Research Department of Clinical, Educational and Health Psychology, University College, London, United Kingdom.
Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
Am J Geriatr Psychiatry. 2017 Nov;25(11):1270-1280. doi: 10.1016/j.jagp.2017.05.017. Epub 2017 Jun 7.
The Hospital Anxiety and Depression Scale (HADS) is a self-report measure of anxiety and depression. It is recommended for clinical assessment and has been used as the primary outcome in large clinical trials with carers of people with dementia. Its validity and utility have never been examined in this population. The current study addresses this.
In a secondary analysis of baseline data from a recent intervention trial (N = 284) with cross-validation in baseline data from a second trial (N = 230), the authors used confirmatory factor analysis to test whether a one-, two-, or three-factor structure best fit the data and used indices of model misspecification to respecify. Internal consistency, concurrent validity of obtained factors, and measurement invariance across gender, age, kinship, and cohabitation status were assessed.
A three-factor structure best fit the data. Removal of one item improved model fit. The factors showed good internal consistency and high levels of concurrent validity. Measurement invariance was adequate across gender and kinship but not age or cohabitation status. Results were replicated in the cross-validation sample, enhancing reliability.
In this group the HADS measured three factors; depression, anxiety, and negative affectivity. The depression scale can be used as originally intended, supporting results of large clinical trials. The HADS does not validly measure distress or anxiety. Consequently, clinical practice recommendations could be revisited, and future research trials should not use HADS anxiety or distress as outcomes. Researchers should pay attention to measurement invariance when using HADS to compare carer subgroups.
医院焦虑抑郁量表（HADS）是一种用于评估焦虑和抑郁的自评量表。它被推荐用于临床评估，并已在针对痴呆患者照顾者的大型临床试验中作为主要结局指标使用。然而，它在该人群中的有效性和实用性尚未得到验证。本研究旨在解决这一问题。
在一项最近干预试验的基线数据的二次分析中（N=284），并在第二项试验的基线数据中进行了交叉验证（N=230），作者使用验证性因子分析来检验单因素、双因素或三因素结构最适合数据，并使用模型指定不当的指标重新指定。评估了获得的因素的内部一致性、同时效度和性别、年龄、亲属关系和同居状况的测量不变性。
三因素结构最适合数据。删除一个项目可以提高模型拟合度。这些因素表现出良好的内部一致性和高水平的同时效度。在性别和亲属关系方面，测量不变性是充分的，但在年龄或同居状况方面则不然。在交叉验证样本中的结果得到了复制，提高了可靠性。
在该群体中，HADS 测量了三个因素；抑郁、焦虑和消极情感。抑郁量表可以像最初设计的那样使用，支持了大型临床试验的结果。HADS 不能有效地测量痛苦或焦虑。因此，临床实践建议可以重新考虑，未来的研究试验不应将 HADS 焦虑或痛苦作为结局指标。研究人员在使用 HADS 比较照顾者亚组时应注意测量不变性。
