The Hospital Anxiety and Depression scale: factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder
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Despite the high frequency of anxiety and depression symptoms in individuals with Autism Spectrum Disorder (ASD) and a significant impact of these comorbidities on both individuals with ASD and their families, research on the validity of anxiety and depression measures in the ASD population is currently lacking. The aim of this study was to explore the psychometric properties of the Hospital Anxiety and Depression Scale [HADS; Zigmond & Snaith, ] in a sample of older adolescents and young adults with ASD. One hundred and fifty one participants (UK Transition longitudinal study: N = 106; 75 males, Mage = 16.04 years, SD = 1.28; Longitudinal Study of Australian Schools Leavers with ASD: N = 45, 30 males; Mage = 18.35 years, SD = 2.55) completed the HADS and a range of mental health and well‐being measures. Combination of the Principal Component Analysis and Parallel Analysis indicated two factors as an optimal solution in our sample, accounting for 43.77% of variance with factors being identical in terms of content with the structure found in the general population. Internal consistency was good for the HADS anxiety scale (HADS‐A; .82–.84) and acceptable for the HADS depression scale (HADS‐D; .60–.72). Convergent validity of both HADS‐A and HADS‐D scales was excellent and divergent validity was acceptable. Our study represents a significant contribution to the literature by providing an initial validation of the HADS in older adolescents and younger adults with ASD. Autism Res 2018, 11: 258–269. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Research on the validity of measurement of anxiety and depression in ASD is currently lacking. The aim of this study was to explore the properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of 151 young people with ASD. Participants completed HADS and a range of mental health and well‐being measures. Encouragingly, our findings suggest that HADS provides a reliable and valid assessment of anxiety and depression in ASD.
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The HADS depression subscale had adequate internal consistency and a modest correlation (r = 0.56, 95% CI 0.25 to 0.77) with PHQ-9 scores in autistic older adolescents and adults.
“The authors 20 reported adequate internal consistency for the depression subscale of the HADS, with a modest correlation ( r = 0.56, 95% CI 0.25 to 0.77) between the HADS depression score and scores on the Patient Health Questionnaire-9 items (PHQ-9), 22”
From Guided self-help for depression in autistic adults: The ADEPT feasibility RCT (2019) · cites this paper as [20]
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Alexithymia traits outweigh autism traits in the explanation of depression in adults with autism
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“It has been validated for use in autistic samples (Uljarević et al., 2018), and in the current sample, the anxiety subscale demonstrated excellent internal consistency in both groups (Cronbach’s alphas: autistic = 0.80; non-autistic = 0.81).”
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Suicide and Autism: A Lifespan Perspective
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- Authors
- Uljarević, M., Richdale, A. L., McConachie, H., Hedley, D., Cai, R. Y., Merrick, H., Parr, J. R., & Le Couteur, A.
- Affiliations
- La Trobe University (AU)
- Newcastle University (GB)
- Institute of Health and Society, Newcastle University Newcastle upon Tyne UK
- Corresponding author
- Uljarević, Mirko
- ORCID
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2017-09-18
- Volume
- 11
- Issue
- 2
- Pages
- 258-269
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- OpenAlex
- W2754349437
- Cited by
- 85
- References
- 79
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 14 · 2019: 8 · 2018: 7 · 2017: 2
- FWCI
- 4.86
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Autism Research (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health Research (RP‐PG‐0610‐10112)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Hospital Anxiety and Depression Scale, autism spectrum disorder, anxiety, depression, psychometric validation, factor structure, adolescents, young adults, comorbidities, convergent validity, discriminant validity, internal consistency
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Australia, Depressive Disorder, Female, United Kingdom, Humans, Longitudinal Studies, Male, Psychometrics, Surveys and Questionnaires, Comorbidity, Principal Component Analysis, Young Adult
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