The Factor Structure of the Hospital Anxiety and Depression Scale (HADS) in a Traumatic Brain Injury (TBI) Population

Clive Skilbeck, Kieran Holm, Mark Slatyer, Matthew Thomas, Tony Bell

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
24 Downloads (Pure)


Primary Objectives: To examine the HADS structure in TBI, using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and investigate the effects of TBI severity, Gender, and Age on factor scores.Methods and Procedures: HADS data from 186 TBI patients in a population study in Tasmania were subjected to EFA. HADS data from a second sample of 185 TBI participants in the same study underwent CFA. One-month follow-up data were used, allowing inclusion of severe TBI patients whilst still being early post-injury. Factor loadings were used to investigate the effects of demographic and clinical variables at two weeks post-injury.Results: Whilst EFA suggested 2- factor (anxiety, depression) and 3-factor (anxiety, psychomotor, depression) structures provided adequate descriptions, CFA strongly supported the 3-factor model. Using this model, significant effects of TBI severity were noted on Psychomotor and Depression scores at two weeks post-injury. Males reported significantly fewer symptoms on all three factors, as did younger participants.Conclusions: CFA indicates that a 3-factor model provides the best fit for HADS data in TBI. One factor, Psychomotor, has been relatively neglected in the literature, and the current findings suggest its assessment and rehabilitation should receive more attention.
Original languageEnglish
Pages (from-to)22-32
Number of pages11
JournalBrain Injury
Issue number1
Publication statusPublished - May 2011


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