Psychometric Properties of the Hospital Anxiety and Depression Scale in Family Caregivers of Palliative Care Patients

The Hospital Anxiety and Depression Scale (HADS) has been used extensively as a screening tool for anxiety and depression in clinical and nonclinical groups. A number of published studies have provided support for the original bidimensional structure of the HADS; however, others have reported irregularities in the factor structure. This study investigated the psychometric properties of the HADS in 106 family caregivers caring for a patient dying of cancer. Caregivers had been recruited to a randomized controlled trial conducted to gain a longitudinal understanding of caregivers' appraisal of their role. Exploratory factor analysis and internal consistency reliability statistics were used to investigate the underlying structure of the HADS. Descriptive statistics were calculated for author-defined subscale scores to assess levels of anxiety and depression among family caregivers. Two- and three-factor models were explored; however, the two-factor model, which closely resembled the intended bidimensional structure, was preferred. Mean author-defined subscale scores indicated higher levels of anxiety and depression in family caregivers than those previously reported for various general population, general practice, and cancer patient samples. Routine screening of anxiety and depression in family caregivers appears warranted based on the results of this study. The HADS may be a suitable screening tool, as indicated by its bidimensional structure; however, further research is required to establish its diagnostic efficiency in this population.