Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations


BACKGROUND The Hospital Anxiety and Depression Scale (HADS) is a common screening instrument excluding somatic symptoms of depression and anxiety, but previous studies have reported inconsistencies of its factor structure. The construct validity of the Japanese version of the HADS has yet to be reported. To examine the factor structure of the HADS in a Japanese population is needed. METHODS Exploratory and confirmatory factor analyses were conducted in the combined data of 408 psychiatric outpatients and 1069 undergraduate students. The data pool was randomly split in half for a cross validation. An exploratory factor analysis was performed on one half of the data, and the fitness of the plausible model was examined in the other half of the data using a confirmatory factor analysis. Simultaneous multi-group analyses between the subgroups (outpatients vs. students, and men vs. women) were subsequently conducted. RESULTS A two-factor model where items 6 and 7 had dual loadings was supported. These factors were interpreted as reflecting anxiety and depression. Item 10 showed low contributions to both of the factors. Simultaneous multi-group analyses indicated a factor pattern stability across the subgroups. CONCLUSION The Japanese version of HADS indicated good factorial validity in our samples. However, ambiguous wording of item 7 should be clarified in future revisions.

DOI: 10.1186/1477-7525-7-42

Extracted Key Phrases

4 Figures and Tables

Citations per Year

56 Citations

Semantic Scholar estimates that this publication has 56 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Matsudaira2009FactorSO, title={Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations}, author={Tomomi Matsudaira and Hiromi Igarashi and Hiroyoshi Kikuchi and Rikihachiro Kano and Hiroshi Mitoma and Kiyoshi Ohuchi and Toshinori Kitamura}, journal={Health and Quality of Life Outcomes}, year={2009}, volume={7}, pages={42 - 42} }