Investigation of the Psychometric Properties of the Hospital Anxiety and Depression Scale (HADS) Recommended for General Medical Practitioners, on a Sample of Patients with Impaired Motor Functions

873

Abstract

The aim of the study is to investigate the psychometric characteristics of the Hospital Anxiety and Depression Scale (HADS) on a sample of patients with impaired motor functions. HADS was used to examine the current psychoemotional state of 73 women and 27 men aged 62.1±13.7 years who were in the hospital for inpatient rehabilitation for motor function disorders arising from a stroke (n=50) or developing against the background of chronic musculoskeletal disorders (n=50). Independent of the psychologist, a psychiatrist examined the same patients, filling out Hamilton Anxiety and Depression scales. A comparison of the findings led to the conclusion of overdiagnosis with the HADS subscales. At the same time, it is shown that the questionnaire items have satisfactory indices of discriminativeness and internal reliability. The combination of low content and convergent validity of some items of the questionnaire allowed modifying subscales, reducing the number of items without prejudice to psychometric characteristics. By comparing the data obtained with an objective external criterion for the Anxiety (HADS-A) and Depression (HADS-D) subscales, new cutoffs (9 points) were determined for diagnosing the presence or absence of anxiety and depression, which allows to use this version of the test more effectively for screening the current psychoemotional state in patients with impaired motor functions who enter the second stage of medical rehabilitation.

General Information

Keywords: Hospital Anxiety and Depression Scale (HADS), psychometric characteristics, movement disorders, musculoskeletal disorders, stroke

Journal rubric: Anxiety and Depression: Symptoms, Predictors, and Consequences

Article type: scientific article

DOI: https://doi.org/10.17759/cpse.2023120201

Funding. The research was carried out within the framework of the research topic (state registration no. 123041200084-9) approved by the Moscow Healthcare Department.

Received: 18.04.2023

Accepted:

For citation: Kukshina A.A., Kotelnikova A.V., Rassulova M.A., Dajlidovich V.S. Investigation of the Psychometric Properties of the Hospital Anxiety and Depression Scale (HADS) Recommended for General Medical Practitioners, on a Sample of Patients with Impaired Motor Functions [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2023. Vol. 12, no. 2, pp. 1–24. DOI: 10.17759/cpse.2023120201. (In Russ., аbstr. in Engl.)

