Evaluation of the Psychometric and Structural Properties of the Spanish Version of the Hospital Anxiety and Depression Scale in Latina Cancer Patients

Context: The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure commonly used to screen for symptoms of anxiety and depression in cancer patients. The HADS has demonstrated validity in over 100 languages, including Spanish. However, validation studies have largely used European Spanish-speaking samples with a variety of medical diagnoses.

Objectives: The aim of this study was to examine the psychometric properties of the Spanish version of the HADS in a sample of Spanish-speaking Latina women with cancer in the U.S.

Methods: Participants (N = 242) completed self-report measures of anxiety and depression (HADS), quality of life (Functional Assessment of Cancer Therapy-General Version), cancer-related distress (Impact of Events Scale-Revised Version Intrusion Subscale), and cancer symptomatology (Memorial Symptom Assessment Scale-Short Form) before initiating chemotherapy and five to seven weeks later. Analyses evaluated internal consistency and test-retest reliability, construct validity, and convergent validity.

Results: Factor analysis supported a two-factor structure as proposed by the original HADS developers (X² [76, N = 242] = 143.3, P < 0.001, comparative fit index = 0.94, root-mean-square error of approximation = 0.06, and standardized root-mean-square residual = 0.06). The HADS and its subscales demonstrated good internal consistency (α = 0.83-0.88) and test-retest reliability (intraclass correlation coefficient = 0.76-0.82). Construct validity was evidenced by factor analysis and item-subscale, item-total, and subscale-total correlations. Convergent validity was demonstrated by strong positive correlations with cancer-related distress (r = 0.51-0.71) and symptom severity (r = 0.54-0.62) and strong negative correlations with quality of life (r = -0.63 to -0.76) (all P's < 0.001).

Conclusion: The Spanish version of the HADS evidenced sound psychometric properties in Latinas with cancer in the U.S., supporting its use in clinical oncology research and practice.