title: Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients.
abstract: OBJECTIVE
  To examine the construct validity of the Swedish version of Hospital Anxiety and Depression Scale (HAD) in women with breast cancer.
  
  
  METHODS
  Acquired data on HAD from 727 women who recently had breast cancer surgery, were aged 20-63 years and worked before diagnosis, and had no previous breast cancer (n = 725) were subjected to confirmatory factor analysis examining the viability of three hypothesized measurement models.
  
  
  RESULTS
  The analysis showed adequate fit to the data for both bi-dimensional and three-factorial models of HAD. The single-factorial model, however, was shown to have inferior fit to the data. Substantive correlations were found between anxiety and depression in the bi-dimensional model, and negative affectivity and anxiety in the three-factorial model of HAD.
  
  
  CONCLUSIONS
  The findings support the utility of scoring procedure based on the original bi-dimensional model, but add indication of co-occurrence of anxiety and depression in this patient population. The discriminant validity of a third factor of negative affectivity in a three-factorial model, however, remains unclear.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden, fredrik.saboonchi@ki.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Saboonchi
authors.forename: Agneta
authors.initials: A
authors.lastname: Wennman-Larsen
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.forename: Lena-Marie
authors.initials: LM
authors.lastname: Petersson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D001943:Breast Neoplasms / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D015203:Reproducibility of Results; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D013548:Sweden