A psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults

Abstract

Objectives The Hospital Anxiety and Depression scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults living at home in a large Norwegian city. Methods In total, 1190 inhabitants >=70 (range 70 – 96) years completed the HADS inventory in the population based Trøndelag Health Study (HUNT) termed "HUNT4 70+" in Trondheim, Norway. Confirmatory factor analyses (CFA) were performed to test the dimensionality, reliability, and construct validity. Results The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6 D ( “ I feel cheerful” ) along with a correlated error term between item 2 D ( “I still enjoy the things I used to enjoy” ) and 12 D ( “I look forward with enjoyment to things ”), Model-3 with a two-factor solution demonstrated an acceptable/good fit. Good to acceptable measurement reliability was demonstrated, and construct validity was supported. Conclusions The HADS involves some items which are not reliable and valid indicators for the depression construct in this population. Especially item 6 which is problematic. To improve the reliability and validity of HADS rewording of some items is recommended.