A Rasch Analysis of the Hospital Anxiety and Depression Scale (HADS) Among Cancer Survivors
A Rasch Analysis of the Hospital Anxiety and Depression Scale (HADS) Among Cancer Survivors
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DOI：
10.1037/a0031154
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发表时间：
2013-06-01
影响因子：
3.6
通讯作者：
Girgis, Afaf
中科院分区：
文献类型：
--
作者：
Lambert, Sylvie D.;Pallant, Julie F.;Girgis, Afaf
目的：医院焦虑和抑郁量表（HADS）通常用于评估癌症患者的痛苦。然而，以前的研究对HADS最合适的维度结构表示怀疑，表明1维或3维结构可能提供比原始2维结构更上级的拟合。本文是第一次使用Rasch分析来研究这些替代结构对应的分量表的心理测量学特性。方法：HADS由1，360名癌症幸存者完成。进行Rasch分析以检查汇总和个体模型拟合统计量、人员分离指数、响应格式、项目偏倚、冗余和维度。结果：HADS-Total量表是多维的，需要删除近一半的条目才能达到拟合。分析仅部分支持原始结构，因为HADS-焦虑和HADS-抑郁均显示初始模型不匹配，并且需要删除项目以实现匹配。在三维结构中，焦虑分量表的Rasch统计量在可接受范围内，无需调整。分析不支持将项目7添加到HADS-抑郁中。结论：结果支持HADS-焦虑和HADS-抑郁的修改版本;然而，不建议将所有项目合并为HADS-总。使用经典测试理论和Rasch分析的许多研究证实了排除某些项目（例如，第7项）和由三维结构定义的分量表的适当性。需要进一步的研究，以确定潜在的修订分量表的增量效度。
Objective: The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess distress among individuals with cancer. However, previous studies cast doubt on the most appropriate dimensional structure for the HADS, suggesting that 1- or 3-dimensional structures might offer superior fit to the original 2-dimensional one. This article is the first to use Rasch analysis to examine the psychometric properties of the subscales corresponding to each of these alternative structures. Method: The HADS was completed by 1,360 cancer survivors. Rasch analyses were conducted to examine summary and individual model fit statistics, person separation index, response format, item bias, redundancy, and dimensionality. Results: The HADS-Total scale was found to be multidimensional, and it was necessary to remove almost half of the items to achieve fit. Analyses only partially supported the original structure, as both HADS-Anxiety and HADS-Depression showed initial model misfit and item deletion was necessary to achieve fit. Within the 3-dimensional structures, the Rasch statistics for the anxiety subscales were within acceptable range and no adjustment was needed. Analyses did not support adding Item 7 to HADS-Depression. Conclusions: Results supported modified versions of the HADS-Anxiety and HADS-Depression; however, combining all items to form HADS-Total is not recommended. Numerous studies using classical test theory and Rasch analyses have corroborated the exclusion of some items (e.g., Item 7) and appropriateness of the subscales defined by a 3-dimensional structure. Further research is required to identify the incremental validity of potential revised subscales.