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Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations
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BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is a common screening instrument excluding somatic symptoms of depression and anxiety, but previous studies have reported inconsistencies of its factor structure. The construct validity of the Japanese version of the HADS has yet to be reported. To examine the factor structure of the HADS in a Japanese population is needed. METHODS: Exploratory and confirmatory factor analyses were conducted in the combined data of 408 psychiatric outpatients and 1069 undergraduate students. The data pool was randomly split in half for a cross validation. An exploratory factor analysis was performed on one half of the data, and the fitness of the plausible model was examined in the other half of the data using a confirmatory factor analysis. Simultaneous multi-group analyses between the subgroups (outpatients vs. students, and men vs. women) were subsequently conducted. RESULTS: A two-factor model where items 6 and 7 had dual loadings was supported. These factors were interpreted as reflecting anxiety and depression. Item 10 showed low contributions to both of the factors. Simultaneous multi-group analyses indicated a factor pattern stability across the subgroups. CONCLUSION: The Japanese version of HADS indicated good factorial validity in our samples. However, ambiguous wording of item 7 should be clarified in future revisions.
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“The validity and reliability of both the original and Japanese versions of the HADS have been confirmed [23,24].”
From Validation of the Tinnitus Acceptance Questionnaire: Japanese Version (2022) · cites this paper as [24]
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Metadata
- Authors
- Matsudaira, T., Igarashi, H., Kikuchi, H., Kano, R., Mitoma, H., Ohuchi, K., & Kitamura, T.
- Affiliations
- Kumamoto University (JP)
- Tokyo International University (JP)
- Corresponding author
- Matsudaira, Tomomi
- Venue
- Health and Quality of Life Outcomes
- Published
- 2009-05-17
- Volume
- 7
- Issue
- 1
- Pages
- 42-42
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC2687424
- OpenAlex
- W2146508862
- Cited by
- 134
- References
- 61
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 11 · 2023: 12 · 2022: 14 · 2021: 15 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 6 · 2014: 8 · 2013: 5 · 2012: 7
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, factor structure, construct validity, Japanese version, anxiety, depression, psychiatric outpatients, university students, multigroup analysis, item wording, screening tool
- MeSH terms
- Adult, Aged, Anxiety, Mental Disorders, Depression, Factor Analysis, Statistical, Female, Humans, Japan, Male, Middle Aged, Outpatients, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires
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