File Name: hospital anxiety and depression scale francais.zip
- Four-Dimensional Symptom Questionnaire (4DSQ)
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- Hospital Anxiety and Depression Scale (HADS)
- Hospital Anxiety and Depression Scale
Unless otherwise stated, CORC is not the developer or copyright holder of these measures. The Revised Child Anxiety and Depression Scale RCADS is a item, youth self-report questionnaire with subscales including: separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and low mood major depressive disorder. It also yields a Total Anxiety Scale sum of the 5 anxiety subscales and a Total Internalizing Scale sum of all 6 subscales.
Four-Dimensional Symptom Questionnaire (4DSQ)
Metrics details. It is used extensively in France, but has never been the subject of a full study in a population at work. The objectives of this study were to present some psychometric properties of the HADS on a large sample of French employees. The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination. In , employees filled in the questionnaire. The model selected was the original two-factor structure. The two subscales showed good internal consistency.
Women scored higher than the men for anxiety and depression; the scores increased with age; engineers and managers had lower average scores than other occupational status blue- or white-collar workers and technicians. The results of the analyses are consistent with those in literature relating to other populations studied in other countries. The HADS questionnaire is pertinent for detecting symptoms of anxiety and depression in a population of people at work.
Peer Review reports. There is therefore an abundant literature on the subject. This tool has been translated and validated in many countries and its capacity to detect anxiety and depressive disorders is widely recognized.
Nonetheless, as soon as it was published, researchers rightly questioned the structure of the questionnaire, its links with the other tools for determining anxiety and depression and its psychometric properties in general. In the first instance, we shall present the points on which there seems to be a consensus, followed by the one for which this is much less the case.
HADS comprises 14 items, seven of which relate to anxiety symptoms and seven to depressive symptoms. Each item is coded from 0 to 3. The scores for anxiety and depression can therefore vary from 0 to 21, depending on the presence and severity of the symptoms. The authors [ 1 ] have proposed cut-off points or thresholds: a score between 0 and 7 does not indicate the presence of the symptoms of anxiety or depression; a score between 8 and 10 indicates the presence of the symptomology but to a moderate degree, therefore doubtful cases; a score greater than or equal to 11 indicates a significant number of symptoms of anxiety or depression corresponding to confirmed cases.
The studies concerning the accuracy of these thresholds all showed them to be reliable: the review of the literature by Bjelland et al. Since , further studies have measured the sensitivity and specificity of the HADS: This tool was proposed in Norway to a general population in the doctor's consulting room [ 3 ], in England with people suffering from heart disease [ 4 ] and to a representative sample of the German population [ 5 ], the threshold of 8 is highly recommended for each of the two scales.
More recently, Roberge et al. Thus, high correlations were found between the scores on the Beck Depression Inventory and the HAD-D scores in diabetic patients [ 7 ], in elderly people in hospital, people attending hospital consultations and people in the general population [ 8 ] or in patients suffering from cancer [ 9 ], to quote only the most recent studies.
The Depression Screening Questionnaire has also been used to check the concurrent validity of the HADS-D scale in the patients of general practices [ 3 ], and the Quality of Life Questionnaire in Iranian patients suffering from different stages of cancer [ 10 ] or people suffering from musculoskeletal disease [ 11 ].
Regarding anxiety, the two principal questionnaires used are the State-Trait Anxiety Inventory and the Generalized Anxiety Questionnaire [ 3 ],[ 8 ]. So, the correlation between sub-score is estimated, in the general population, at between.
For this reason, some authors recommend the use of HADS-A to assess both anxious and depressive symptoms [ 7 ],[ 13 ]. It should, however, be remembered that the meta analysis produced by Mitchell, Meader and Symonds [ 13 ] involved only patients suffering from cancer and in palliative care, for whom it can easily be understood that anxiety symptoms are closely intertwined with depressive symptoms; the same argument can be advanced for the study by Sultan, Luminet and Hartemann [ 7 ] which concerns diabetics, for whom the depressive experience is highly marked by anxiety.
