Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population
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Background: The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale. Aims: To examine the psychometric properties of the HAD scale in a large population. Method: All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations. Results: Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively. Conclusions: Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.
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HADS demonstrated good factor structure, intercorrelation, homogeneity and internal consistency.
“Also, it demonstrated good factor structure, intercorrelation, homogeneity and internal consistency.28”
From Protocol for a feasibility and acceptability study using a brief ACT-based intervention for people from Southwest Wales who live with persistent pain (2018) · cites this paper as [28]
The HADS is a validated 14-item measure of anxiety and depression.
“The HADS is a validated (Bjelland, Dahl, Haug, & Neckelmann, 2002; Mykletun, Stordal, & Dahl, 2001), 14-item measure of anxiety and depression.”
From A pilot case series of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life and mood in muscle disorders (2017) · cites this paper as Mykletun, Stordal, & Dahl, 2001
The Hospital Anxiety and Depression Scale (HADS) seems more appropriate to use because it has shown solid psychometric properties regarding factor analysis and internal consistency.
“Therefore, the Hospital Anxiety and Depression Scale (HADS) seems more appropriate to use: this instrument has shown solid psychometric properties regarding factor analysis and internal consistency.”
From The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries (2015) · cites this paper as Mykletun et al., 2001
The psychometric approach to evaluate depression used a self-administered scale with strong psychometric properties.
“However, the psychometric approach to evaluate depression used a self-administrated scale with strong psychometric properties.”
From The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries (2015) · cites this paper as Mykletun et al., 2001
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- Authors
- Mykletun, A., Stordal, E., & Dahl, A. A.
- Affiliations
- University of Bergen (NO)
- University of Oslo (NO)
- Corresponding author
- Mykletun, Arnstein
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2001-12
- Volume
- 179
- Issue
- 6
- Pages
- 540-544
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2106572906
- Cited by
- 908
- References
- 23
- Citations by year
- 2026: 16 · 2025: 28 · 2024: 33 · 2023: 31 · 2022: 39 · 2021: 31 · 2020: 28 · 2019: 31 · 2018: 36 · 2017: 38 · 2016: 48 · 2015: 60 · 2014: 58 · 2013: 61 · 2012: 56
- FWCI
- 21.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- 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
- Social Sciences › Education › Health Education and Validation
- Keywords
- Hospital Anxiety and Depression Scale, psychometric properties, factor structure, internal consistency, anxiety, depression, self-report questionnaire, Nord-Trøndelag Health Study, item analysis
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety Disorders, Mental Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results
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