BACKGROUND Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease. METHODS The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression. RESULTS A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items. CONCLUSIONS The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research. TRIAL REGISTRATION ClinicalTrials.gov: NCT01926145.

中文翻译：

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丹麦心脏病患者抑郁症量表的心理测量特性：DenHeart调查的结果。

背景技术焦虑和抑郁症状在心脏病患者中很常见。医院焦虑和抑郁量表（HADS）通常用于测量焦虑和抑郁症状。但是，尚未对丹麦心脏病患者使用量表的有效性和可靠性进行任何研究。因此，目的是评估大量丹麦患者中具有四种最常见的心脏病诊断：缺血性心脏病，心律不齐，心力衰竭和心脏瓣膜疾病的HADS的心理测量特性。方法DenHeart研究被设计为包括HADS，SF-12和HeartQoL在内的全国性横断面调查，并结合了来自国家登记册的数据。心理评估包括对地板和天花板影响的分析，使用探索性和确认性因素分析的结构效度，以及通过将HADS得分与SF-12和HeartQoL相关联来对收敛效度和发散效度进行假设检验。内部一致性可靠性通过Cronbach'sα评估，性别差异项功能使用序数逻辑回归分析。结果共有12,806例患者（应答率51％）回答了HADS。探索性因素分析支持HADS的原始两因素结构，而确认性因素分析则支持由原始抑郁量表和两个焦虑量表组成的三因素结构。所有项目都有地板效应，而项目8有天花板效应。证实了关于收敛效度的假设，但关于HADS-D的分歧效度的假设没有得到证实。内部一致性良好，HADS-A的Cronbachα为0.87，HADS-D的Cronbachα为0.82。没有迹象表明任何项目的性别差异明显。结论本研究支持了丹麦心脏病患者大量样本中两种HADS结果的收敛效度和高度内部一致性的证据。然而，关于量表的因素结构，与先前的研究相矛盾的结果。试验注册ClinicalTrials.gov：NCT01926145。没有迹象表明任何项目的性别差异明显。结论本研究支持了丹麦心脏病患者大量样本中两种HADS结果的收敛效度和高度内部一致性的证据。然而，关于量表的因素结构，与先前的研究相矛盾的结果。试验注册ClinicalTrials.gov：NCT01926145。没有迹象表明任何项目的性别差异明显。结论本研究支持丹麦心脏病患者大量样本中两种HADS结果的收敛效度和高度内部一致性的证据。然而，关于量表的因素结构，与先前的研究相矛盾的结果。试验注册ClinicalTrials.gov：NCT01926145。