title: Use of the Hospital Anxiety and Depression Scale in Spanish caregivers.
abstract: BACKGROUND
  The Hospital Anxiety and Depression Scale (HADS) is widely used in the assessment of anxiety and depression, but there are scarce data about its psychometric properties in caregivers of older relatives.
  
  
  OBJECTIVE
  The goal of this study was to analyse the factor structure of the HADS to verify its suitability to assess emotional symptomatology in family caregivers of old people, its internal consistency and confirming its relation with the General Health Questionnaire (GHQ-12) and an index of disease and physical complaints.
  
  
  METHODS
  One hundred and seventy-five family caregivers (25 men and 150 women) aged 32-86, who were taking care of at least one older person in a situation of dependence, were recruited for this study. A descriptive, comparative, correlational design was employed. The scientific adequacy of the questionnaire and its structure were analysed using confirmatory factor analysis. The scores obtained in the GHQ and in an index of disease and physical complaints were used as external criteria to assess the adequacy of the HADS for caregivers.
  
  
  RESULTS
  Higher levels of anxiety and depression than in the normal population were obtained. The reliability/internal validity of the questionnaire was adequate. A bifactor model, with one subscale for anxiety and one for depression, provides the best fit to the data. The subscales were related to GHQ-12 and index of diseases/physical complaints.
  
  
  CONCLUSIONS
  The HADS was shown to be useful to assess the presence of anxiety and depression in family caregivers, and the original two-dimensional model is the most adequate.
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.|Red Hygeia (Health y GEnder International Alliance).
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Sánchez-López
authors.affiliation: Red Hygeia (Health y GEnder International Alliance).|Universidad de Murcia, Murcia, Spain.
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Limiñana-Gras
authors.affiliation: Red Hygeia (Health y GEnder International Alliance).|Universidad de Murcia, Murcia, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Colodro-Conde
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.|Red Hygeia (Health y GEnder International Alliance).
authors.forename: Isabel
authors.initials: I
authors.lastname: Cuéllar-Flores
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D013030:Spain; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Hospital Anxiety and Depression Scale; anxiety; caregivers; confirmatory factor analysis; depression