Volume 15, Issue 5 (6-2017)                   IJRM 2017, 15(5): 287-296 | Back to browse issues page

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Amini P, Maroufizadeh S, Omani Samani R. Evaluating the factor structure, item analyses, and internal consistency of hospital anxiety and depression scale in Iranian infertile patients. IJRM. 2017; 15 (5) :287-296
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-823-en.html
1- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
2- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , samani@royaninstitute.org
Abstract:   (771 Views)
Background: The hospital anxiety and depression scale (HADS) is a commonscreening tool designed to measure the level of anxiety and depression in differentfactor structures and has been extensively used in non-psychiatric populations andindividuals experiencing fertility problems.
Objective: The aims of this study were to evaluate the factor structure, itemanalyses, and internal consistency of HADS in Iranian infertile patients.
Materials and Methods: This cross-sectional study included 651 infertile patients(248 men and 403 women) referred to a referral infertility Center in Tehran, Iranbetween January 2014 and January 2015. Confirmatory factor analysis was used todetermine the underlying factor structure of the HADS among one, two, and threefactormodels. Several goodness of fit indices were utilized such as comparative,normed and goodness of fit indices, Akaike information criterion, and the root meansquared error of approximation. In addition to HADS, the Satisfaction with LifeScale questionnaires as well as demographic and clinical information wereadministered to all patients.
Results: The goodness of fit indices through CFAs exposed that three and one-factormodel provided the best and worst fit to the total, male and female datasetscompared to the other factor structure models for the infertile patients. TheCronbach’s alpha for anxiety and depression subscales were 0.866 and 0.753respectively. The HADS subscales significantly correlated with SWLS, indicating anacceptable convergent validity.
Conclusion: The HADS was found to be a three-factor structure screeninginstrument in the field of infertility.
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Type of Study: Original Article |

1. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003; 1: 29. [DOI:10.1186/1477-7525-1-29]
2. Matsudaira T, Igarashi H, Kikuchi H, Kano R, Mitoma H, Ohuchi K, Kitamura T. Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations. Health Qual Life Outcomes 2009; 7:42. [DOI:10.1186/1477-7525-7-42]
3. Razavi D, Delvaux N, Farvacques C, Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatr 1990; 156: 79-83. [DOI:10.1192/bjp.156.1.79]
4. Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: A review. J Edu Res 2006; 99: 323-338. [DOI:10.3200/JOER.99.6.323-338]
5. Walker L, Heys S, Walker M, Ogston K, Miller I, Hutcheon A, Sarkar T, Ah-See A, Eremin O. Psychological factors can predict the response to primary chemotherapy in patients with locally advanced breast cancer. Eur J Cancer 1999; 35: 1783-1788. [DOI:10.1016/S0959-8049(99)00169-0]
6. Martin CR, Tweed AE, Metcalfe MS. A psychometric evaluation of the hospital anxiety and depression scale in patients diagnosed with end‐stage renal disease. Br J Clin Psychol 2004; 43: 51-64. [DOI:10.1348/014466504772812968]
7. Caci H, Baylé FJ, Mattei V, Dossios C, Robert P, Boyer P. How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects? Psychiatr Res 2003; 118: 89-99. [DOI:10.1016/S0165-1781(03)00044-1]
8. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnormal Psychol 1991; 100: 316. [DOI:10.1037/0021-843X.100.3.316]
9. Dunbar M, Ford G, Hunt K, Der G. A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. Br J Clin Psychol 2000; 39: 79-94. [DOI:10.1348/014466500163121]
10. Andersson E. The hospital anxiety and depression scale: Homogeneity of the subscales. Soc Behav Personal 1993; 21: 197-204. [DOI:10.2224/sbp.1993.21.3.197]
11. Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, Tennant A. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 2012; 12: 6. [DOI:10.1186/1471-244X-12-6]
12. Cosco TD, Doyle F, Watson R, Ward M, McGee H. Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease. General Hospital Psychiatr 2012; 34: 167-172. [DOI:10.1016/j.genhosppsych.2011.11.005]
13. Barth J, Martin CR. Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients. Health Qual Life Outcomes 2005; 3: 15. [DOI:10.1186/1477-7525-3-15]
14. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22: 1506-1512. [DOI:10.1093/humrep/dem046]
15. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012; 9: e1001356. [DOI:10.1371/journal.pmed.1001356]
16. Connolly KJ, Edelmann RJ, Cooke ID, Robson J. The impact of infertility on psychological functioning. J Psychosomatic Res 1992; 36: 459-468. [DOI:10.1016/0022-3999(92)90006-N]
17. Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, Jafarabadi M. A survey of relationship between anxiety, depression and duration of infertility. BMC women's Health 2004; 4: 9. [DOI:10.1186/1472-6874-4-9]
18. El Kissi Y, Romdhane AB, Hidar S, Bannour S, Idrissi KA, Khairi H, Ali BBH. General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women. Eur J Obstet Gynecol Reprod Biol 2013; 167: 185-189. [DOI:10.1016/j.ejogrb.2012.12.014]
19. Chiaffarino F, Baldini MP, Scarduelli C, Bommarito F, Ambrosio S, D'Orsi C, Torretta R, Bonizzoni M, Ragni G. Prevalence and incidence of depressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility department. Eur J Obstet Gynecol Reprod Biol 2011; 158: 235-241. [DOI:10.1016/j.ejogrb.2011.04.032]
20. Maroufizadeh S, Karimi E, Vesali S, Samani RO. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility. Int J Gynecol Obstet 2015; 130: 253-256. [DOI:10.1016/j.ijgo.2015.03.044]
21. Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR. Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertil Steril 2014; 102: 1384-1387. [DOI:10.1016/j.fertnstert.2014.07.765]
22. Fassino S, Piero A, Boggio S, Piccioni V, Garzaro L. Anxiety, depression and anger suppression in infertile couples: a controlled study. Hum Reprod 2002; 17: 2986-2994. [DOI:10.1093/humrep/17.11.2986]
23. Maroufizadeh S, Ghaheri A, Omani Samani R. Factors associated with poor quality of life among Iranian infertile women undergoing IVF. Psychol Health Med 2017; 22: 145-151. [DOI:10.1080/13548506.2016.1153681]
24. Ghaheri A, Shojaei Shahrokhabadi M, Zayeri F, Maroufizadeh S, Karimi M. Relationship among life satisfaction, anxiety and fertility quality of life in women. Koomesh 2016; 17: 957-965.
25. Maroufizadeh S, Ghaheri A, Amini P, Omani Samani R. Psychometric properties of the fertility quality of life instrument in infertile Iranian women. Int J Fertil Steril 2017; 10: 371-379.
26. Ogawa M, Takamatsu K, Horiguchi F. Evaluation of factors associated with the anxiety and depression of female infertility patients. Biopsychosoc Med 2011; 5: 15. [DOI:10.1186/1751-0759-5-15]
27. Abedini M, Ghaheri A, Omani Samani R. Assisted reproductive technology in Iran: the first nationalreport on centers, 2011. Int J Fertil Steril 2016; 10: 283-289.
28. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1: 14. [DOI:10.1186/1477-7525-1-14]
29. Maroufizadeh S, Ghaheri A, Samani RO, Ezabadi Z. Psychometric properties of the satisfaction with life scale (SWLS) in Iranian infertile women. Int J Reprod BioMed 2016; 14: 57.
30. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370. [DOI:10.1111/j.1600-0447.1983.tb09716.x]
31. Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, et al. The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiatr 1991; 158: 255-259. [DOI:10.1192/bjp.158.2.255]
32. Friedman S, Samuelian J-C, Lancrenon S, Even C, Chiarelli P. Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatr Res 2001; 104: 247-257. [DOI:10.1016/S0165-1781(01)00309-2]
33. Leung C, Ho S, Kan C, Hung C, Chen C. Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale: A cross-cultural perspective. Int J Psychosom 1993; 40: 29-34.
