A psychometric evaluation of the hospital anxiety and depression scale in cardiac patients: Addressing factor structure and gender invariance

Objectives: The present study examined the factor structure of the Hospital Anxiety and Depression Scale (HADS) and tested measurement invariance between genders in a representative sample of cardiac patients across 2 years. Design: Confirmatory factor analysis and structural equational modelling were used to assess the factor structure, measurement, and structural invariance of the HADS. Methods: Eight hundred and one cardiac patients completed the HADS at baseline, 6, 12, and 24 months. Results: Confirmatory factor analysis consistently supported a three-factor structure of the HADS, with the best fitting model comprised of negative affect, autonomic anxiety, and depression. Structural equation modelling showed that the HADS was invariant by gender among cardiac patients. Conclusions: The HADS can be appropriately used with both male and female cardiac patients to assess three domains of psychological distress. Future investigations should consider the predictive validity and relevance of the HADS subscales with respect to diagnostic distinctions and clinical outcomes among cardiac patients and other clinical populations.