The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis (original) (raw)
Related papers
Distinguishing between depression and anxiety: A proposal for an extension of the tripartite model
European Psychiatry, 2010
The aim of the current study was to develop scales that assess symptoms of depression and anxiety and can adequately differentiate between depression and anxiety disorders, and also can distinguish within anxiety disorders. As point of departure, we used the tripartite model of Clark and Watson that discerns three dimensions: negative affect, positive affect and physiological hyperarousal. Methods: Analyses were performed on the data of 1449 patients, who completed the Mood and Anxiety Symptoms Questionnaire (MASQ) and the Brief Symptom Inventory (BSI). From this, 1434 patients were assessed with a standardized diagnostic interview. Results: A model with five dimensions was found: depressed mood, lack of positive affect, somatic arousal, phobic fear and hostility. The scales appear capable to differentiate between patients with a mood and with an anxiety disorder. Within the anxiety disorders, somatic arousal was specific for patients with panic disorder. Phobic fear was associated with panic disorder, simple phobia and social anxiety disorder, but not with generalized anxiety disorder. Conclusions: We present a five-factor model as an extension of the tripartite model. Through the addition of phobic fear, anxiety is better represented than in the tripartite model. The new scales are capable to accurately differentiate between depression and anxiety disorders, as well as between several anxiety disorders. #
The tripartite model of anxiety and depression: A new look at theory and measurement
The relationship between anxiety and depression remains unclear, despite ongoing revision of diagnostic concepts over the last sixty years. Various proposals have been suggested which attempt to explain this relationship. Some have suggested that anxiety and depression are distinct disorders, with different etiologies, symptoms, natural courses, and response to treatment (the pluralist position). Others have suggested that anxiety and depression are a single disorder, or at least different manifestations of the same underlying pathology (the unitary position). Clark & Watson (1991) proposed an alternative model in which anxiety and depression symptoms are divided into three clusters-a specific set of symptoms for each, as well as a shared set of non-specific symptoms seen in both disorders. They suggested that such a tripartite model of anxiety and depression symptoms provided the best description of the manifestation of anxiety and depression symptoms. Clark & Watson (1991) further suggested that by focusing on the specific symptoms of anxiety and depression, the discriminant validity of psychometric assessments of the two could be improved. The current research reviews the literature in support of unitary, pluralist and tripartite models of anxiety and depression symptoms, and concludes that a tripartite model is the most consistently supported by the literature, including studies of symptoms, course, treatment, etiology, family patterns and genetics in both. It examines in detail the research into the tripartite structure of anxiety and depression symptoms, and concludes that previous research also supports a three-factor structure of anxiety and depression symptoms in existing self-report measures. The Mood and Anxiety Symptom Questionnaire (MASQ) is reviewed as the only existing clinical symptom measure based on the tripartite model. Although previous authors have reported broad support for the MASQ, the present research uniquely used a sample of anxious and depressed patients and confirmatory factor analytic methods, and failed to support the MASQ as a valid tripartite measure. Specifically, there was no support at the item or subscale level for any of the two-factor or three-factor models tested. Furthermore, the MASQ subscales did not show the expected differences when compared between anxious and depression patients, and the instrument was found to be inadequate in discriminating between those diagnosed with anxiety versus those diagnosed with depression. In response to the psychometric inadequacy of the MASQ, the Tripartite Clinical Symptom Inventory (TCSI) was proposed as a measure based on the tripartite model which would be clinically useful, as well as showing strong reliability and validity. It was also proposed that the TCSI would further validate several aspects of the tripartite theory of anxiety and depression symptoms. The original 45-item set was reduced over a series of exploratory factor analyses, designed to yield a core subset of symptoms that were reliably and stably associated with
Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications
Journal of Abnormal Psychology, 1991
We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self-and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.
Journal of Abnormal …, 1995
- proposed a tripartite model that groups symptoms of depression and anxiety into 3 subtypes: symptoms of general distress that are largely nonspecific, manifestations of somatic tension and arousal that are relatively unique to anxiety, and symptoms of anhedonia and low Positive Affect that are specific to depression. This model was tested in 5 samples (3 student, 1 adult, and 1 patient sample) using the Mood and Anxiety Symptom Questionnaire (MASQ; D. Watson & L. A. Clark, 1991), which was designed to assess the hypothesized symptom groups, together with other symptom and cognition measures. Consistent with the tripartite model, the MASQ Anxious Arousal and Anhedonic Depression scales both differentiated anxiety and depression well and also showed excellent convergent validity. Thus, differentiation of these constructs can be improved by focusing on symptoms that are relatively unique to each.