Others, that we have already mentioned, recommend the use of the global scale to assess the intensity of emotional distress e. The few divergences we have just mentioned are not, however, subject to significant debate. On the other hand, they are revealing about a point on which the authors are not in agreement, that is to say the factorial structure of the HADS.
This is in order to evaluate the disorders more related to the patients' psychological symptoms rather than physical ones. Thus, the depressive dimension is strongly marked by the measure of anhedonia five items out of seven , a characteristic symptom of depression, and the anxiety dimension by the measure of feelings of tension, worry, fear and panic five items out of seven.
Nonetheless, some of these ten items can give an account of both an emotional state and a physical state as well as the two supplementary items that complete each of the scales. We can estimate that these items do not fully meet the authors' first objective and we shall see that these are the items that are subject to discussion in the majority of cases.
Although some research studies point to a structure with four factors [ 17 ],[ 18 ] or a single factor [ 5 ],[ 7 ],[ 13 ]-[ 16 ], the main debate concerns two or three factors cf. Martin [ 20 ] deems that we have to take the negative linguistic form of some items into consideration either as a general factor influencing the factors of anxiety and depression, or as a supplementary factor.
Others take the tripartite model of Clark and Watson [ 21 ],[ 22 ] as a basis and obtain a more satisfactory factorial solution by considering three factors: An anxiety factor, a depression factor and a negative emotional or psychomotor agitation factor [ 14 ],[ 23 ]-[ 28 ].
Lastly, a large number of research studies point to the initial two-factor structure of HADS [ 2 ],[ 3 ],[ 7 ]-[ 9 ],[ 12 ],[ 13 ],[ 29 ]-[ 40 ]. Nonetheless, it is difficult, a priori , to adopt a position in favor of one or the other, given the very diverse populations involved in the analyses witness the debate between Friedmann et al. In addition, the study by Straat, Andries van der Ark and Sijtsma [ 42 ] shows that the differences obtained by the authors in respect of the dimensional structure of the HADS are essentially due to methodological factors.
However, Norton et al. Our aim is to present some psychometric properties of the HADS on a large population of French employees and to see whether we obtain the same main results as in the literature. The population in our research is original, since it concerns working employees; it is assumed to be in better health than all the other populations. There is no study relating to this type of population. Also, this questionnaire is very often used by companies in France we specify the context in the next paragraph without there being any previous psychometric analyses done on such data.
We shall compare our results with the studies involving a general population only [ 2 ],[ 5 ],[ 23 ],[ 31 ],[ 33 ],[ 34 ] and with a small number of existing French studies [ 7 ],[ 14 ],[ 26 ],[ 44 ]-[ 46 ]. The data were gathered throughout in 19 major French companies, some of which are established on different sites, representing a total of 32 different French towns in the Paris area and the other regions.
They come from various business sectors:. The professions of employees within head offices are relatively similar, even though the companies' businesses are different e. On production sites, jobs differ according to the nature of the business. Each item is coded 0 to 3, which gives a score varying between 0 and 21 for each scale. The version used is the French version introduced by Lepine et al.
The HADS was preceded by socio-demographic questions. We kept the variables common to the companies. In this way, we possess information relative to gender, age category and occupational status for all our population.
In the companies that we work with and in the French legal framework for preventing psychosocial risks, the occupational health service administers questionnaires to all the employees during their medical examination on a dedicated computer. One of the questionnaires is the HADS and employees have the ability to print out their scores; this means that they can discuss them immediately with the doctor.
The execution was computerized and the data collected was fully anonymous. Once a year, usually, companies ask us for a global analysis, by type, by age, by job, etc. We also participate, if the company so wishes, in setting up action plans with groups of employees who obtained the lowest scores.
The rotation requested was oblique oblimin rotation given that the factors are correlated. The results of the EFAs show that there are several possible factorial solutions.
We then proceeded to carry out a reliability analysis by measuring the internal consistency using Cronbach's alpha and calculating the scale-item correlations SPSS We checked that the scores obtained were compatible with those of the literature by means of variance analyses SPSS We carry out an EFA on all the subjects that leads to extraction of three factors, which account for But according to Costello and Osborne [ 53 ], this method often overestimates the number of factors: they thus suggest fixing the number of factors manually and comparing the item loading tables.
