King's College London

Research portal

Evaluation of the Hospital Anxiety and Depression Scale (HADS) in Screening Stroke Patients for Symptoms: Item Response Theory (IRT) Analysis

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)33-40
JournalJournal of Affective Disorders
Early online date28 Nov 2017
Publication statusPublished - Mar 2018


King's Authors


Background Variations have been reported in the number of underlying constructs and choice of thresholds that determine caseness of anxiety and /or depression using the Hospital Anxiety and Depression scale (HADS). This study examined the properties of each item of HADS as perceived by stroke patients, and assessed the information these items convey about anxiety and depression between 3 months to 5 years after stroke. Methods The study included 1443 stroke patients from the South London Stroke Register (SLSR). The dimensionality of HADS was examined using factor analysis methods, and items’ properties up to 5 years after stroke were tested using Item Response Theory (IRT) methods, including graded response models (GRMs). Results The presence of two dimensions of HADS (anxiety and depression) for stroke patients was confirmed. Items that accurately inferred about the severity of anxiety and depression, and offered good discrimination of caseness were identified as “I can laugh and see the funny side of things” (Q4) and “I get sudden feelings of panic” (Q13), discrimination 2.44 (se=.26), and 3.34 (se=0.35), respectively. Items that shared properties, hence replicate inference were: “I get a sort of frightened feeling as if something awful is about to happen” (Q3) and “Worrying thoughts go through my mind” (Q9). Item properties were maintained over time. Limitations approximately 20% of patients were lost to follow up. Conclusion A more concise selection of items based on their properties, would provide a precise approach for screening patients and for an optimal allocation of patients into clinical trials.

Download statistics

No data available

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454