Psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in individuals with stable chronic obstructive pulmonary disease (COPD): a systematic review

Abstract

Purpose

The Hospital Anxiety and Depression Scale (HADS) is used to assess anxiety and depression in individuals with chronic obstructive pulmonary disease (COPD); however, its measurement properties lack critical appraisal. We aimed to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in COPD.

Materials and methods

Five electronic databases were searched. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines were used to assess the methodological and evidence quality in the selected studies.

Results

Twelve studies assessed the psychometric properties of the HADS-Total and its subscales HADS-Anxiety and HADS-Depression in COPD. High-quality evidence supported the structural and criterion validity of the HADS-A, the internal consistency of the HADS-T, HADS-A, and HADS-D with Cronbach’s alpha values of 0.73–0.87, and before–after treatment responsiveness of HADS-T and its subscales (minimal clinically important difference = 1.4–2; effect size = 0.45–1.40). Moderate-quality evidence supported the test–retest reliability of the HADS-A and HADS-D with excellent coefficient values of 0.86–0.90.

Conclusions

The HADS-A is recommended for use in individuals with stable COPD. The lack of high-quality evidence on the validity of the HADS-D and HADS-T prevented drawing robust conclusions about their clinical utility in COPD.

IMPLICATIONS FOR REHABILITATION

• Anxiety and depression are common in individuals with chronic obstructive pulmonary disease (COPD).

• Anxiety and depression can negatively impact the physical and mental health of individuals with COPD.

• The HADS can be used to assess anxiety and depression in COPD in rehabilitation settings.

Keywords:

• COPD
• HADS
• reliability
• responsiveness
• validity

Acknowledgements

Dr. Dina Brooks holds the National Sanitarium Association (NSA) Chair in Respiratory Rehabilitation Research. Dr. Sanaa Alsubheen is supported by the E.B. Eastburn Postdoctoral Fellowship. This review was completed as partial credit for course work at McMaster University towards a Master of Physiotherapy (MScPT) credential.

Protocol registration: #CRD42022302064.

Author contributions

Sanaa A. Alsubheen: conceptualization, formal analysis, methodology, writing – original draft, writing – review and editing, and approval of final version. Ana Oliveira: conceptualization, data curation, formal analysis, methodology, writing – review and editing, and approval of final version. Aleksandra Nikolovski: data curation, methodology, writing – review and editing, and approval of final version. Lara Gamgoum: data curation, writing – review and editing, and approval of final version. Arshpreet Deol: data curation, writing – review and editing, and approval of final version. Shea Quilichini: data curation, writing – review and editing, and approval of final version. Ethan Kazemir: data curation, writing – review and editing, and approval of final version. Jonathan Rhodenizer: data curation, writing – review and editing, and approval of final version. Dina Brooks: conceptualization, formal analysis, funding acquisition, methodology, writing – review and editing, and approval of final version. All authors agree to be accountable for all aspects of the work.

Disclosure statement

We have no conflicts of interest to disclose.

Data availability statement

All data generated or analyzed during this systematic review are included in the manuscript. The review is submitted with four tables and two supplements that summarize the research process, hypotheses construct, studies characteristics and the validity and reliability of each included study with an overall summery of the results and the quality of evidence.

Additional information

Funding

This study was not funded.