So we have explored a two- and three-factor solution cf. Quite similar patterns of results are obtained for all subsets women, men, and the four age groups with one exception. In women subset analyses, we find the original two-factor solution of Zigmond and Snaith [ 1 ]. In other analyses, differences lie in small variations of loadings which do not alter the overall pattern and HAD7-A4 and HAD8-D4 items load cross the two or three factors in the same way.
The three-factor solution reveals two of three disadvantages quoted by the authors: factor 3 consists only of two items and HAD7-A4 and HADD7 items load cross two or three factors. We thus choose the two-factor model. There is no model which distinguishes itself in a more favorable way than the other one: every four models quite similar fits.
Some authors consider the values of these indices to be satisfactory [ 52 ]. Nonetheless, they can be improved by allowing correlations between the error variances between some items and the factors or between items themselves. This last analysis shows an X 2 74 value of Other numerous links are proposed between items, which would allow us to improve still adjustment indicators.
Nevertheless, we prefer to stop there for three reasons: i the present factorial structure is enough good to report data, ii it also reports loadings of HAD8-D4 and HAD7-A4 items on factors 1 and 2, as suggested it the EFAs, and iii we know well that items and factors are inter correlated; it is not thus necessary to weigh down the model by adding links between items only to obtain a RMSEA lower than. Factor structure of HADS. The dotted arrows indicate the correlations recommended by the model for improvement; in bold italics, the r 2 associated with each scale.
The internal consistency of the two scales is good. Concerning the depression scale, Cronbach's alpha is. Concerning the anxiety scale, Cronbach's alpha is. The anxiety and depression scores are correlated at. The sample is composed of The occupational status categories are as follows: The WT have on average a level of study lower than second-year University, Ma have a level of study upper.
These differences are to be found in the population we used cf. The size of our sample allows us to give indicative scores for the population of French employees according to gender, age and occupational status.
After carrying out EFAs on all the people in our sample, as well as the sub-groups defined according to gender and age, we used CFA to test the different possible theoretical models. It turns out that the original model, as defined by Zigmond and Snaith [ 1 ] is the one that demonstrates the best fit. This is therefore the one we selected at least for the population we are interested in, that is to say, French employees.
In EFAs, two types of items are observed: items which substantially load one of the two factors and two items with smaller loadings that load the two factors.
The chosen model is the original two-factor model but, to obtain a good adequacy of the model with the data, we have of to add a link between HAD8-D4 and the anxiety factor as well as a link between HAD7-A4 and depression factor; what was expected according to the results of the EFAs. These items are often quoted in the literature as having no weight satisfying on the factor to which they are supposed to belong e.
Roberge et al. Indeed, there have been a large number of studies concerning the thresholds calculated from the initial anxiety and depression scales.
These studies [ 2 ]-[ 5 ] have largely validated the use of thresholds one threshold at 8 and another at 11 and a calling into question of the calculation of anxiety and depression scores necessarily calls into question the value of the thresholds.
Hospital Anxiety and Depression Scale (HADS)
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Hospital Anxiety and Depression Scale
The Edinburgh Postnatal Depression Scale EPDS is a set of 10 screening questions that can indicate whether a parent has symptoms that are common in women with depression and anxiety during pregnancy and in the year following the birth of a child. This is not intended to provide a diagnosis — only trained health professionals should do this. To complete this set of questions, the parent should select the number next to the response that comes closest to how they have felt in the past seven days. The total score is calculated by adding the numbers selected for each of the 10 items. All Rights Reserved. It is strongly recommended that this set of questions is completed with a health professional.
Work and Stress ; 18 3 : The Four-Dimensional Symptom Questionnaire 4DSQ : a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry ; BMC Fam Pract ; Many health care problems in primary care are stress-related distress and do not represent true psychiatric disorder irrespective of whether DSM-IV criteria for depressive or anxiety disorders are fulfilled.
Metrics details. It is used extensively in France, but has never been the subject of a full study in a population at work. The objectives of this study were to present some psychometric properties of the HADS on a large sample of French employees. The HADS questionnaire was given to salaried employees at 19 major French companies as part of their biennial occupational medical examination.
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