Rasch analysis of the hospital anxiety and depression scale (hads) for use in motor neurone disease

Abstract

BackgroundThe Hospital Anxiety and Depression Scale (HADS) is commonly used to assess symptoms of anxiety and depression in motor neurone disease (MND). The measure has never been specifically validated for use within this population, despite questions raised about the scale's validity. This study seeks to analyse the construct validity of the HADS in MND by fitting its data to the Rasch model.MethodsThe scale was administered to 298 patients with MND. Scale assessment included model fit, differential item functioning (DIF), unidimensionality, local dependency and category threshold analysis.ResultsRasch analyses were carried out on the HADS total score as well as depression and anxiety subscales (HADS-T, D and A respectively). After removing one item from both of the seven item scales, it was possible to produce modified HADS-A and HADS-D scales which fit the Rasch model. An 11-item higher-order HADS-T total scale was found to fit the Rasch model following the removal of one further item.ConclusionOur results suggest that a modified HADS-A and HADS-D are unidimensional, free of DIF and have good fit to the Rasch model in this population. As such they are suitable for use in MND clinics or research. The use of the modified HADS-T as a higher-order measure of psychological distress was supported by our data. Revised cut-off points are given for the modified HADS-A and HADS-D subscales.

The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis

“…In addition, seven studies meeting the recruitment criteria for the Cosco et al review but published since the literature search was conducted were also included [19][20][21][22][23][24][25][26]. Again, the corresponding author was contacted if the inter-item correlation matrices were not included in the publication.…”

Executive dysfunction predicts social cognition impairment in amyotrophic lateral sclerosis

“…The modified Hospital Anxiety and Depression Scale (HADS) [27] measured symptoms of anxiety and depression. In the patients, functional abilities were assessed using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) [28].…”

Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

“…In light of the British Psychological Society Division of Clinical Psychology's position that individual and contextualised accounts of distress are more useful than psychiatric diagnoses [33] this may seem unproblematic and, despite their limitations, the HADS and CORE-10 may provide useful indices of general distress [34]. However, it has been suggested that the HADS item "I feel as if I am slowed down" should be removed in samples where it may be confounded by symptoms of physical illness [35]. There may also be significant overlap between the HADS and the CORE-10, which both measure generalised psychological distress.…”