Rheumatology, 2010
Background: The Hospital Anxiety and Depression Scale (HADS) is a commonly used measure of psychological distress in patient populations. The HADS was designed to measure two correlated anxiety and depression factors, however previous research is inconclusive finding support for several alternative models. In addition, some items may be biased by the somatic features of a disease. Currently there are no published studies considering item bias in rheumatological patients. The objective of this study was to (1) examine the factor structure of the HADS and (2) assess for the presence of item bias. Methods: The sample consisted of 160 patients attending one of the Early Rheumatoid Arthritis Study centres, for whom individual HADS item responses were available. All completed questionnaires were pooled resulting in a total sample of 1728. Alternative models were compared using confirmatory factor analysis. Item bias was assessed by examining relation between individual HADS items and covariates (disease duration, age, sex, HAQ, DAS and pain) whilst controlling for underlying level of psychological distress. Results: Superior fit was observed for a bifactor structure (2(20) ¼ 87, RMSEA ¼ 0.04, CFI ¼ 0.97, TLI ¼ 0.99), indicating that the HADS taps into a general psychological distress factor as well as specific anxiety and depression factors. The HADS anxiety and depression scores correlated highly with the respective specific factor but even more so with the general factor (HADS-A: r(anxiety) ¼ 0.59, r(general) ¼ 0.86; HADS-D: r(depression) ¼ 0.64, r(general) ¼ 0.83). Item bias was observed for item D8 ''I feel slowed down'' with individuals with same underlying level of psychological distress but worse disability (b ¼ 0.34, P < 0.001) and higher disease activity (b ¼ 0.13, P < 0.001) more likely to respond positively to the item. Further item bias was observed for item D14 ''I can enjoy a good book or radio or TV programme'' with females less likely to respond positively to the item than males with the same level of psychological distress (b ¼-0.50, P < 0.001). However, the magnitude of the bias was small and controlling for it made no substantive difference in the association between the covariates and psychological distress factors. Conclusions: The HADS total score may be used as an assessment of general psychological distress, incorporating specific features of anxiety and depression. However, factor scores, which can be calculated using a simple tool provided by the author, may provide greater insight into an individual's psychological well-being, by allowing for the assessment of anxiety and depression separately. Although item bias was observed, it is unlikely to have a substantive effect.
Psihologija, 2020
This study explored several, latent factor models of the Depression Anxiety and Stress Scale?21 (DASS?21) using both a sample of clinically depressed patients and a Facebook sample from Serbia. The DASS?21, the Beck Depression Inventory?II, and the State Trait Anxiety Inventory?Trait were administered to a sample of depressed individuals (N = 296; Mage = 52.21, SDage = 11.56). A Facebook sample (N = 376; Mage =29.12, SD = 8.96) completed the DASS?21 only. A bifactor model with one general distress (G) and two specific factors (Depression and Anxiety) were supported. The three factors had high omega coefficients, whereas omega hierarchical for Depression and Anxiety were low. Based on all evidence from our study, external validation, factor determinacy, and replicability, we concluded that the Serbian version of the DASS?21 assesses reliably general distress and anhedonia in both people with the clinical level of severity of distress and in general population. The Anxiety subscale ca...
The British Journal of Psychiatry, 2001
Background The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale. Aims To examine the psychometric properties of the HAD scale in a large population. Method All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations. Results Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively. Conclusions Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument shoul...
Australian and New Zealand Journal of Psychiatry, 2006
MASQ Factor Structure 2 Abstract Objective: The tripartite model of anxiety and depression (Clark & Watson, 1991) has been proposed as a representation of the structure of anxiety and depression symptoms. The Mood and Anxiety Symptom Questionnaire (MASQ) has been put forward as a valid measure of the tripartite model of anxiety and depression symptoms. This research set out to examine the factor structure of anxiety and depression symptoms in a clinical sample to assess the MASQ's validity for use in this population. Method: The present study, uses confirmatory factor analytic methods to examine the psychometric properties of the MASQ in 470 outpatients with anxiety and mood disorder.
Personality and Individual Differences, 1997
Four published studies which include factor analyses of the items of the Hospital Anxiety and Depression Scale (HAD) are reviewed and new data on psychiatric out-patients are presented. By contrast with the rest, the two studies in English with British subjects clearly support the interpretation of the HAD as a bidimensional measure. However, one anxiety item appears sex-related and misaligned. The problem of item meaning in other cultures is raised. Overall, despite the HAD's use internationally, there has been a lack of systematic structural evaluation. 0 1997