engleski

Hospital anxiety and depression scale: psychometric validation on a sample of croatian breast cancer patients

Objectives/purpose: Research repeatedly shows that breast cancer can have detrimental effects on mental health as well. To increase the awareness of clinicians treating breast cancer on the psychological burden of this disease and provide adequate care, it is important to implement screening for mental health disturbances in adjuvant treatment. Quick and validated standardized tools are therefore necessary in clinical practice. Among those, the Hospital and Anxiety and Depression Scale (HADS) is a standardized self-report questionnaire aimed at measuring psychological distress, namely anxiety and depression, in non-psychiatric patients. Although HADS is a frequently used and quick screening tool, so far it has not been validated in Croatia. Therefore, this study aimed to examine its psychometric properties, including factor structure, reliability, and discriminant validity on a sample of Croatian breast cancer patients. Methods: In this study, 325 women (age range 31-83 years, mean age of 59 years, sd=10.95) were recruited between 2009 and 2013 from two large tertiary institutions in a cross- sectional study at four points of adjuvant treatment (two weeks after primary surgery, during adjuvant chemotherapy, adjuvant radiotherapy, and at a 6- month follow-up). Apart from pen-paper questionnaires (HADS, Body Image Scale), basic socio-demographic and relevant medical data were also collected (treatment point, comorbidity, surgery type). Results: Confirmatory factor analyses was conducted in the Mplus 8.3 software where we compared several alternative models of HADS. The two-factor model, which consist of Anxiety (HADS-A) and Depression (HADS-D) subscales, showed a good fit (χ2(df) = 118.63 (76), RMSEA = .04, CFI = .96, SRMR = .04). However, some of items on the HADS-A subscale had low loadings. The internal consistency reliability coefficients were acceptable for both HADS-A (α = .75), and HADS-D (α = .74). There were no differences in HADS-A and HADS-D scores in various points of adjuvant treatment, nor between those who had different types of surgery (mastectomy and breast conservation surgery). However, women without comorbidity experienced lower depression. Anxiety and Depression subscales were moderately correlated (r =.62, p < .01). Women with higher body image concerns experienced higher anxiety and higher depression (r =.37, p < .01, r =.34, p < .01). Conclusion and clinical implications: The obtained results provide support for the original two-dimensional structure, reliability, and discriminant validity of the Hospital Anxiety and Depression Scale on a sample of Croatian breast cancer patients. No differences were found concerning points of adjuvant treatment or surgery type, but higher depression was found in women with other comorbidities, while both anxiety and depression were higher in women with higher body image concerns. These results demonstrate this instrument has overall good psychometric validity and can be useful in adjuvant care of women with breast cancer.

anxiety ; breast cancer ; depression ; validation

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