TY - JOUR
T1 - Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease
T2 - results from the DenHeart survey
AU - Christensen, Anne Vinggaard
AU - Dixon, Jane K
AU - Juel, Knud
AU - Ekholm, Ola
AU - Rasmussen, Trine Bernholdt
AU - Borregaard, Britt
AU - Mols, Rikke Elmose
AU - Thrysøe, Lars
AU - Thorup, Charlotte Brun
AU - Berg, Selina Kikkenborg
PY - 2020/1/7
Y1 - 2020/1/7
N2 - BACKGROUND: Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease.METHODS: The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression.RESULTS: A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items.CONCLUSIONS: The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01926145.
AB - BACKGROUND: Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease.METHODS: The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression.RESULTS: A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items.CONCLUSIONS: The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01926145.
KW - Aged
KW - Anxiety/diagnosis
KW - Cardiovascular Diseases/epidemiology
KW - Cross-Sectional Studies
KW - Denmark/epidemiology
KW - Depression/diagnosis
KW - Factor Analysis, Statistical
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Quality of Life
KW - Registries
KW - Reproducibility of Results
KW - Surveys and Questionnaires
U2 - 10.1186/s12955-019-1264-0
DO - 10.1186/s12955-019-1264-0
M3 - Journal article
C2 - 31910859
SN - 1477-7525
VL - 18
SP - 9
JO - Health and Quality of Life Outcomes
JF - Health and Quality of Life Outcomes
IS - 1
ER -