The validity and clinical utility of the Hospital Anxiety and Depression Scale (HADS) with older adult New Zealanders

Background: The Hospital Anxiety and Depression Scale (HADS) has established use with older adult populations in New Zealand but few studies have evaluated its psychometric properties. Research with the psychometric properties of the HADS in elderly populations has primarily used correlational methods that do not allow for the effects of measurement error to be observed. The hypothesized tripartite model of anxiety and depression within the HADS was evaluated using confirmatory factor analysis (CFA) methods. Methods: Overall, 203 community-dwelling older adults who were recruited from older adult community groups completed the HADS. Competing two- and three-factor structures were trialled using CFA. Results: A three-factor model indicated a lack of differentiation between factors and poor clinical utility and was rejected in favor of a two-factor model. Significant correlations were observed between the anxiety and depression factors on the two-factor model, but it was considered to have validity for older adult samples. Good internal consistency was found for the HADS. Conclusions: A two-factor model of the HADS was favored due to the lack of differentiation between factors on the three-factor model, and the higher clinical utility of a two-factor solution. The validity of the HADS may be limited by over-diagnosing anxiety in non-clinical populations. It is recommended that the HADS be used to measure change over time through treatment and not be used as a diagnostic tool until future research establishes appropriate norms and cut-offs.