Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients
- 1 May 2021
- journal article
- research article
- Published by AACN Publishing in American Journal of Critical Care
- Vol. 30 (3), 212-220
- https://doi.org/10.4037/ajcc2021214
Abstract
The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined. To examine the structural validity of the HADS. This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis. The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items. Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients.Keywords
This publication has 42 references indexed in Scilit:
- Item Banks for Measuring Emotional Distress From the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, Anxiety, and AngerAssessment, 2011
- Rethinking Interventions to Improve Surrogate Decision Making in Intensive Care UnitsAmerican Journal of Critical Care, 2011
- Bifactor Models and Rotations: Exploring the Extent to Which Multidimensional Data Yield Univocal Scale ScoresJournal of Personality Assessment, 2010
- Symptom experiences of family members of intensive care unit patients at high risk for dyingCritical Care Medicine, 2010
- Author Guidelines for Reporting Scale Development and Validation Results in the Journal of the Society for Social Work and ResearchJournal of the Society for Social Work and Research, 2010
- Psychometric Properties of the Hospital Anxiety and Depression Scale in Family Caregivers of Palliative Care PatientsJournal of Pain and Symptom Management, 2009
- Symptoms Experienced by Family Members of Patients in Intensive Care UnitsAmerican Journal of Critical Care, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- The Comorbidity of Major Depression and Anxiety DisordersThe Primary Care Companion For CNS Disorders, 2001
- The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 1983