Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality?

Exhaustion, depression and hopelessness in cardiac patients: a unidimensional hierarchy of symptoms revealed by Mokken scaling

“…For example, the inappropriate use of factor analytic techniques with skewed/binary items, a misinterpretation of Cronbach's a to indicate unidimensionality, the use of simple correlations to decide whether constructs are 'moderately' related, or a choice of scales which have no overlapping symptoms. 5,10,17,21 In the present study, internal consistencies were very good for the original depression and vital exhaustion scales, which then correlated at a level which indicated only 18% shared variance. Such correlational results, however, can simply be indicative of different levels of severity of a single trait -as borne out by the subsequent Mokken results presented herein.…”

“…5 For example, although not a diagnostic criterion, hopelessness is regarded as one of the most severe symptoms of depression. 6,7 However, hopelessness is included on both vital exhaustion and depression measures.…”

“…6,7 However, hopelessness is included on both vital exhaustion and depression measures. 5 Indeed, factor analytic studies which have attempted to determine the dimensionality of depression and vital exhaustion have been inconclusive, finding either one or multiple factors. [8][9][10] However, this may simply reflect that the scales used assessed differing symptoms, 5 or the fact that factor analysis is not appropriate for binary or highly skewed items, 11,12 and such items are typically seen in vital exhaustion and depression interviews or questionnaires.…”

Revisiting the dimensionality of the Hospital Anxiety and Depression Scale in an international sample of patients with ischaemic heart disease

“…More recently, however, the HADS has been shown to have poor content validity. The exclusion of somatic items, use of colloquial British expressions (such as "'butterflies' in the stomach"), and emphasis on anhedonia mean that the assessed symptoms do not accurately reflect the diagnostic criteria for major depressive disorder or GAD (8)(9)(10). Doyle et al found that only 4 of 13 diagnostic symptoms for major depression were assessed by the depression subscale (9).…”

“…The exclusion of somatic items, use of colloquial British expressions (such as "'butterflies' in the stomach"), and emphasis on anhedonia mean that the assessed symptoms do not accurately reflect the diagnostic criteria for major depressive disorder or GAD (8)(9)(10). Doyle et al found that only 4 of 13 diagnostic symptoms for major depression were assessed by the depression subscale (9). Maters et al further demonstrated that the colloquial British expressions used mean that translation of the HADS is problematic, and that several different versions of the HADS can exist in one language leading to interpretation issues (10).…”