Cited by 134Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingHealth Education and Validation

The DOI matches its Crossref record; 62 of the 64 references it cites were found in a registry or an index, and 2 are not checked yet.

Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations

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Abstract

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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Figure 1 Factor structure of the HADS. Boxes represent observed variables; Ellipses represent latent variables; Single-headed arrows represent regression weights; Double-headed arrow represents correlation.
Figure 1 Factor structure of the HADS. Boxes represent observed variables; Ellipses represent latent variables; Single-headed arrows represent regression weights; Double-headed arrow represents correlation.CC BY · PubMed Central

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Cites

Show all 61 references

Research works printed but not linked: 5

  1. Kitamura T: The Hospital Anxiety and Depression Scale. Archives of Psychiatric Diagnostics and Clinical Evaluation 1993, 4: 371–372. (in Japanese).
  2. SPSS Inc: SPSS 10.0 for Windows. Chicago, SPSS Inc; 1999.
  3. Arbuckle JL, Wothke W: AMOS 4.0 User's Guide. Chicago, Smallwaters; 1999.
  4. Kanba S: Utsubyou no koudouidengakutekikouzou [Behaviour genetic structure of depression]. In Modern perspectives in the clinical psychiatry of the depressive disorders. Edited by: Hirose T, Utsumi T. Tokyo, Seiwa shoten; 2005:1–23. (in Japanese)
  5. Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory. 2nd edition. San Antonio, Psychological Corporation; 1996.

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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)
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
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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