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Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale (HADS)

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Abstract

Purpose

The objective of this study was to generate normative values and to test psychometric properties of the Hospital Anxiety and Depression Scale (HADS) for the general population of Colombia. While there are several normative studies in Europe, Latin American normative values are missing. The identification of people with mental distress requires norms obtained for the specific country.

Methods

A representative face-to-face household study (n = 1,500) was conducted in 2012. The survey questionnaire contained the HADS, several other questionnaires, and sociodemographic variables.

Results

HADS mean values (anxiety: M = 4.61 ± 3.64, depression: M = 4.30 ± 3.91) were similar to those reported from European studies. Females were more anxious and depressed than males. The depression scale showed a nearly linear age dependency with increasing scores for old people. Mean scores and percentiles (75 and 90 %) are presented for each age decade for both genders. Both anxiety and depression correlated significantly with the total score of the multidimensional fatigue inventory and with the mental component summary score of the quality of life questionnaire SF-8. Internal consistency coefficients of both scales were satisfying, but confirmatory factorial analysis results only partially supported the two-dimensional structure of the questionnaire.

Conclusion

This study supports the reliability of the HADS in one Latin American country. The normative scores can be used to compare a patient’s score with those derived from a reference group. However, the generalizability to other Latin American regions requires further research.

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References

  1. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen YC, Huang YQ, Zhang MY, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Alonso J, Brugha TS, Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. JAMA 291(21):2581–2590

    Article  PubMed  Google Scholar 

  2. Lowe B, Spitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78(2):131–140

    Article  PubMed  Google Scholar 

  3. Singer S, Brown A, Einenkel J, Hauss J, Hinz A, Klein A, Papsdorf K, Stolzenburg JU, Brähler E (2011) Identifying tumor patients’ depression. Support Care Cancer 19(11):1697–1703

    Article  PubMed  Google Scholar 

  4. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370

    Article  CAS  PubMed  Google Scholar 

  5. Luckett T, Butow PN, King MT, Oguchi M, Heading G, Hackl NA, Rankin N, Price MA (2010) A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer 18(10):1241–1262

    Article  PubMed  Google Scholar 

  6. Mykletun A, Bjerkeset O, Overland S, Prince M, Dewey M, Stewart R (2009) Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry 195(2):118–125

    Article  PubMed  Google Scholar 

  7. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 52(2):69–77

    Article  PubMed  Google Scholar 

  8. Cosco TD, Doyle F, Ward M, Mcgee H (2012) Latent structure of the Hospital Anxiety and Depression Scale: a 10-year systematic review. J Psychosom Res 72(3):180–184

    Article  PubMed  Google Scholar 

  9. Caci H, Bayle FJ, Mattei V, Dossios C, Robert P, Boyer P (2003) How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects? Psychiatry Res 118(1):89–99

    Article  PubMed  Google Scholar 

  10. Dunbar M, Ford G, Hunt K, Der G (2000) A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. Br J Clin Psychol 39:79–94

    Article  PubMed  Google Scholar 

  11. Friedman S, Samuelian JC, Lancrenon S, Even C, Chiarelli P (2001) Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Res 104(3):247–257

    Article  CAS  PubMed  Google Scholar 

  12. Norton S, Cosco T, Doyle F, Done J, Sacker A (2013) The Hospital Anxiety and Depression Scale: a meta confirmatory factor analysis. J Psychosom Res 74(1):74–81

    Article  PubMed  Google Scholar 

  13. Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauß O, Lehmann A, Schwarz R (2009) Hospital Anxiety and Depression Scale cut-off scores for cancer patients in acute care. Br J Cancer 100(6):908–912

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Cosco TD, Doyle F, Watson R, Ward M, Mcgee H (2012) Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease. Gen Hosp Psychiatry 34(2):167–172

    Article  PubMed  Google Scholar 

  15. Kendel F, Wirtz M, Dunkel A, Lehmkuhl E, Hetzer R, Regitz-Zagrosek V (2010) Screening for depression: rasch analysis of the dimensional structure of the PHQ-9 and the HADS-D. J Affect Disord 122(3):241–246

    Article  PubMed  Google Scholar 

  16. Smith AB, Wright EP, Rush R, Stark DP, Velikova G, Selby PJ (2006) Rasch analysis of the dimensional structure of the hospital anxiety and depression scale. Psychooncology 15(9):817–827

    Article  CAS  PubMed  Google Scholar 

  17. Hinz A, Brähler E (2011) Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population. J Psychosom Res 71(2):74–78

    Article  PubMed  Google Scholar 

  18. Crawford JR, Henry JD, Crombie C, Taylor EP (2001) Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40:429–434

    Article  CAS  PubMed  Google Scholar 

  19. Crawford JR, Garthwaite PH, Lawrie CJ, Henry JD, MacDonald MA, Sutherland J, Sinha P (2009) A convenient method of obtaining percentile norms and accompanying interval estimates for self-report mood scales (DASS, DASS-21, HADS, PANAS, and sAD). Br J Clin Psychol 48:163–180

    Article  PubMed  Google Scholar 

  20. Stordal E, Kruger MB, Dahl NH, Kruger O, Mykletun A, Dahl AA (2001) Depression in relation to age and gender in the general population: the Nord-Trondelag health study (HUNT). Acta Psychiatr Scand 104(3):210–216

    Article  CAS  PubMed  Google Scholar 

  21. Jorngarden A, Wettergen L, von Essen L (2006) Measuring health-related quality of life in adolescents and young adults: Swedish normative data for the SF-36 and the HADS, and the influence of age, gender, and method of administration. Health Qual Life Outcomes 4:91. doi:10.1186/1477-7525-4-91

