File Name: hospital anxiety and depression scale scoring .zip
- The Hospital Anxiety And Depression Scale
- Hospital Anxiety and Depression Scale
- Hospital Anxiety and Depression Scale (HADS)
Psychological distress is a common problem associated with cancer.
The Hospital Anxiety And Depression Scale
Materials and methods: This was a cross-sectional study. Three hundred and eighty individuals with a diagnosis of MS, according to the revised McDonald criteria, were recruited from an outpatient Neuroimmunology Clinic of the city of Porto. Participants had a mean age of HADS consists of two subscales — anxiety and depression — scored separately, with seven items each. Results: The results of our study show the appropriateness of HADS for the identification of mood changes in people with MS and show good metric properties.
Conclusion: It seems to be a useful tool for the scrutiny of mood disorders in Portuguese patients with MS. The questionnaire is also sensitive to disease when compared to people with other severe illnesses, and with people without the disease.
Keywords: multiple sclerosis, depression, anxiety, HADS. Multiple sclerosis MS is a chronic disease of the nervous system that produces various symptoms and may lead to severe disability with critical psychological implications. Population-based studies show that most patients are ambulatory even after many years of disease duration. The Hospital Anxiety and Depression Scale HADS is a brief self-reporting two-dimensional questionnaire developed to screen for levels of anxiety and depression among patients in a general hospital setting.
This matter led to calls for the abandonment of the HADS. Stern 7 confirms that HADS is appropriate for initial diagnosis and to track the progression of psychological symptoms. National Institute for Health and Care Excellence section 1.
HADS is one of the most widely used questionnaires among patients with neurological illnesses, and it is useful for assessing patients who tire easily or have limited concentration spans. Litster et al 11 in a systematic review about the assessment of anxiety in people with MS state that HADS-A shows promise as an applicable measure for this population.
However, research alerts about possible problems in the translated versions and cross-cultural use of the HADS and claims that rates of anxiety and depression using the same cut point across languages and culture may be wrong or subject to critical scrutiny. In a previous study, 14 the metric properties of a Portuguese version of HADS were described when applied to 1, individuals with chronic diseases, namely, cancer, stroke, epilepsy, coronary heart disease, morbid obesity, diabetes, myotonic dystrophy, obstructive sleep apnea, depression, and a non-disease group.
We analyzed a consecutive sample of individuals HADS consists of two subscales, one measuring anxiety, with seven items, and another measuring depression, with seven items, which score separately. Each item was answered by the patient on a 4-point 0—3 scale, so the possible scores ranged from 0 to 21 for each of the two subscales, taking 2—5 minutes to complete. Other studies suggest that the recommended cutoff scores for the HADS may result in under-reporting of psychiatric morbidity in different chronic diseases.
In a review of different screening measures to identify anxiety disorders in MS, Litster et al 11 conclude that HADS is the best available tool for detecting the symptoms of anxiety in individuals with MS. The study used a cross-sectional design with all measures taken at the same time. Ethical approval for the study was given by the ethical committee at the hospital St. Antonio, Porto, according to hospital rules and Portuguese law. Namely, signed informed consent was obtained before participation in the study in accordance with the Declaration of Helsinki.
A registered psychologist administered the tests individually during the patient routine visit to the hospital. To identify the factorial structure of the scale, in this group of MS patients, exploratory factor analysis was applied. Moreover, to test the hypothesized two model dimensions, CFA was used.
Exploratory factor analysis using principal component analysis, oblimin rotation method with Kaiser normalization for the 14 items, showed two components: the first one associated with the seven anxiety items and the second one related to the seven items from depression.
The total variance of the solution explains Loadings on the component that they belong to are in bold format in Table 1. All items load on the dimension they belong to. Table 1 Exploratory factor analysis — presenting loadings above 0. Rotation method: oblimin with Kaiser normalization. Bold figures represent that the item belongs to that factor or dimension in coincidence with the higher loading.
Differences in loadings between the component the item belongs to and the component it does not belong to are above 0. Table 1 shows loadings on the dimensions above 0. CFA is a theory-testing model as opposed to a theory-generating method such as exploratory factor analysis. Byrne 20 suggests that there is a wide array of fit indexes from which to choose, but that only one or two needs be reported.
Independent t -tests were used to compare the anxiety and depression subscale scores between MS patients and the other disease groups from previous studies with Portuguese samples. Table 2 Anxiety and depression means by disease group, and statistically significant differences with MS patients Abbreviations: M, mean; MS, Multiple sclerosis; P , level of statistical significance; t , test for independent samples.
Correlations between age and anxiety are not statistically significant. These values are different from the ones reported by Jones et al 27 which, for depression, report higher values in men: these differences are also reported in other studies in different languages and problems. In the present study, for depression, 8. These values are similar to those reported by Siegert and Abernethy. For anxiety, These scores suggests a possible presence of mood disorder for most of the sample for anxiety.
