Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) for use in motor neurone disease
Open accessAbstract
BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess symptoms of anxiety and depression in motor neurone disease (MND). The measure has never been specifically validated for use within this population, despite questions raised about the scale's validity. This study seeks to analyse the construct validity of the HADS in MND by fitting its data to the Rasch model. METHODS: The scale was administered to 298 patients with MND. Scale assessment included model fit, differential item functioning (DIF), unidimensionality, local dependency and category threshold analysis. RESULTS: Rasch analyses were carried out on the HADS total score as well as depression and anxiety subscales (HADS-T, D and A respectively). After removing one item from both of the seven item scales, it was possible to produce modified HADS-A and HADS-D scales which fit the Rasch model. An 11-item higher-order HADS-T total scale was found to fit the Rasch model following the removal of one further item. CONCLUSION: Our results suggest that a modified HADS-A and HADS-D are unidimensional, free of DIF and have good fit to the Rasch model in this population. As such they are suitable for use in MND clinics or research. The use of the modified HADS-T as a higher-order measure of psychological distress was supported by our data. Revised cut-off points are given for the modified HADS-A and HADS-D subscales.
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For the purpose of analysis, a subset of HADS data will be analysed which omits one item on the depression scale that assesses psychomotor retardation and one item on the anxiety scale that assesses restlessness as these overlap with physical symptoms of MND.
“For the purpose of analysis and, following validation in plwMND and subsequent published recommendations [51], a subset of data will be analysed which omits one item on the depression scale that assesses psychomotor retardation and one item on the anxiety scale that assesses restlessness as these overlap with physical symptoms of MND”
From A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND): study protocol. (2022) · cites this paper as [51]
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Experimental — accuracy not yet measuredOne depression item and one anxiety item were not scored on the HADS, as recommended for people with motor neuron disease.
“†One depression item and one anxiety item were not scored on the HADS, as recommended for people with motor neuron disease. 27”
Depression questionnaires (BDI and HADS) tend to overestimate depression in ALS because scores are influenced by physical impairment.
“there is recent evidence suggesting that depression questionnaires, specifically the Beck Depression Inventory (BDI) [53] and to a lesser degree the Hospital Anxiety and Depression Scale (HADS) [54], tend to overestimate depression in ALS, since these scores are highly influenced by the physical impairment of the patients [55, 56].”
From Associations between psychological factors and health-related quality of life and global quality of life in patients with ALS: a systematic review (2016) · cites this paper as [56]
The mHADS has been previously validated by Rasch analysis for use in an MND population, with removal of two items from the original 14-item scale.
“a version of the HADS has been previously validated by Rasch analysis for use in an MND population, with removal of two items from the original 14-item scale.”
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Gould, R. L., Thompson, B. J., Rawlinson, C., Kumar, P., White, D., Serfaty, M. A., Graham, C. D., McCracken, L. M., Bursnall, M., Bradburn, M., et al. (2022) · BMC Neurology · doi:10.1186/s12883-022-02950-5 · Cited by 16 · see citing works
“Additional exploratory analysis will also be undertaken to assess the consistency of treatment effect across the following subgroups: i) severity of depression and/or anxiety at baseline, according to MND-specific clinical cut-offs on the Hospital Anxiety and Depression Scale [51]; ii) patient preference for treatment…”
MethodInfluentialCognitive reserve is associated with altered clinical expression in amyotrophic lateral sclerosis
Consonni, M., Bella, E. D., Bersano, E., Telesca, A., & Lauria, G. (2020) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2020.1849306 · Cited by 21 · see citing works
The spectrum of language impairments in amyotrophic lateral sclerosis
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Risk factors for social withdrawal in amyotrophic lateral sclerosis/motor neurone disease
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Empathy-based supportive treatment in amyotrophic lateral sclerosis: A pragmatic study
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Mapping ALSFRS-R and ALSUI to EQ-5D in Patients with Motor Neuron Disease
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Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis
Chiò, A., Canosa, A., Calvo, A., Moglia, C., Cicolin, A., & Mora, G. (2021) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1984883 · Cited by 14 · see citing works
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Rasch analysis of the hospital anxiety and depression scale among Chinese cataract patients
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The Factor Structure of the Hospital Anxiety and Depression Scale in Orthopedic Trauma Patients
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Gould, R. L., Rawlinson, C., Thompson, B., Weeks, K., Gossage-Worrall, R., Cantrill, H., Serfaty, M. A., Graham, C. D., McCracken, L. M., White, D., et al. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01354-7 · Cited by 10 · see citing works
“b Recommended MND-specific scoring cut-offs for anxiety and depression are based on a Rasch analysis [43] Hospital Anxiety and Depression Scale modified for plwMNDa Baseline N 6 months N”
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Processing and memory for emotional and neutral material in amyotrophic lateral sclerosis
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Using scalability coefficients and conditional association to assess monotone homogeneity
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Loneliness as neurobehavioral issue in amyotrophic lateral sclerosis
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- Authors
- Gibbons, C. J., Mills, R. J., Thornton, E. W., Ealing, J., Mitchell, J. D., Shaw, P. J., Talbot, K., Tennant, A., & Young, C. A.
- Affiliations
- Walton Centre (GB)
- University of Liverpool (GB)
- Royal Preston Hospital (GB)
- University of Sheffield (GB)
- John Radcliffe Hospital (GB)
- Leeds General Infirmary (GB)
- Venue
- Health and Quality of Life Outcomes
- Published
- 2011
- Volume
- 9
- Issue
- 1
- Pages
- 82
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC3192662
- OpenAlex
- W2147467671
- Cited by
- 130
- References
- 28
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 12 · 2023: 8 · 2022: 7 · 2021: 13 · 2020: 6 · 2019: 8 · 2018: 7 · 2017: 12 · 2016: 9 · 2015: 7 · 2014: 4 · 2013: 14 · 2012: 9
- FWCI
- 11.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- Hospital Anxiety and Depression Scale, motor neuron disease, construct validity, Rasch model, differential item functioning, unidimensionality, local dependence, psychological distress, anxiety, depression, scale modification, cut-off values
- MeSH terms
- Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Chi-Square Distribution, Motor Neuron Disease
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