Cited by 383Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingHealth Education and Validation

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Construct validation of the hospital anxiety and depression scale with clinical populations

Johnston, Marie, Pollard, Beth, Hennessey, Peter·2000·Journal of Psychosomatic Research

DOI 10.1016/s0022-3999(00)00102-1

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Abstract

Objective the hospital anxiety and depression scale (HADS) attempts to measure anxiety and depression without confounding by somatic symptoms of physical disorder, and is widely used for this purpose. This paper addresses three questions about the validity of the HADS concerning its independence of physical symptoms, the extent to which its items robustly measure the identified constructs with varying clinical populations and situations, and its capacity to differentiate anxiety and depression.Methods data from patients with breast disease, myocardial infarction (MI), and stroke were examined using factor analytic and psychometric analyses.Results using exploratory factor analysis in patients with breast disease, 13 of the 14 HADS items fell on a psychological factor and loadings on the psychological factor were higher than loadings on the somatic factor for all items. The HADS showed high levels of internal consistency and there was little evidence that removing items would improve it. Confirmatory factor analyses (CFA) in MI and stroke groups confirmed the separation of anxiety and depression. Analyses indicated items, which were performing poorly for these clinical groups.Conclusions there was support for the validity of the HADS for all three questions. However, there were some evidences of individual items performing poorly. Given the ease of administration and the acceptability of this measure to ill or weak respondents, the HADS continues to perform satisfactorily.

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“This measure, originally designed for medical outpatients, has been validated for use with a number of chronic health problems, including coronary heart disease (Stafford et al., 2007), myocardial infarction and stroke (Johnston et al., 2000) and multiple sclerosis (Honarmand & Feinstein, 2009).”
Background
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Authors: Johnston, M., Pollard, B., & Hennessey, P.
Affiliations: University of St Andrews (GB)
Corresponding author: Johnston, Marie
ORCID: Johnston, Marie
Pollard, Beth
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 2000-06
Volume: 48
Issue: 6
Pages: 579-584
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/s0022-3999(00)00102-1
OpenAlex: W2037426394
Cited by: 383
References: 13
Citations by year: 2026: 11 · 2025: 10 · 2024: 15 · 2023: 10 · 2022: 13 · 2021: 14 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 16 · 2016: 16 · 2015: 13 · 2014: 18 · 2013: 17 · 2012: 25
FWCI: 13.48
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychosomatic Research (publishedVersion)
PubMed (publishedVersion)
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 › Nursing › Research and Theory › Health Education and Validation
Keywords: Hospital Anxiety and Depression Scale, construct validity, anxiety, depression, somatic symptoms, breast diseases, myocardial infarction, stroke, factor structure, internal consistency, psychometric properties
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Breast Diseases, Breast Neoplasms, Depression, Female, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction, Personality Inventory, Psychometrics, Sick Role, Somatoform Disorders, Reproducibility of Results, Stroke

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Construct validation of the hospital anxiety and depression scale with clinical populations

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