie Dupret
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0354-0

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