A psychometric evaluation of the Hospital Anxiety and Depression Scale in cardiac patients: addressing factor structure and gender invariance.
OBJECTIVE
The present study examined the factor structure of the Hospital Anxiety and Depression Scale (HADS) and tested measurement invariance between genders in a representative sample of cardiac patients across 2 years.


METHODS
Confirmatory factor analysis and structural equational modelling were used to assess the factor structure, measurement, and structural invariance of the HADS.


METHODS
Eight hundred and one cardiac patients completed the HADS at baseline, 6, 12, and 24 months.


RESULTS
Confirmatory factor analysis consistently supported a three-factor structure of the HADS, with the best fitting model comprised of negative affect, autonomic anxiety, and depression. Structural equation modelling showed that the HADS was invariant by gender among cardiac patients.


CONCLUSIONS
The HADS can be appropriately used with both male and female cardiac patients to assess three domains of psychological distress. Future investigations should consider the predictive validity and relevance of the HADS subscales with respect to diagnostic distinctions and clinical outcomes among cardiac patients and other clinical populations.
School of Psychology, University of Ottawa, Canada. thunt017@uottawa.ca
Tiffany
T
Hunt-Shanks
Christopher
C
Blanchard
Robert
R
Reid
Michelle
M
Fortier
Mario
M
Cappelli
D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D017678:Sex Distribution