title: The hospital anxiety and depression scale--dimensionality, reliability and construct validity among cognitively intact nursing home patients.
abstract: BACKGROUND
  Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted.
  
  
  OBJECTIVE
  To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population.
  
  
  METHODS
  Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used.
  
  
  RESULTS
  The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported.
  
  
  CONCLUSIONS
  Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias.
  
  
  CONCLUSIONS
  Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.
authors.affiliation: Sør-Trøndelag University College, Faculty of Nursing and Research Centre for Health Promotion and Resources, HIST, Norway. Electronic address: gorill.haugan@hist.no.
authors.forename: Gørill
authors.initials: G
authors.lastname: Haugan
authors.affiliation: Bergen University College, Faculty of Nursing, Norway. Electronic address: jorunn.drageset@hib.no.
authors.forename: Jorunn
authors.initials: J
authors.lastname: Drageset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006761:Hospitals; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009664:Norway; D009735:Nursing Homes; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Confirmatory factor analysis; Construct validity; Dimensionality; HADS; Nursing home; Reliability