The Factor Structure of the Hospital Anxiety and Depression Scale in Orthopedic Trauma Patients

BACKGROUND: Many instruments exist to assess mental disorders and anxiety, such as the hospital anxiety and depression scale (HADS). Nothing has been evaluated on the HADS factor structure for use with orthopedic trauma patients. The aim of this study was to validate the underlying structure of the HADS. Specifically, we sought to understand which of the factor structures found in the literature is appropriate for the orthopedic trauma patient population. METHODS: This study included 348 patients with an average age of 49.8 years (SD: 18.4; range: 18 - 95). Confirmatory data analysis was performed to analyze the latent structure of the HADS. Akaike information criterion (AIC) was used to compare all the models, with the lowest AIC being the best fitting model. RESULTS: We found that both the anxiety and the depression factors were highly correlated (with Pearson correlations greater than 0.700). After removing one item from each subscale, we found that a two-factor model was the best fitting one (AIC: 8,298.901); all other models had an AIC over 10,000. CONCLUSION: Our results support a satisfactory two-factor structure for the HADS in the orthopedic trauma patients. Further studies are needed to test for higher factor structures in larger samples and in a different population.