References

  1. Anryushchenko A.V., Drobizhev M.Yu., Dobrovol'skii A.V. Sravnitel'naya otsenka shkal CES-D, BDI i HADS(D) v diagnostike depressii v obshchemeditsinskoi praktike [A comparative validation of the scale CES-D, BDI, and HADS(d) in diagnosis of depressive disorders in general practice]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S. Korsakov Journal of Neurology and Psychiatry, 2003, no. 5, pp. 11–17 (In Russ., abstr. in Engl.).
  2. Zinchuk M.S., Kustov G.V., Pashnin E.V. et al. Skrining trevozhnykh i depressivnykh rasstroistv pri epilepsii: sovremennoe sostoyanie problem [Screening for anxiety and depressive disorders in epilepsy: current state of the art]. Rossiiskii psikhiatricheskii zhurnal = Russian Journal of Psychiatry, 2021, no. 3, pp. 87–97. DOI: 10.47877/1560-957Х-2021-10309 (In Russ., abstr. in Engl.).
  3. Ayerbe L., Ayis S., Wolfe C.D. et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. British Journal of Psychiatry: The Journal of Mental Science, Vol. 202, no. 1, pp. 14–21. DOI: 10.1192/bjp.bp.111.107664
  4. Bjelland I., Dahl A.A., Haug T.T. et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, Vol. 52 (2), pp. 69–77. DOI: 10.1016/s0022-3999(01)00296-3
  5. Brehaut E., Neupane D., Levis B. et al. Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis. Journal of Psychosomatic Research, Vol. 139, pp. 110256. DOI: 10.1016/j.jpsychores.2020.110256
  6. Brennan C., Worrall-Davies A., McMillan D. et al. The Hospital Anxiety and Depression Scale: A diagnostic meta-analysis of case-finding ability. Journal of Psychosomatic Researches, Vol. 69 (4), pp. 371–378. DOI: 10.1016/j.jpsychores.2010.04.006
  7. Cassiani-Miranda C.A., Scoppetta O., Cabanzo-Arenas D.F. Validity of the Hospital Anxiety and Depression Scale (HADS) in primary care patients in Colombia. General Hospital Psychiatry, Vol. 74, pp. 102–109. DOI: 10.1016/j.genhosppsych.2021.01.014
  8. Chan C.Y.Y., Tsang H.H.L., Lau C.S. et al. Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in axial spondyloarthritis patients. International Journal of Rheumatic Diseases, Vol. 20 (3), pp. 317–325. DOI: 10.1111/1756-185X.12456
  9. Colomo N., Olveira C., Hernández-Pedrosa J. et al. Validity of Self-rating Screening Scales for the diagnosis of depression and anxiety in adult patients with bronchiectasis. Archivos de Bronconeumología, Vol. 57 (3), pp. 179–185. DOI: 10.1016/j.arbres.2020.01.009
  10. Cosco T.D., Doyle F., Ward M. et al. Latent structure of the Hospital Anxiety and Depression Scale: A 10-year systematic review. Journal of Psychosomatic Research, Vol. 72 (3), pp. 180–184. DOI: 10.1016/j.jpsychores.2011.06.008
  11. Covic T., Pallant J.F., Tennant A. et al. Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales. BMC Musculoskeletal Disorders, Vol. 10, p. 18. DOI: 10.1186/1471-2474-10-18
  12. Coyne J.C., Van Sonderen E. No further research needed: Abandoning the hospital and anxiety depression scale (HADS). Journal of Psychosomatic Research, Vol. 72, pp. 173–174. DOI: 10.1016/j.jpsychores.2011.12.003
  13. Eriksen S., Bjørkløf G.H., Helvik A.S. et al. The validity of the Hospital Anxiety and Depression Scale and the geriatric depression scale-5 in home-dwelling old adults in Norway. Journal of the Affective Disorders, Vol. 256, pp. 380–385. DOI: 10.1016/j.jad.2019.05.049
  14. Fallowfield L.J. Quality of life measurement in patients with breast cancer. Journal of the Royal Society of Medicine, Vol. 86 (1), pp. 10–12.
  15. Giusti E.M., Jonkman A., Manzoni G.M. et al. Proposal for improvement of the Hospital Anxiety and Depression Scale for the assessment of emotional distress in patients with chronic musculoskeletal pain: A bifactor and Item Response Theory analysis. The Journal of Pain, Vol. 21, no. 3-4, pp. 375–389. DOI: 10.1016/j.jpain.2019.08.003
  16. Hamilton M.С. A Rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, Vol. 23, no. 1, pp. 56–62. DOI: 10.1136/jnnp.23.1.56
  17. Hamilton M.C. Hamilton Anxiety Scale (HAMA). In N.S. Schutte, J.M. Malouff (Eds.), Sourcebook of Adult Assessment (Applied clinical Psychology) (pp. 154–157.). NY: Plenum Press, 1959.
  18. Herrmann C. International experience with the Hospital Anxiety and Depression Scale. A review of validation data and clinical results. Journal of Psychosomatic Research, 1997, no. 42 (1), pp. 17–41. DOI: 1016/s0022-3999(96)00216-4
  19. Kline P. Handbook of Psychological Testing (2nd ed.). London: Routledge, 1999. 752 p.
  20. Pallant J.F., Bailey C.M. Assessment of the structure of the Hospital Anxiety and Depression Scale in musculoskeletal patients. Health and Quality of Life Outcomes, Vol. 3, p. 82. DOI: 10.1186/1477-7525-3-82
  21. Roberts M.H., Fletcher R.B., Merrick P.L. The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders. International Psychogeriatrics, Vol. 26 (2), pp. 325–333. DOI: 10.1017/S104161021300197X
  22. Sagen U., Vik T.G., Moum T. et al. Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. Journal of Psychosomatic Research, 2009. Vol. 67 (4), pp. 325–332. DOI: 1016/j.jpsychores.2009.03.007
  23. Schönberger M, Ponsford J. The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiatry Research, Vol. 179 (3), pp. 342–349. DOI: 10.1016/j.psychres.2009.07.003
  24. Snaith R.P. The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes, 2003, no. 1, p. 29. DOI: 10.1186/1477-7525-1-29
  25. Thompson E. Hamilton Rating Scale for Anxiety (HAM-A). Occupational Medicine, Vol. 65 (7), p. 601. DOI: 10.1093/occmed/kqv054
  26. Whelan-Goodinson R., Ponsford J., Schönberger M. Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of Affective Disorders, Vol. 114 (1-3), pp. 94–102. DOI: 10.1016/j.jad.2008.06.007
  27. Wu Y., Levis B., Sun Y. et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: Systematic review and individual participant data meta-analysis. BMJ, Vol. 373, n972. DOI: 10.1136/bmj.n972
  28. Zigmond A.S., Snaith R.P. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, Vol. 67 (6), pp. 361–370. DOI: 10.1111/j.1600-0447.1983.tb09716.x
  29. Zimmerman M., Martinez J.H., Young D. et al. Severity classification on the Hamilton Depression Rating Scale. Journal of Affective Disorders, Vol. 150 (2), pp. 384–388. DOI: 10.1016/j.jad.2013.04.028
  30. Zimmerman M., Morgan T.A., Stanton K. The severity of psychiatric disorders. World Psychiatry, 2018. Vol. 17 (3), pp. 258–275. DOI: 10.1002/wps.20569 

Information About the Authors

Anastasia A. Kukshina, Doctor of Medicine, Leading Researcher of Medical Rehabilitation Department, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department, Moscow, Russia, ORCID: https://orcid.org/0000-0002-2290-3687, e-mail: kukshina@list.ru

Anastasia V. Kotelnikova, PhD in Psychology, Senior Research Assistant of Medical Rehabilitation Department, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department, Moscow, Russia, ORCID: https://orcid.org/0000-0003-1584-4815, e-mail: pav-kotelnikov@ya.ru

Marina A. Rassulova, Doctor of Medicine, professor, Principal Researcher of Medical Rehabilitation Department, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department, Moscow, Russia, ORCID: https://orcid.org/0000-0002-9566-9799, e-mail: drrassulovama@yandex.ru

Valentina S. Dajlidovich, Psychotherapist of Branch 3, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department, Moscow, Russia, ORCID: https://orcid.org/0009-0006-0782-694X, e-mail: daylipsychiatry@gmail.com

Metrics

Views

Total: 2657
Previous month: 202
Current month: 114

Downloads

Total: 873
Previous month: 75
Current month: 28