title: Psychometric evaluation of the Hospital Anxiety and Depression Scale 3 months after acute lung injury.
abstract: OBJECTIVE
  To conduct a psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) and to evaluate associations of 2 measures of psychological distress with the HADS Anxiety (HADS-A) and HADS Depression (HADS-D) subscales in acute lung injury (ALI) survivors.
  
  
  METHODS
  We used 3-month post-ALI follow-up data from 151 participants in a multisite prospective cohort study to evaluate the internal consistency and structure of the HADS subscales and items, respectively. We used Spearman ρ correlations and other statistics to relate the 3-level version of the EuroQol-5D (EQ-5D-3L) anxiety/depression item and Medical Outcomes Study Short Form-36 (SF-36) "mental health"-related domains to the HADS subscales.
  
  
  RESULTS
  Internal consistency was good for each of the HADS subscales (α ≥ .70). Exploratory factor analysis revealed a 2-factor structure (anxiety and depression). The EQ-5D-3L item and the SF-36 mental health-related domain scores were associated with HADS-A (ρ = 0.54 and -0.48 to -0.70, respectively) and HADS-D (ρ = 0.41 and -0.48 to -0.52, respectively) scores (all P < .01). The relationship between the SF-36 mental health domain score and the HADS-A subscale score was particularly strong (ρ = -0.70, P < .01).
  
  
  CONCLUSIONS
  When evaluated in ALI survivors, the HADS has good internal consistency and a 2-factor structure. The HADS subscales were substantially correlated with the EQ-5D-3L anxiety/depression item and SF-36 mental health-related domain scores, suggesting convergent validity for these measures of psychological distress in ALI survivors.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Jutte
authors.affiliation: Department of Physical Medicine and Rehabilitation, the Johns Hopkins University School of Medicine, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, the Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.affiliation: Division of General Internal Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, the Johns Hopkins University, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, MD; Department of Mental Health, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Electronic address: obienve1@jhmi.edu.
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
mesh_terms: D055371:Acute Lung Injury / Q000523:psychology*; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011594:Psychometrics; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Acute lung injury; Anxiety; Critical care; Depression; Intensive care unit; Psychometrics