Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients.
Grant A Pignatiello, Aloen L Townsend, Ronald L Hickman
PMID 34161981WHAT IT FOUND
In family decision-makers of critically ill patients, HADS scores fit one overall distress pattern better than separate anxiety and depression.
Do not read anxiety and depression subscale scores as distinct symptoms; use it as a broad distress screen or another validated measure.
Key findings
01In 250 surrogate decision-makers, the HADS fit an overall psychological distress pattern better than separate anxiety and depression patterns.
02The overall psychological distress pattern accounted for 79.4% of common variance, and nine of the 14 items were weakly tied to separate anxiety or depression scores.
03In the two-factor and three-factor models, anxiety and depression were strongly correlated, with r = .84 and r = .75.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample came from six ICUs at one medical center and was mostly White women, so the result may not apply to other families. The researchers could not split the sample to check the model on separate groups, which made false positive findings more likely. The HADS uses four-point responses and the data were not normally distributed, so the model fit and item loadings may be biased. The study did not show how well the HADS overall distress measure matched other measures of psychological distress, so its accuracy as a distress screen was not established.
Declared interests
The supplied metadata lists NIH extramural research support. No conflicts of interest statement appears in the provided text.
The easy way to misread this
Do not conclude that the HADS can reliably separate anxiety from depression in family members of critically ill patients. The best-fitting scoring pattern was dominated by broad psychological distress, and nine of the 14 items did not clearly contribute to separate anxiety or depression scores.