Kristofer Årestedt
Associate professor and research leader for the iCARE group
Associated editor of the European Journal of Cardiovascular Nursing Department of medical and health sciences
Linköping university
SE-581 83 Linköping, Sweden Phone +46 (0)709 206462 E-mail kristofer.arestedt@liu.se
Purpose
Emotional distress, in terms of anxiety and depression, is common in sudden cardiac arrest (SCA) survivors. The Hospital Anxiety and Depression scale (HAD) is one of the most used instruments to assess emotional distress. Despite this, measurement properties of HAD have to our knowledge not been evaluated in this group of patients. The aim was therefore to evaluate the psychometric prop-erties of the HAD in SCA survivors, with focus on factor structure.
Materials and methods
Data from the Swedish Registry of Cardiopulmonary Re-suscitation was used. In the registry, data is collected 3-6 months after resuscitation by using a questionnaire in-cluding HAD. Parallel analyse and confirmatory factor analysis (based on polychoric correlations and a WLSMV estimator) was conducted to evaluate the hypothesized two factor structure, i.e. anxiety and depression. Internal consistency was evaluated with an ordinal variant of Cronbach’s alpha.
Results
The sample consisted of 488 in-hospital cardiac arrest (IHCA) survivors (mean age 69.4±12.6), 304 men and 184 women.
The parallel analysis, based on a polychoric correla-tion matrix, supported the hypothesized two factor structure. Two CFA models were examined; I) a base-line model without modifications and II) a model with collapsed response categories (2 and 3) and a cross loading for item 7. Model I showed good fit accord-ing to some of the fit indices but not all (χ2(76)=258.0, p<0.001, RMSEA=0.07, 95% CI=0.06-0.08, CFI=0.98, TLI=0.97, WRMR=1.11). Model II (Figure 1) demonstrated excellent fit except for χ2 (χ2(75) =168.0, p<0.001, RMSEA=0.05, 95% CI=0.04-0.06, CFI=0.99, TLI=0.98, WRMR=0.91).
HAD demonstrated excellent internal consistency ac-cording to ordinal alpha, 0.93 for both Anxiety and Depression.
Conclusions
The HAD demonstrated good psychometric properties among SCA survivors. Both Anxiety and Depression, seems to be uni-dimensional measures with good in-ternal consistency. Therefore, HAD can be recom-mended to assess emotional distress among SCA sur-vivors.
Psychometric properties of the Hospital Anxiety and
Depression scale in sudden cardiac arrest survivors
Kristofer Årestedt, RN, Associate professor
1,2, Johan Herlitz, MD, Professor
3, Johan Israelsson, RN, PhD student
1,4, Anders Bremer, RN, PhD
3,41 Department of Medical and Health Sciences, Linköping University, Sweden, 2 Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden, 3 Working life and social welfare, Academy of Care, University of Borås, Sweden, 4 Kalmar county hospital, Sweden
Figure 1. Factor loadings from Modell II, including a cross-loading for item 7. The 14 items in HAD are presented as q1-q14.
