A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction

Martin, Colin R.; Lewin, Robert J.P.; Thompson, David R.

doi:10.1016/S0165-1781(03)00162-8

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Volume 120, Issue 1 , Pages 85-94, 30 August 2003

A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction

Department of Health Sciences, University of York, Alcuin College, C Block, University of York, York YO10 5DD, UK

Received 23 September 2002; received in revised form 19 May 2003; accepted 29 May 2003.

Abstract

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test–retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups.

Keywords: Hospital Anxiety and Depression Scale, Factor structure, Myocardial infarction