A preliminary psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) in 963 people livingwith a spinal cord injury

Abstract

This study aimed to evaluate the preliminary psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a community sample of adults living with a spinal cord injury (SCI). A cross-sectional design was used with 963 people living in the community with an SCI. Participants were recruited via three spinal centres in the United Kingdom. They completed the HADS and the Life Satisfaction Questionnaire. Psychometric analyses were conducted for the whole sample, by gender and level of injury. The HADS demonstrated good internal consistency, with promising content validity. Two factors, approximating to anxiety and depression were extracted via factor analysis for the whole sample, by gender and level of injury. In line with existing literature, females scored significantly higher than males on the anxiety subscale. Item 7 (“I can sit at ease and feel relaxed”) was found to be a complex item, with a potentially different meaning within this population. This study presents preliminary findings, which support the psychometric integrity of the HADS within an outpatient population with SCI. Items that included potential somatic components revealed a more complex factor loading profile. Recommendations are made to further investigate this measure with amendments to such items, incorporating inpatients and independent measures of anxiety and depression to address validity directly.

Keywords:

• Anxiety
• depression
• HADS
• spinal cord injury
• psychometrics

Acknowledgements

This study is part of a larger research project looking into quality of life, sports and recreation involvement, in people with a spinal cord injury. The study was funded by the European Commission, Research Directorate General, Brussels, Belgium (Contract No. QLGA-CT-2000-51115). Special thanks to David Ash and Jonathan Hasler for identifying study participants and collecting data in two geographical UK regions (Scotland and East Midlands), and to all those who took part in the study.