Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

Elisabeth L. Zeilinger; Ingo W. Nader; Wolfgang Wiedermann; Mencia R. Gutierrez-Colosia; Matthias Unseld; Simone Lubowitzki; Markus Raderer; Philipp B. Staber; Peter Valent; Alexander Gaiger

doi:10.1016/j.ijchp.2022.100315

Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

Elisabeth L. Zeilinger
, Ingo W. Nader
, Wolfgang Wiedermann
, Mencia R. Gutierrez-Colosia
, Matthias Unseld
, Simone Lubowitzki
, Markus Raderer
, Philipp B. Staber
, Peter Valent
, Alexander Gaiger^*

^*Corresponding author for this work

Research output: Journal article (peer-reviewed) › Journal article

14 Citations (Scopus)

Abstract

Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.

Original language	English
Article number	100315
Journal	International Journal of Clinical and Health Psychology
Volume	22
Issue number	3
DOIs	https://doi.org/10.1016/j.ijchp.2022.100315
Publication status	Published - 01 Sept 2022
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Anxiety
Depression
Factor structure
Instrumental study
Psychometric properties

ASJC Scopus subject areas

Clinical Psychology

Access to Document

10.1016/j.ijchp.2022.100315

Cite this

Zeilinger, E. L., Nader, I. W., Wiedermann, W., Gutierrez-Colosia, M. R., Unseld, M., Lubowitzki, S., Raderer, M., Staber, P. B., Valent, P., & Gaiger, A. (2022). Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients. International Journal of Clinical and Health Psychology, 22(3), Article 100315. https://doi.org/10.1016/j.ijchp.2022.100315

@article{e3c6a933e7544cf09adc2aeb4718e860,

title = "Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients",

abstract = "Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.",

keywords = "Anxiety, Depression, Factor structure, Instrumental study, Psychometric properties",

author = "Zeilinger, \{Elisabeth L.\} and Nader, \{Ingo W.\} and Wolfgang Wiedermann and Gutierrez-Colosia, \{Mencia R.\} and Matthias Unseld and Simone Lubowitzki and Markus Raderer and Staber, \{Philipp B.\} and Peter Valent and Alexander Gaiger",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = sep,

day = "1",

doi = "10.1016/j.ijchp.2022.100315",

language = "English",

volume = "22",

journal = "International Journal of Clinical and Health Psychology",

issn = "1697-2600",

publisher = "Elsevier B.V.",

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Zeilinger, EL, Nader, IW, Wiedermann, W, Gutierrez-Colosia, MR, Unseld, M, Lubowitzki, S, Raderer, M, Staber, PB, Valent, P & Gaiger, A 2022, 'Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients', International Journal of Clinical and Health Psychology, vol. 22, no. 3, 100315. https://doi.org/10.1016/j.ijchp.2022.100315

TY - JOUR

T1 - Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

AU - Zeilinger, Elisabeth L.

AU - Nader, Ingo W.

AU - Wiedermann, Wolfgang

AU - Gutierrez-Colosia, Mencia R.

AU - Unseld, Matthias

AU - Lubowitzki, Simone

AU - Raderer, Markus

AU - Staber, Philipp B.

AU - Valent, Peter

AU - Gaiger, Alexander

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.

AB - Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.

KW - Anxiety

KW - Depression

KW - Factor structure

KW - Instrumental study

KW - Psychometric properties

UR - https://www.scopus.com/pages/publications/85131082766

U2 - 10.1016/j.ijchp.2022.100315

DO - 10.1016/j.ijchp.2022.100315

M3 - Journal article

AN - SCOPUS:85131082766

SN - 1697-2600

VL - 22

JO - International Journal of Clinical and Health Psychology

JF - International Journal of Clinical and Health Psychology

IS - 3

M1 - 100315

ER -

Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

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