Examining the Stability of the Hospital Anxiety and Depression Scale Factor Structure in Adolescents and Young Adults With Cystic Fibrosis: A Confirmatory Factor Analysis.

Publisher: Oxford University Press Country of Publication: United States NLM ID: 7801773 Publication Model: Print Cited Medium: Internet ISSN: 1465-735X (Electronic) Linking ISSN: 01468693 NLM ISO Abbreviation: J Pediatr Psychol Subsets: MEDLINE

Publication: 1998- : Cary, NC : Oxford University Press
Original Publication: Washington, Society of Pediatric Psychology.

Anxiety/*diagnosis ; Cystic Fibrosis/*psychology ; Depression/*diagnosis; Adolescent ; Adult ; Anxiety/etiology ; Child ; Depression/etiology ; Factor Analysis, Statistical ; Female ; Hospitalization ; Humans ; Male ; Psychometrics ; Reproducibility of Results ; Young Adult

Objective: The Hospital Anxiety and Depression Scale (HADS) is a widely used screening measure of anxiety and depression symptoms. However, prior analyses of the measure have found heterogeneous factor structures and called into question its ability to differentiate between symptoms of anxiety and depression. As part of efforts to implement mental health screening in cystic fibrosis (CF) care, the European Cystic Fibrosis Society (ECFS) and Cystic Fibrosis Foundation (CFF) conducted an international survey of 1,454 CF professionals. The HADS was the most commonly used measure in Europe and third most across all 48 countries surveyed. However, the HADS has not been validated for CF. Thus, the objective of this study was to examine its factor structure in a sample of adolescents and young adults with CF.
Methods: Three theory-based models were tested in 727 individuals with CF (ages 12-25 years, 54% female) using confirmatory factor analyses, with an additional two models tested to improve model fit.
Results: Chi-square difference tests and majority of fit indices indicated a three-factor structure based on Clark and Watson's tripartite model best fit the data.
Conclusions: The original HADS two-factor structure demonstrated problematic fit in this sample, indicating poor discrimination between symptoms of anxiety and depression. A three-factor structure demonstrated best fit, indicating existing scoring guidelines and cutoffs would be inappropriate for use with this patient population. Use of the HADS to screen for anxiety and depression in CF could lead to an underestimation of clinically relevant symptomatology for depression and potential overestimation of anxiety symptoms.

Date Created: 20180109 Date Completed: 20191106 Latest Revision: 20220331

20221213

10.1093/jpepsy/jsx155

29309626