# An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in patients with breast cancer

## TL;DR

This study examines how well the Hospital Anxiety and Depression Scale works for breast cancer patients, finding a three-factor model better fits their psychological distress.

## Contribution

The study identifies a three-factor structure of the HADS in breast cancer patients, suggesting a modified scoring approach for better clinical utility.

## Key findings

- Three-factor models fit the HADS data better than the traditional two-factor model in breast cancer patients.
- The three factors identified are negative affectivity, autonomic anxiety, and anhedonic depression.
- A modified scoring method based on the three-factor model is proposed for improved screening of psychological distress.

## Abstract

To determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer and determine the suitability of the instrument for use with this clinical group.

A cross-sectional design was used. The study used a pooled data set from three breast cancer clinical groups. The dependent variables were HADS anxiety and depression sub-scale scores. Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 110 patients with breast cancer. Seven models were tested to determine model fit to the data.

Both factor analysis methods indicated that three-factor models provided a better fit to the data compared to two-factor (anxiety and depression) models for breast cancer patients. Clark and Watson's three factor tripartite and three factor hierarchical models provided the best fit.

The underlying factor structure of the HADS in breast cancer patients comprises three distinct, but correlated factors, negative affectivity, autonomic anxiety and anhedonic depression. The clinical utility of the HADS in screening for anxiety and depression in breast cancer patients may be enhanced by using a modified scoring procedure based on a three-factor model of psychological distress. This proposed alternate scoring method involving regressing autonomic anxiety and anhedonic depression factors onto the third factor (negative affectivity) requires further investigation in order to establish its efficacy.