THE STRUCTURE OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE (HAD) - ANAPPRAISAL WITH NORMAL, PSYCHIATRIC AND MEDICAL PATIENT SUBJECTS

Four published studies which include factor analyses of the items of t he Hospital Anxiety and Depression Scale (HAD) are reviewed and new da ta on psychiatric out-patients are presented. By contrast with the res t, the two studies in English with British subjects clearly support th e interpretation of the HAD as a bidimensional measure. However, one a nxiety item appears sex-related and misaligned. The problem of item me aning in other cultures is raised. Overall, despite the HAD's use inte rnationally, there has been a lack of systematic structural evaluation . (C) 1997 Elsevier Science Ltd.