A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly

Nord J Psychiatry. 2011 Oct;65(5):338-44. doi: 10.3109/08039488.2011.560684. Epub 2011 Feb 22.


Background: Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals.

Methods: The participants were 484 elderly (65-101 years, 241 men) patients in an acute medical unit. The HADS, the Montgomery-Aasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected item-total correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbach's) and 3) concurrent validity by means of Spearman's rho.

Results: We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbach's alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51.

Conclusion: The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 ("I feel as if I have slowed down") did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anxiety / diagnosis*
  • Anxiety / psychology
  • Anxiety Disorders / diagnosis
  • Depression / diagnosis*
  • Depression / psychology
  • Depressive Disorder / diagnosis
  • Depressive Disorder / psychology
  • Hospitals
  • Humans
  • Inpatients / psychology*
  • Male
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Weights and Measures