A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees

Christine Bocéréan, Emilie Dupret, Christine Bocéréan, Emilie Dupret

Abstract

Background: The Hospital Anxiety and Depression Scale (HADS) is a questionnaire widely used for detecting anxiety and depressive disorders. It is used extensively in France, but has never been the subject of a full study in a population at work. The objectives of this study were to present some psychometric properties of the HADS on a large sample of French employees.

Method: The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination. In 2011, 20992 employees filled in the questionnaire. HADS's structure was studied first by exploratory, then confirmatory factorial analyses.

Results: The model selected was the original two-factor structure. The two subscales showed good internal consistency. Women scored higher than the men for anxiety and depression; the scores increased with age; engineers and managers had lower average scores than other occupational status (blue- or white-collar workers and technicians).

Conclusion: The results of the analyses are consistent with those in literature relating to other populations studied in other countries. The HADS questionnaire is pertinent for detecting symptoms of anxiety and depression in a population of people at work.

Figures

Figure 1
Figure 1
Factor structure of HADS. The dotted arrows indicate the correlations recommended by the model for improvement; in bold italics, the r2 associated with each scale.

References

    1. Zigmond AS, Snaith P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validation of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Olssøn I, Mykletun A, Dahl AA. The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry. 2005;5:46. doi: 10.1186/1471-244X-5-46.
    1. Poole NA, Morgan JF. Validity and reliability of the Hospital Anxiety and Depression Scale in a hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population. Gen Hosp Psychiat. 2006;28:55–58. doi: 10.1016/j.genhosppsych.2005.08.004.
    1. Hinz A, Brähler E. Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population. J Psychosom Res. 2011;71:74–78. doi: 10.1016/j.jpsychores.2011.01.005.
    1. Roberge P, Doré I, Menear M, Chartrand E, Ciampi A, Duhoux A, Fournier L. A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population. J Affect Disord. 2013;147:171–179. doi: 10.1016/j.jad.2012.10.029.
    1. Sultan S, Luminet O, Hartemann A. Cognitive and anxiety symptoms in screening for clinical depression in diabetes. A systematic examination of diagnostic of the HADS and BDI-SF. J Affect Disorders. 2010;123:332–336. doi: 10.1016/j.jad.2009.09.022.
    1. Michopoulos I, Douzenis A, Kalkavoura C, Christodoulou C, Michalopoulou P, Kalemi G, Fineti K, Patapis P, Protopapas K, Lykouras L. Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Ann Gen Psychiat. 2008;7:4. doi: 10.1186/1744-859X-7-4.
    1. Muszbek K, Szekely A, Balogh EM, Molnar M, Rohansky M, Ruzsa A, Varga K, Szöllosi M, Vadasz P. Validation of the Hungarian translation of hospital anxiety and depression scale. Qual Life Res. 2006;15:761–766. doi: 10.1007/s11136-005-3627-8.
    1. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual of Life Out. 2003;1:14. doi: 10.1186/1477-7525-1-14.
    1. Härter M, Reuter K, Gross-Hardt K, Bengel J. Screening for anxiety, depressive and somatoform disorders in rehabilitation: validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disabil Rehabil. 2001;23:737–744. doi: 10.1080/09638280110062176.
    1. Schönberger M, Ponsford J. The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiat Res. 2010;179:342–349. doi: 10.1016/j.psychres.2009.07.003.
    1. Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disorders. 2010;126:335–348. doi: 10.1016/j.jad.2010.01.067.
    1. Razadi D, Delvaux N, Farvacques C, Robaye E. Validation of the French version of the HADS in a population of inpatients with cancer. Rev Psychol Appl. 1989;39:295–307.
