Confirmatory Factor Analysis and Standardization of the Hospital Anxiety and Depression Scale (HADS)
Keywords:
Confirmatory factor analysis, ROC curve, HADS, Anxiety, DepressionAbstract
The main objectives of this study were to perform a confirmatory factor analysis of the Hospital Anxiety and
Depression Scale (HADS) and to conduct ROC curves for standardization of cut-off points, in a nonclinical sample. The results
showed evidences of the structural validity of HADS and changes were proposed to the diagnostic parameters of anxiety (≥7
points) and depression (≥6 points). Finally, we highlight that caution is needed for the interpretation of the scores and diagnostic
decision, especially for the depression measure.
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References
Andrade, L. H., Andreoni, L., Silveira, C. M., Silva, A.C.,
Nishimura, R., James, A. C., ... Viana, M. C. (2012). Mental
disorders in megacities: Findings from the São Paulo Megacity
Mental Health Survey, Brazil. PLoS ONE, 7(2), e31879.
Andrade, L. H., Baptista, M. C., Alonso, J., Petukhova, M.,
Bruffaerts, R., Kessler, R. C., … Viana, M. C. (2013). Days outof-
role due to common physical and mental health problems:
Results from the Sao Paulo Megacity Mental Health Survey,
Brazil. Clinics, 68, 1392-1399.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002).
The validity of the Hospital Anxiety and Depression Scale: An
update literature review. Journal of Psychosomatic Research,
52, 69-77.
Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia Júnior, C., &
Pereira, W. A. (1995). Transtornos do humor em enfermaria
de clínica média e validação de escala de medida (HAD) de
ansiedade e depressão. Revista de Saúde Pública, 29, 355-363.
Burgueño, M. J., Garcia-Bastos, J. L., & González-Buitrago, J.
M. (1995). Las curvas ROC en la evaluación de las pruebas
diagnósticas. Medicina Clínica (Barcelona), 104, 661-670.
Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent
structure of the Hospital Anxiety and Depression Scale: A 10-
year systematic review. Journal of Psychosomatic Research,
72, 180-184.
Cunha, J. A. (2001). Manual da versão em português das Escalas
Beck. São Paulo, SP: Casa do Psicólogo.
Garson, D. G. (2012). Structural equation modeling. Asheboro, NC:
Statistical Association Publishing.
Hinz, A., & Brähler, E. (2011). Normative values for the Hospital
Anxiety and Depression Scale (HADS) in the general German
population. Journal of Psychosomatic Research, 71, 74-78.
López, P. M., Ferrandis, E. D., Vailo, Y. A., Garrido, M. J. G.,
Murgui, M. J., Pérez, S. M., & Guerra, E. I. (2012). Structural
validity and distress screening potential of the Hospital Anxiety
and Depression Scale in cancer. International Journal of
Clinical and Health Psychology, 12, 435-447.
Martin, C. R., Thompson, D. R., & Barth, J. (2008). Factor structure
of the Hospital Anxiety and Depression Scale in coronary heart
disease patients in three countries. Journal of Evaluation in
Clinical Practice, 14, 281-287.
Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The
Hospital Anxiety and Depression Scale: A meta-confirmatory
factor analysis. Journal of Psychosomatic Research, 74, 74-81.
Roberge, P., Doré, I., Menear, M., Chartrand, E., Ciampi, A.,
Duhoux, A., & Fournier, L. (2013). A psychometric evaluation
of the French Canadian version of the Hospital Anxiety and
Depression Scale in a large primary care population. Journal
of Affective Disorders, 147, 171-179.
Russ, T. C., Stamakis, E., Hamer, M., Starr, J. M., Kivimãki, M.,
& Batty, G. D. (2012). Association between psychological
distress and mortality: Individual participant pooled analysis
of 10 prospective cohort studies. British Medical Journal,
345, e4933.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety
and Depression Scale. Acta Psychiatrica Scandinavica, 67,
361-370.
Nishimura, R., James, A. C., ... Viana, M. C. (2012). Mental
disorders in megacities: Findings from the São Paulo Megacity
Mental Health Survey, Brazil. PLoS ONE, 7(2), e31879.
Andrade, L. H., Baptista, M. C., Alonso, J., Petukhova, M.,
Bruffaerts, R., Kessler, R. C., … Viana, M. C. (2013). Days outof-
role due to common physical and mental health problems:
Results from the Sao Paulo Megacity Mental Health Survey,
Brazil. Clinics, 68, 1392-1399.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002).
The validity of the Hospital Anxiety and Depression Scale: An
update literature review. Journal of Psychosomatic Research,
52, 69-77.
Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia Júnior, C., &
Pereira, W. A. (1995). Transtornos do humor em enfermaria
de clínica média e validação de escala de medida (HAD) de
ansiedade e depressão. Revista de Saúde Pública, 29, 355-363.
Burgueño, M. J., Garcia-Bastos, J. L., & González-Buitrago, J.
M. (1995). Las curvas ROC en la evaluación de las pruebas
diagnósticas. Medicina Clínica (Barcelona), 104, 661-670.
Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent
structure of the Hospital Anxiety and Depression Scale: A 10-
year systematic review. Journal of Psychosomatic Research,
72, 180-184.
Cunha, J. A. (2001). Manual da versão em português das Escalas
Beck. São Paulo, SP: Casa do Psicólogo.
Garson, D. G. (2012). Structural equation modeling. Asheboro, NC:
Statistical Association Publishing.
Hinz, A., & Brähler, E. (2011). Normative values for the Hospital
Anxiety and Depression Scale (HADS) in the general German
population. Journal of Psychosomatic Research, 71, 74-78.
López, P. M., Ferrandis, E. D., Vailo, Y. A., Garrido, M. J. G.,
Murgui, M. J., Pérez, S. M., & Guerra, E. I. (2012). Structural
validity and distress screening potential of the Hospital Anxiety
and Depression Scale in cancer. International Journal of
Clinical and Health Psychology, 12, 435-447.
Martin, C. R., Thompson, D. R., & Barth, J. (2008). Factor structure
of the Hospital Anxiety and Depression Scale in coronary heart
disease patients in three countries. Journal of Evaluation in
Clinical Practice, 14, 281-287.
Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The
Hospital Anxiety and Depression Scale: A meta-confirmatory
factor analysis. Journal of Psychosomatic Research, 74, 74-81.
Roberge, P., Doré, I., Menear, M., Chartrand, E., Ciampi, A.,
Duhoux, A., & Fournier, L. (2013). A psychometric evaluation
of the French Canadian version of the Hospital Anxiety and
Depression Scale in a large primary care population. Journal
of Affective Disorders, 147, 171-179.
Russ, T. C., Stamakis, E., Hamer, M., Starr, J. M., Kivimãki, M.,
& Batty, G. D. (2012). Association between psychological
distress and mortality: Individual participant pooled analysis
of 10 prospective cohort studies. British Medical Journal,
345, e4933.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety
and Depression Scale. Acta Psychiatrica Scandinavica, 67,
361-370.
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Published
2015-11-17
How to Cite
Faro, A. (2015). Confirmatory Factor Analysis and Standardization of the Hospital Anxiety and Depression Scale (HADS). Psicologia: Teoria E Pesquisa, 31(3), 349–353. Retrieved from https://periodicos.unb.br/index.php/revistaptp/article/view/18604
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