University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
PLoS One. 2024 Aug 26;19(8):e0306754. doi: 10.1371/journal.pone.0306754. eCollection 2024.
The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation.
Stroke patients aged 18-66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation.
The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument's psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach's alpha and McDonald's omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms.
HADS showed a stable two-factor structure over the rehabilitation period. Patients' perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18-66 years.
本研究旨在考察在住院康复前后，医院焦虑抑郁量表（HADS）在成年卒中幸存者队列中的心理测量学特性。
在全国质量登记 WebRehab Sweden 中登记的年龄在 18-66 岁的卒中患者在入院时（n=256）、出院时（n=223）和 1 年随访时（n=313）被纳入本研究。使用经典和现代（Rasch）方法进行心理测量评估。
测量焦虑和抑郁的双因素 HADS 模型比单一因素测量情感困扰具有更好的拟合度。康复前后仪器的心理测量稳定性令人满意。焦虑量表具有良好的心理测量特性，但第 7 项不是专门测量焦虑的。观察到一些关于抑郁项目的问题，这些项目的鉴别力较弱，第 8 项作为抑郁测量的效果较差。克朗巴赫α和麦克唐纳ω系数显示出令人满意的内部一致性信度，而 Rasch 个体可靠性系数则表明可靠性较弱，尤其是在抑郁量表方面。入院和出院之间的变化效应大小显示焦虑和抑郁症状有所减轻。
HADS 在康复期间表现出稳定的双因素结构。患者对项目的感知不受恢复的影响，因此可以在康复过程的不同阶段对 HADS 评分进行相关比较。反应性测量表明，HADS 能够敏感地捕捉到康复干预后情绪困扰的改善。总体而言，尽管存在一些心理测量弱点，但 HADS 是评估 18-66 岁卒中患者焦虑和抑郁症状的合适工具。