    1. Herrmann C. International experiences with the Hospital Anxiety and Depression scale - A review of validation data and clinical results. J Psychosom Res. 1997;42:17–41. doi: 10.1016/S0022-3999(96)00216-4.
    1. Krespi Boothby MR, Cases A, Carrington K, Mulholland I, Bolger T. The accuracy of HADS in detecting emotional distress in male prisoners. Procedia S+BS. 2010;5:95–98. doi: 10.1016/j.proeng.2010.09.056.
    1. Andersson E. The Hospital and Depression Scale. Homogeneity of the subscales. Soc Behav Personal. 1993;21:197–204. doi: 10.2224/sbp.1993.21.3.197.
    1. Martin CR, Thompson DR. A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychology, Health & Medecine. 2000;5:193–201. doi: 10.1080/713690189.
    1. Cosco T, Doyle F, Ward M, McGee H. Latent structure of the The Hospital Anxiety and Depression Scale: A 10 year systematic review. J Psychosom Res. 2012;72:180–184. doi: 10.1016/j.jpsychores.2011.06.008.
    1. Martin CR. What does the Hospital Anxiety and Depression Scale (HADS) really measure in liaison psychiatry settings? Curr Psychiat Rev. 2005;1:69–73. doi: 10.2174/1573400052953510.
    1. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol. 1991;100:316–336. doi: 10.1037/0021-843X.100.3.316.
    1. Watson D, Clark LA. Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. J Abnorm Psychol. 1995;104:15–25. doi: 10.1037/0021-843X.104.1.15.
    1. Leung CM, Ho S, Kan CS, Hung CH, Chen CN. Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom. 1993;40:29–34.
    1. Dunbar M, Ford G, Hunt K, Der G. A confirmatory factor analysis of the Hospital Anxiety and Depression scale: Comparing empirically and theoretically derived structures. Brit J Clin Psychol. 2000;39:79–94. doi: 10.1348/014466500163121.
    1. Friedman S, Samuelian JC, Lancrenon S, Even C, Chiarelli P. Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiat Res. 2001;104:247–257. doi: 10.1016/S0165-1781(01)00309-2.
    1. Caci H, Baylé FJ, Mattei V, Dossios C, Robert P, Boyer P. How does the Hospital Anxiety and Depression Scale measure anxiety and depression in healthy subjects? Psychiat Res. 2002;118:89–99. doi: 10.1016/S0165-1781(03)00044-1.
    1. Martin CR, Lewin RJP, Thompson DR. A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiat Res. 2003;120:85–94. doi: 10.1016/S0165-1781(03)00162-8.
    1. Martin CR, Bonner A, Brook A, Luscombe C. Factor structure and use of the Hospital Anxiety and Depression Scale in the homeless and socially marginalized. Psychology, Health & Medicine. 2006;2:190–197. doi: 10.1080/13548500500155883.
    1. Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertson B, Bliss J. The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Brit J Psychiat. 1991;158:255–259. doi: 10.1192/bjp.158.2.255.
    1. Spinhoven PH, Ormel J, Sloekers PP, Kempen GIJ, Speckens AE, Van Hermerts AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–370. doi: 10.1017/S0033291796004382.
    1. Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiat Scan. 1997;96:281–286. doi: 10.1111/j.1600-0447.1997.tb10164.x.
    1. Bedford A, De Pauw K, Grant E. The structure of the hospital anxiety and depression scale (HAD): an appraisal with normal, psychiatric and medical patient subjects. Pers Indiv Differ. 1997;23:473–478. doi: 10.1016/S0191-8869(97)00058-5.
    1. Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Brit J Clin Psychol. 2001;40:429–434. doi: 10.1348/014466501163904.
    1. Mykletun A, Stordal E, Dahl AA. Hospital Anxiety and Depression (HAD) scale: factor structure, items analyses and internal consistency in a large population. Brit J Psychiat. 2001;179:540–544. doi: 10.1192/bjp.179.6.540.
    1. Flint AJ, Rifat SL. Factor structure of the hospital anxiety and depression scale in older patients with major depression. Int J of Geriatr Psych. 2002;17:117–123. doi: 10.1002/gps.535.
    1. Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, Cull A. Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother-T. 2002;75:165–176. doi: 10.1348/147608302169625.
    1. Herrero ML, Blanch J, Peri JM, De Pablo J, Pintor L, Bulbena A. A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiat. 2003;25:277–283. doi: 10.1016/S0163-8343(03)00043-4.
