The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Abstract

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test's validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.

Factor structure of the Hospital Anxiety and Depression Scale in adolescent patients with chronic disease

“…9,11,[16][17][18][19][20][21] Although it was initially developed for people aged 16 to 65 years, 9 its use has been extended to other age ranges, from 10 to 85 years old. 14,17,[21][22][23][24][25][26] This is because it provides adequate information, is easily understood and can be administered in a short time. 27 Several publications have found adequate psychometric properties, [21][22][23][28][29][30] noting its appropriate internal consistency indices.…”

La estructura factorial de la Escala hospitalaria de Ansiedad y Depresión en pacientes adolescentes con enfermedad crónica

“…En definitiva, el número final de ítems, al realizar los análisis de validez y fiabilidad, fue de 11. Eliminando los ítems 4, 7 y 14 por sus cargas anómalas, 23 se obtuvieron adecuados índices de fiabilidad, excepto en depresión, como ocurría en estudios anteriores. 24,30 El ítem 14 fue el que mostraba mayor problemática respecto a las cargas factoriales.…”

“…9,11,[16][17][18][19][20][21] Aunque, inicialmente, se desarrolló para personas de entre 16 y 65 años, 9 se ha ampliado el rango de edad de su uso y se ha utilizado desde los 10 años hasta los 85. 14,17,[21][22][23][24][25][26] Esto se debe a la información que aporta, a su fácil comprensión y a la corta duración de su aplicación. 27 S o n n u m e r o s a s l a s p u b l i c a c i o n e s q u e e n c u e n t r a n a d e c u a d a s p r o p i e d a d e s psicométricas, [21][22][23][28][29][30] que destacan índices de consistencia interna apropiados.…”

“…14,17,[21][22][23][24][25][26] Esto se debe a la información que aporta, a su fácil comprensión y a la corta duración de su aplicación. 27 S o n n u m e r o s a s l a s p u b l i c a c i o n e s q u e e n c u e n t r a n a d e c u a d a s p r o p i e d a d e s psicométricas, [21][22][23][28][29][30] que destacan índices de consistencia interna apropiados. 26,30 Su aplicación en niños y adolescentes, en poblaciones diferentes a la española, ha arrojado buenas propiedades psicométricas para la escala general de malestar emocional y para la HADS-A, aunque menos potentes psicométricamente para la HADS-D. 25,30 Asimismo, los estudios en esta población han mostrado como la HADS es un buen predictor para la clínica ansioso-depresiva.…”

Medico-Social Aspects of Complex Rehabilitation of Patients Who Underwent Transient Ischemic Attacks

“…Ими были выявлены наиболее значимые факторы модификации образа жизни, среди которых самоэффективность, страх и эффек-тивность ответа [25]. Spurgeon et al подчеркивают нали-чие у пациентов, перенесших ТИА, психоэмоциональных расстройств, которые могут оказать влияние на течение заболевания и стать причиной вторичного инсульта или затруднять проведение лечебно-реабилитационных мероприятий [26].…”