The Factor Structure of the Hospital Anxiety and Depression Scale (HADS) in a Traumatic Brain Injury (TBI) Population

Primary Objectives: To examine the HADS structure in TBI, using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and investigate the effects of TBI severity, Gender, and Age on factor scores. Methods and Procedures: HADS data from 186 TBI patients in a population study in Tasmania were subjected to EFA. HADS data from a second sample of 185 TBI participants in the same study underwent CFA. One-month follow-up data were used, allowing inclusion of severe TBI patients while still being early post-injury. Factor loadings were used to investigate the effects of demographic and clinical variables at 2 weeks post-injury. Results: While EFA suggested 2-factor (anxiety, depression) and 3-factor (anxiety, psychomotor, depression) structures provided adequate descriptions, CFA strongly supported the 3-factor model. Using this model, significant effects of TBI severity were noted on Psychomotor and Depression scores at 2 weeks post-injury. Males reported significantly fewer symptoms on all 3 factors, as did younger participants. Conclusions: CFA indicates that a 3-factor model provides the best fit for HADS data in TBI. One factor, Psychomotor, has been relatively neglected in the literature, and the current findings suggest its assessment and rehabilitation should receive more attention.