Evaluation of the Hospital Anxiety and Depression Scale (HADS) in screening stroke patients for symptoms: Item Response Theory (IRT) analysis
Open accessAbstract
Background Variations have been reported in the number of underlying constructs and choice of thresholds that determine caseness of anxiety and /or depression using the Hospital Anxiety and Depression scale (HADS). This study examined the properties of each item of HADS as perceived by stroke patients, and assessed the information these items convey about anxiety and depression between 3 months to 5 years after stroke.Methods The study included 1443 stroke patients from the South London Stroke Register (SLSR). The dimensionality of HADS was examined using factor analysis methods, and items' properties up to 5 years after stroke were tested using Item Response Theory (IRT) methods, including graded response models (GRMs).Results The presence of two dimensions of HADS (anxiety and depression) for stroke patients was confirmed. Items that accurately inferred about the severity of anxiety and depression, and offered good discrimination of caseness were identified as "I can laugh and see the funny side of things" (Q4) and "I get sudden feelings of panic" (Q13), discrimination 2.44 (se = 0.26), and 3.34 (se = 0.35), respectively. Items that shared properties, hence replicate inference were: "I get a sort of frightened feeling as if something awful is about to happen" (Q3), "I get a sort of frightened feeling like butterflies in my stomach" (Q6), and "Worrying thoughts go through my mind" (Q9). Item properties were maintained over time.Limitations Approximately 20% of patients were lost to follow up.Conclusion A more concise selection of items based on their properties, would provide a precise approach for screening patients and for an optimal allocation of patients into clinical trials.
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Good internal consistency for both HADS subscales was found in a stroke population.
“Furthermore, a good internal consistency for both subscales (Cronbach α depression scale = .81; anxiety scale = .84) was found in a stroke population (Ayis et al., 2018).”
From Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. (2023) · cites this paper as Ayis et al., 2018
The Hospital Anxiety and Depression Scale has been validated in a sample of patients with traumatic brain injury, and there was good internal consistency for both subscales in patients with stroke (Cronbach α depression 0.81; anxiety 0.84).
“This questionnaire has been validated in a sample of patients with TBI [32]. Furthermore, there was good internal consistency for both subscales (Cronbach α depression scale, 0.81; anxiety scale, 0.84) in patients with stroke [33].”
The Hospital Anxiety and Depression Scale (HADS) has been validated in traumatic brain injury and stroke samples.
“This questionnaire has been validated in TBI and stroke samples [18,19].”
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“Possible The total score is calculated based on the average of the domains, with a maximum of 100% [52]. scores for each item range from 0 to 3, and symptom severity is evidenced when items The HADS assesses depression and anxiety within 14 items. exhibit higher values [53].”
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- Authors
- Ayis, S. A., Ayerbe, L., Ashworth, M., & DA Wolfe, C.
- Affiliations
- King's College London (GB)
- Queen Mary University of London (GB)
- Corresponding author
- Ayis, Salma A.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 228
- Pages
- 33-40
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2769527085
- Cited by
- 55
- References
- 49
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 10 · 2023: 6 · 2022: 12 · 2021: 8 · 2020: 4 · 2019: 6 · 2018: 1
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health Research (RP-PG-0407–10184)
- Topics
- 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
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- Hospital Anxiety and Depression Scale, stroke, anxiety, depression, screening, item response theory, graded response model, item discrimination, dimensionality, psychometric properties, South London Stroke Register
- MeSH terms
- Aged, Anxiety, Depression, Depressive Disorder, Factor Analysis, Statistical, Female, Humans, London, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Registries, Stroke
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