When comparing the MS group with other chronic diseases, more statistically significant differences are found for depression than for anxiety.
For anxiety, no statistically significant differences were found between the MS group and the non-disease group. Comparing with the depression disease group, the magnitude of values is much higher for the depression group. These results seem to confirm the results of a review by Siegert and Abernethy, 29 which states that depression is common in MS.
Statistically significant differences were found when anxiety and depression scores were compared between MS patients and those with other diseases Table 2. Furthermore, similar differences were found in anxiety scores in cancer, stroke, and morbid obesity patients, and in depression scores in stroke and morbid obesity patients.
MS patients had significantly higher depression scores than obstructive sleep apnea patients. International research on HADS shows that it is a useful tool to evaluate anxiety and depression in people suffering from different diseases, including MS. In an extensive study, Dahl et al 30 show that anxiety and depression occur more frequently in MS patients than in the general population. Because anxiety and depression seem to be common in people with MS, 17 it seems appropriate to screen for possible mood elevation in these patients.
Our study identifies, for depression, essential differences between people with MS and people without diseases, and people with a diagnostic of depression and people with MS, suggesting the existence of a sensibility that differentiates between people with MS and people with and without the diagnosis of depression when using HADS dimensions.
The results of our report confirm the findings from international research and suggest that the Portuguese HADS version behaves similarly. It seems to be a useful tool for the scrutiny of mood in Portuguese patients with MS as it is for other diseases. Remember that in the original development of the scale, because scores can be affected by the physical illness of the patient, authors eliminated items relating simultaneously to emotional disorder and physical disorder. Items selected were based solely on the anxiety and depression symptoms.
HADS is a useful tool to help people in medical settings cope with the disease and reduce emotional distress. The psychometric properties are good, and a clinimetric analysis shows sensitivity when we compare people with different chronic diseases to people without any condition.
Multiple sclerosis and lifestyle factors: the Hordaland Health Study. Neurol Sci. Windsor: Nfer-Nelson; The hospital anxiety and depression scale.
Acta Psychiatr Scand. Latent structure of the Hospital Anxiety and Depression Scale: a year systematic review. J Psychosom Res. Coyne JC, van Sonderen E. The Hospital Anxiety and Depression Scale: a meta confirmatory factor analysis. Stern AF. The Hospital Anxiety and Depression Scale. Occup Med Lond. National Institute for Health and Care Excellence. Common mental health problems: identification and pathways to care.
Clinical guideline [CG ]; Accessed October Murrell R. Quality of life and neurological illness: a review of the literature. Neuropsychol Rev. Validation of mood measures for people with multiple sclerosis.
Int J MS Care. Screening tools for anxiety in people with multiple sclerosis: a systematic review. The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies. BMC Psychiatry. PLoS One. Psychol Health Med.
Hospital Anxiety and Depression Scale
Hospital Anxiety and Depression Scale HADS was originally developed by Zigmond and Snaith  and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing. The HADS is a fourteen item scale that generates: Seven of the items relate to anxiety and seven relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symptoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, would create a tool for the detection of anxiety and depression in people with physical health problems. Each item on the questionnaire is scored from and this means that a person can score between 0 and 21 for either anxiety or depression.
The journal is oriented to the study of mental illnesses, their pathological processes, and their psychosocial consequences, and has as its aim to disseminate the scientific advances in all fields related to the illness and mental health. It accepts unpublished works on psychiatry and mental health, and its medical and social repercussions. For this reason, space is provided in the Journal for works in the biological, clinical and psychosocial field. Manuscripts are evaluated, before being accepted, by external reviewers peer-review. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
Hospital Anxiety and Depression Scale (HADS)
There is a need to assess the contribution of mood disorder, especially anxiety and depression, in order to understand the experience of suffering in the setting of medical practice. Most physicians are aware of this aspect of the illness of their patients but many feel incompetent to provide the patient with reliable information. The term 'hospital' in its title suggests that it is only valid in such a setting but many studies conducted throughout the world have confirmed that it is valid when used in community settings and primary care medical practice. It should be emphasised that self-assessment scales are only valid for screening purposes; definitive diagnosis must rest on the process of clinical examination.
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. The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination. In , employees filled in the questionnaire. The model selected was the original two-factor structure.
HADS is a item scale with seven items each for anxiety and depression subscales. Scoring for each item ranges from zero to three. Mean age at presentation was
The journal is oriented to the study of mental illnesses, their pathological processes, and their psychosocial consequences, and has as its aim to disseminate the scientific advances in all fields related to the illness and mental health. It accepts unpublished works on psychiatry and mental health, and its medical and social repercussions. For this reason, space is provided in the Journal for works in the biological, clinical and psychosocial field. Manuscripts are evaluated, before being accepted, by external reviewers peer-review. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published.
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