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The value of the Hospital Anxiety and Depression Scale (HADS) for comparing women with early onset breast cancer with population-based reference women
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Background The Hospital Anxiety and Depression Scale (HADS) is frequently used in cancer studies, yet its utility for comparing people with cancer with people in the community is uncertain.Methods HADS scores were obtained from population-based samples of women with (n = 731) and without (n = 158) early-onset breast cancer. Psychometric properties were examined using differential item functioning (DIF) which is the presence of systematic group differences in certain response items independent of the trait being measured.Results Women with breast cancer scored lower than reference women on anxiety (mean (SD) 7.5 (4.3) vs. 8.2 (4.0); p = 0.06) and depression (3.3 (3.2) vs. 4.2 (3.0); p = 0.003). Group differences remained following adjustment for demographics. Time since diagnosis was not related to anxiety or depression scores. DIF was present in two anxiety and five depression items. Adjustment for DIF did not substantially change the anxiety or depression group differences.Conclusion Specific sampling or DIF effects do not explain the observation that women with breast cancer have lower levels of anxiety and depression than population controls. The psychometric properties of the HADS appear to be acceptable in these groups.
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Several studies with patients with cancer, including patients with breast cancer, indicate that the Hospital Anxiety and Depression Scale total score is a sensitive measure of global psychological distress, with good internal consistency (α>0.87).
“Several studies with patients with cancer, including patients with BC, indicate that the HADS total score is a sensitive measure of global psychological distress,96–98 with good internal consistency (α>0.87).99”
From Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark (2023) · cites this paper as [99]
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Metadata
- Authors
- Osborne, R. H., Elsworth, G. R., Sprangers, M. A. G., Oort, F. J., & Hopper, J. L.
- Affiliations
- The University of Melbourne (AU)
- RMIT University (AU)
- University of Amsterdam (NL)
- Corresponding author
- Osborne, R.H.
- Venue
- Quality of Life Research
- Published
- 2004-02
- Volume
- 13
- Issue
- 1
- Pages
- 191-206
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- OpenAlex
- W2085127502
- Cited by
- 119
- References
- 49
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 8 · 2018: 4 · 2017: 2 · 2016: 9 · 2015: 4 · 2014: 3 · 2013: 4 · 2012: 13
- FWCI
- 1.76
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Quality of Life Research (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Deakin Research Online (Deakin University) (submittedVersion)
- RMIT Research Repository (RMIT University Library) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Cancer Institute (CA 95003)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- 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, early-onset breast cancer, anxiety, depression, differential item functioning, psychometric properties, women with cancer, time since diagnosis
- MeSH terms
- Adult, Anxiety, Australia, Breast Neoplasms, Depression, Factor Analysis, Statistical, Female, Humans, Middle Aged, Neoplasm Staging, Psychometrics, Registries, Self-Assessment, Case-Control Studies, Age of Onset, Sickness Impact Profile
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