MRC Epidemiology Resource Centre, University of Southampton, Southampton SO16 6YD, UK.
Int Psychogeriatr. 2010 Jun;22(4):559-71. doi: 10.1017/S1041610210000256. Epub 2010 Mar 10.
The Hospital Anxiety and Depression Scale (HADS) is widely used but evaluation of its psychometric properties has produced equivocal results. Little is known about its structure in non-clinical samples of older people.
We used data from four cohorts in the HALCyon collaborative research program into healthy aging: the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study, and the Lothian Birth Cohort 1921. We used exploratory factor analysis and confirmatory factor analysis with multi-group comparisons to establish the structure of the HADS and test for factorial invariance between samples.
Exploratory factor analysis showed a bi-dimensional structure (anxiety and depression) of the scale in men and women in each cohort. We tested a hypothesized three-factor model but high correlations between two of the factors made a two-factor model more psychologically plausible. Multi-group confirmatory factor analysis revealed that the sizes of the respective item loadings on the two factors were effectively identical in men and women from the same cohort. There was more variation between cohorts, particularly those from different parts of the U.K. and in whom the HADS was administered differently. Differences in social-class distribution accounted for part of this variation.
Scoring the HADS as two subscales of anxiety and depression is appropriate in non-clinical populations of older men and women. However, there were differences between cohorts in the way that individual items were linked with the constructs of anxiety and depression, perhaps due to differences in sociocultural factors and/or in the administration of the scale.
医院焦虑抑郁量表（HADS）应用广泛，但对其心理测量特性的评估结果却存在分歧。人们对其在非临床老年人群样本中的结构知之甚少。
我们使用 HALCyon 协作研究计划中四个关于健康老龄化的队列的数据：卡菲利前瞻性研究、赫特福德郡衰老研究、赫特福德郡队列研究和洛锡安 1921 年出生队列。我们使用探索性因子分析和验证性因子分析以及多组比较来确定 HADS 的结构，并检验样本之间的因子不变性。
探索性因子分析显示，在每个队列的男性和女性中，该量表均具有双维度结构（焦虑和抑郁）。我们检验了一个假设的三因素模型，但由于两个因素之间的高度相关性，使得两因素模型在心理上更合理。多组验证性因子分析显示，在来自同一队列的男性和女性中，两个因素的各自项目负荷大小基本相同。不同队列之间存在更多差异，特别是来自英国不同地区且 HADS 评估方式不同的队列。社会阶层分布的差异部分解释了这种差异。
在非临床老年男性和女性人群中，将 HADS 评分作为焦虑和抑郁两个亚量表是合适的。然而，在不同队列中，个体项目与焦虑和抑郁结构的关联方式存在差异，这可能是由于社会文化因素和/或量表的管理方式不同所致。