  22. Wong WS, Fielding R (2010) Prevalence of chronic fatigue among Chinese adults in Hong Kong: a population-based study. J Affect Disord 127(1–3):248–256

    Article  PubMed  Google Scholar 

  23. Yun YH, Kim SH, Lee KM, Park SM, Kim YM (2007) Age, sex, and comorbidities were considered in comparing reference data for health-related quality of life in the general and cancer populations. J Clin Epidemiol 60(11):1164–1175

    Article  PubMed  Google Scholar 

  24. Lisspers J, Nygren A, Soderman E (1997) Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 96(4):281–286

    Article  CAS  PubMed  Google Scholar 

  25. Nortvedt MW, Riise T, Sanne B (2006) Are men more depressed than women in Norway? Validity of the Hospital Anxiety and Depression Scale. J Psychosom Res 60(2):195–198

    Article  PubMed  Google Scholar 

  26. Yu LS, Chojniak R, Borba MA, Girao DS, Lourenco MTDP (2011) Prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center in Brazil. Psychooncology 20(11):1242–1245

    Article  CAS  PubMed  Google Scholar 

  27. Soares GLF, Freire RC, Biancha K, Pacheco T, Volschan A, Valenca AM, Nardi AE (2009) Use of the Hospital Anxiety and Depression Scale (HADS) in a cardiac emergency room: chest pain unit. Clinics 64(3):209–214

    Google Scholar 

  28. Carod-Artal FJ, Ziomkowski S, Mesquita HM, Martinez-Martin P (2008) Anxiety and depression: main determinants of health-related quality of life in Brazilian patients with Parkinson’s disease. Parkinsonism Related Disord 14(2):102–108

    Article  Google Scholar 

  29. Gavito MD, Ledezma P, Morales J, Villalba J, Ortega-Soto HA (1999) Effect of induced relaxation on pain and anxiety in thoracotomized patients. Salud Ment 22(5):24–27

    Google Scholar 

  30. Cruz LN, Polanczyk CA, Camey SA, Hoffmann JF, Fleck MP (2011) Quality of life in Brazil: normative values for the WHOQOL-BREF in a southern general population sample. Qual Life Res 20(7):1123–1129

    Article  PubMed  Google Scholar 

  31. Duran-Arenas L, Gallegos-Carrillo K, Salinas-Escudero G, Martinez-Salgado H (2004) Towards a Mexican normative standard for measurement of the short format 36 health-related quality of life instrument. Salud Publica Mex 46(4):306–315

    Article  PubMed  Google Scholar 

  32. Cruz LN, Camey SA, Hoffmann JF, Rowen D, Brazier JE, Fleck MP, Polanczyk CA (2011) Estimating the SF-6D value set for a population-based sample of Brazilians. Value Health 14(5):S108–S114

    Article  PubMed  Google Scholar 

  33. Skevington SM, Lotfy M, O’Connell KA (2004) The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 13(2):299–310

    Article  CAS  PubMed  Google Scholar 

  34. Mingote JC, Jiménez Arriero MA, Osorio Suárez R, Palomo T (2004) Suicidio: asistencia clínica. Guía práctica de psiquiatría médica, Madrid

    Google Scholar 

  35. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27(1):191–197

    Article  CAS  PubMed  Google Scholar 

  36. Smets EMA, Garssen B, Bonke B, Dehaes JCJM (1995) The multidimensional fatigue inventory (MFI): psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325

    Article  CAS  PubMed  Google Scholar 

  37. Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol 67(6):1063–1078

    Article  CAS  PubMed  Google Scholar 

  38. Ware JE, Kosinski M, Dewey JE, Gandek B (2001) How to score and interpret single-item health status measures: a manual for users of the SF-8™ health survey. QualityMetric Incorporated, Lincoln

    Google Scholar 

  39. Henrich G, Herschbach P (2000) Questions on Life Satisfaction (FLZ(M)): a short questionnaire for assessing subjective quality of life. Eur J Psychol Assess 16(3):150–159

    Article  Google Scholar 

  40. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  41. Rammstedt B, John OP (2007) Measuring personality in one minute or less: a 10-item short version of the big five inventory in English and German. J Res Pers 41(1):203–212

    Article  Google Scholar 

  42. Steiger JH (1990) Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res 25(2):173–180

    Article  Google Scholar 

  43. Bentler PM, Bonett DG (1980) Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 88(3):588–606

    Article  Google Scholar 

  44. Tucker LR, Lewis C (1973) Reliability coefficient for maximum likelihood factor analysis. Psychometrika 38(1):1–10

    Article  Google Scholar 

  45. Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6(1):1–55

    Article  Google Scholar 

  46. Departamento Administrativo Nacional de Estadistica (DANE) (2013). http://www.dane.gov.co

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Acknowledgments

The study was funded by the “Fondo de Promoción para Profesores Asistentes” (FAPA-Fund to promote research of Assistant Professors) awarded to Carolyn Finck by the Universidad de los Andes, Bogotá, Colombia. The funding source had no role in designing the study, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103, Leipzig, Germany

    Andreas Hinz & Heide Glaesmer

  2. Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia

    Carolyn Finck & Yvonne Gómez

  3. Institute of Medical Psychology, Charité University Medicine, Berlin, Germany

    Isolde Daig

  4. Department of Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany

    Susanne Singer

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  1. Andreas Hinz
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Correspondence to Andreas Hinz.

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Hinz, A., Finck, C., Gómez, Y. et al. Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale (HADS). Soc Psychiatry Psychiatr Epidemiol 49, 41–49 (2014). https://doi.org/10.1007/s00127-013-0714-y

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