34. Kaur S, Zainal NZ, Low WY, Ramasamy R, Sidhu JS. Factor Structure of Hospital Anxiety and Depression Scale in Malaysian Patients With Coronary Artery Disease. Asia-Pacific J Public Health 2015; 27: 450-460. [DOI:10.1177/1010539514533719]
35. Brandberg Y, Bolund C, Sigurdardottir V, Sjödén PO, Sullivan M. Anxiety and depressive symptoms at different stages of malignant melanoma. Psycho‐Oncol 1992; 1: 71-78. [DOI:10.1002/pon.2960010204]
36. Kine RB. Principles and practice of structural equation modeling. 3rd Ed. Guilford press; London, 2012.
37. Hooper D, Coughlan J, Mullen M. Structural equation modelling: guidelines for determining model fit. Electronic J Business Res Methods 2008: 2.
38. Biringer E, Howard LM, Kessler U, Stewart R, Mykletun A. Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway. J Psychosomatic Obstet Gynecol 2015; 36: 38-45. [DOI:10.3109/0167482X.2014.992411]
39. Kahyaoglu Sut H, Balkanli Kaplan P. Quality of life in women with infertility via the FertiQoL and the Hospital Anxiety and Depression Scales. Nurs Health Sci 2015; 17: 84-89. [DOI:10.1111/nhs.12167]
40. Verma P, Rastogi R, SachdevaS, Gandhi R, Kapoor R, Sachdeva S. Psychiatr Morbid Infertil Patients Tertiar Care Setup. J Clin Diagn Res 2015; 9: VC01-VC06.
41. Osborn CE. Statistical applications for health information management. Jones & Bartlett Learning; 2006.
42. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosomat Res 2002; 52: 69-77. [DOI:10.1016/S0022-3999(01)00296-3]
43. Rodgers J, Martin CR, Morse RC, Kendell K, Verrill M. An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in patients with breast cancer. Health Qual Life Outcomes 2005; 3: 41. [DOI:10.1186/1477-7525-3-41]
44. Martin CR, Thompson DR. Prediction of quality of life in patients with end‐stage renal disease. Br J Health Psychol 2000; 5: 41-55. [DOI:10.1348/135910700168757]
45. McCue P, Martin CR, Buchanan T, Rodgers J, Scholey AB. An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in individuals with Chronic Fatigue Syndrome. Psychol Health Med 2003; 8: 425-439. [DOI:10.1080/1354850310001604568]
46. Smith AB, Selby PJ, Velikova G, Stark D. Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother 2002; 75: 165. [DOI:10.1348/147608302169625]
47. Mykletun A, Stordal E, Dahl AA. Hospital Anxiety andDepression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatr 2001; 179: 540-544. [DOI:10.1192/bjp.179.6.540]
48. Spinhoven P, Ormel J, Sloekers P, Kempen G, Speckens A, Hemert Av. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997; 27: 363-370. [DOI:10.1017/S0033291796004382]
49. Anderson K, Sharpe M, Rattray A, Irvine D. Distress and concerns in couples referred to a specialist infertility clinic. J Psychosomat Res 2003; 54: 353-355. [DOI:10.1016/S0022-3999(02)00398-7]
50. Matsubayashi H, Hosaka T, Izumi S-i, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. General Hospital Psychiatr 2004; 26: 398-404. [DOI:10.1016/j.genhosppsych.2004.05.002]
51. Glover L, Hunter M, Richards J-M, Katz M, Abel PD. Development of the fertility adjustment scale. Fertil Steril 1999; 72: 623-628. [DOI:10.1016/S0015-0282(99)00304-0]
52. Slade P, O'Neill C, Simpson AJ, Lashen H. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Hum Reprod 2007; 22: 2309-2317. [DOI:10.1093/humrep/dem115]
53. Fido A, Zahid MA. Coping with infertility among Kuwaiti women: Cultural perspectives. Int J Soc Psychiatr 2004; 50: 294-300. [DOI:10.1177/0020764004050334]

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