    1. Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine. 2007;12:225–237. doi: 10.1080/13548500500524088.
    1. Gough K, Hudson P. Psychometric properties of the Hospital and Depression Scale in family caregivers of palliative care patients. J Pain Symptom Manag. 2009;37:797–806. doi: 10.1016/j.jpainsymman.2008.04.012.
    1. Untas A, Aguirrezabal M, Chauveau P, Leguen E, Combe C, Rascle N. Anxiété et dépression en hémodialyse : validation de l'Hospital Anxiety and Depression Scale (HADS) Nephrol Ther. 2009;5:193–200. doi: 10.1016/j.nephro.2009.01.007.
    1. Friedmann S, Even C, Samuelian JC, Guelfi JD. Factor structure of the Hospital Anxiety and Depression (HAD) scale. Brit J Psychiat. 2002;181:165–166.
    1. Straat JH, Van der Ark LA, Sijtsma K. Methodological artifacts in dimensionality assessment of the hospital anxiety and depression scale (HADS) J Psychosom Res. 2013;74:116–121. doi: 10.1016/j.jpsychores.2012.11.012.
    1. Norton S, Cosco T, Doyle F, Done J, Sacker A. The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis. J Psychosom Res. 2013;74:74–81. doi: 10.1016/j.jpsychores.2012.10.010.
    1. Lépine JP, Godchau M, Brun P. Anxiety and depression in inpatients. Lancet. 1985;28:1425–1426. doi: 10.1016/S0140-6736(85)92589-9.
    1. Lepine JP, Godchau M, Brun P, Lemperière T. Evaluation de l'anxiété et de la dépression chez des patients hospitalisés dans un service de médecine interne. Ann Med-Psychol. 1985;2:175–189.
    1. Lépine JP. L'échelle HAD. In: Guelfi JD, editor. L'évaluation clinique standardisée en psychiatrie. Paris: Editions Médicales Pierre Fabre; 1996. pp. 367–374.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396. doi: 10.2307/2136404.
    1. Dupret E, Bocéréan C, Teherani M, Feltrin M, Petersen J. Psychosocial risks evaluation : French validation of the Copenhagen Psychosocial Questionnaire (COPSOQ) Scand J Public Health. 2012;40:482–490. doi: 10.1177/1403494812453888.
    1. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55. doi: 10.1080/10705519909540118.
    1. Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res. 1990;25:173–180. doi: 10.1207/s15327906mbr2502_4.
    1. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, Newbury CA, editors. Testing structural equation models. Newbury Park, CA: Sage; 1993. pp. 132–162.
    1. Bentler PM, Bonett DG. Significance tests and goodness-of-fit in the analysis of covariance structures. Psychol Bull. 1980;88:588–606. doi: 10.1037/0033-2909.88.3.588.
    1. Costello AB, Osborne J: Best practices in exploratory factor analysis: four recommendations for getting the most from yours analysis.Pract Asses Res & Eval 2005, 10(7). Available online: .
    1. Stordal E, Bjartveit Krüger M, Dahl NH, Mykletun A, Dahl AA. Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT) Acta Psychiat Scan. 2001;104:210–216. doi: 10.1034/j.1600-0447.2001.00130.x.
    1. Stellman J. Encyclopédie de sécurité et de santé au travail. Bureau International du Travail: Genève; 2000.
    1. Besançon G. Manuel de Psychopathologie. Paris: Dunot; 2005.
    1. Cohidon C. Prévalence des troubles de santé mentale et conséquences sur l’activité professionnelle en France dans l’enquête « Santé mentale en population générale ». Bulletin épidémiologique hebdomadaire. 2007;ᅟ:1–6.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:34–57.
    1. Cases C, Salines E. Statistiques en psychiatrie en France: données de cadrage. Revue Française des Affaires Sociales. 2004;1:181–204.
    1. Legros M, Bauer D, Goyaux D. Pour un accès aux soins plus égal et facilité à la santé et aux soins. Paris: Ministère des affaires sociales, de la Santé et des droits des femmes; 2012.
    1. Askenazy P, Baudelot C, Brochard P, Brun JP, Cases C, Davezie P, Falissard B, Gallie D, Gollac M, Griffiths A, Grignon M, Imbernon E, Leclerc A, Molinier P, Niedhammer I, Parent-Thirion A, Verger D, Vézina M, Volkoff S, Weill-Fassina A. Mesurer les facteurs psychosociaux de risque au travail pour les maîtriser. ᅟ. 2011;ᅟ:ᅟ.

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