title: An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS).
abstract: OBJECTIVE
  To demonstrate the use of Rasch analysis by assessing the appropriateness of utilizing the Hospital Anxiety and Depression Scale (HADS) total score (HADS-14) as a measure of psychological distress.
  
  
  METHODS
  Cross-sectional, using Rasch analysis.
  
  
  METHODS
  The HADS was administered to 296 patients attending an out-patient musculoskeletal rehabilitation program. Rasch analysis was conducted using RUMM2020 software to assess the overall fit of the model, the response scale used, individual item fit, differential item functioning (DIF) and person separation.
  
  
  RESULTS
  Rasch analysis supported the viability of the HADS-14 as a measure of psychological distress. It showed good person separation, little disordering of the thresholds and no evidence of DIE One anxiety item (item 11) showed some misfit to the model. The residuals patterned into the two subscales (anxiety and depression), but the person estimate derived from these two subscales was not statistically different to that derived from all items taken together, supporting the assumption of unidimensionality. A cut-point of 12 on the HADS-14 identified all cases that were classified as both anxious and depressed on the original individual HADS subscales.
  
  
  CONCLUSIONS
  The results of Rasch analysis support the use of the HADS-14 as a global measure of psychological distress. The study demonstrates the usefulness of Rasch analysis in assessing the psychometric properties of a scale and suggests that further use of this technique to assess the HADS-14 in other clinical groups is warranted.
authors.affiliation: Faculty of Life and Social Sciences, Swinburne University of Technology, Australia. jpallant@swin.edu.au
authors.forename: Julie F
authors.initials: JF
authors.lastname: Pallant
authors.forename: Alan
authors.initials: A
authors.lastname: Tennant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012737:Sex Factors; D012984:Software