title: The nature and structure of psychological distress in people at high risk for melanoma: a factor analytic study.
abstract: OBJECTIVE
  This study examined the psychometric properties of two commonly used measures of psychological distress, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Events Scale (IES) in a sample of individuals at high risk of developing melanoma due to strong family history.
  
  
  METHODS
  One hundred thirty-two individuals with a known family-specific CDKN2A mutation (74% response rate) completed a mailed, self-administered questionnaire including the HADS and the IES. Initial correlational analyses were followed by both exploratory and confirmatory factor analyses, according to a predetermined procedure for order of analyses.
  
  
  RESULTS
  Exploratory factor analyses found that neither a two-, three- or four-factor solution satisfactorily accounted for all IES items in the present sample. By contrast, a unidimensional account of the data emerged to best account for all IES items, leaving no items unaccounted for. In contrast, the traditional two-factor (anxiety and depression) structure of the HADS appeared to fit the data well.
  
  
  CONCLUSIONS
  The traditional, two-factor (intrusion and avoidance) structure of the IES was not borne out within this familial melanoma cohort. Assessment of a single dimension of emotional distress in response to melanoma risk may facilitate more meaningful explorations of psychological adjustment in this context. These findings also raise questions about whether a post-traumatic stress framework is indeed the most appropriate framework to capture the unique nature of melanoma- or cancer-related distress.
authors: School of Psychology, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia. N.Kasparian@unsw.edu.au.
authors: Nadine A
authors: NA
authors: Kasparian
authors: Ursula
authors: U
authors: Sansom-Daly
authors: Roderick P
authors: RP
authors: McDonald
authors: Bettina
authors: B
authors: Meiser
authors: Phyllis N
authors: PN
authors: Butow
authors: Graham J
authors: GJ
authors: Mann