Rasch analysis of the hospital anxiety and depression scale in patients with chronic fatigue syndrome

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-09-03 DOI:10.1016/j.jpsychores.2025.112370

Emerson J. Bartholomew , Oleg N. Medvedev , Keith J. Petrie , Trudie Chalder

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引用次数: 0

Abstract

Background

The Hospital Anxiety and Depression Scale (HADS) is widely utilized for assessing psychological distress in medical populations, yet its clinimetric properties in chronic fatigue conditions remain underexplored. Given the complex symptom presentation in chronic fatigue syndrome (CFS), rigorous clinimetric validation is essential for accurate clinical assessment.

Objective

This study aimed to evaluate the clinimetric properties of the HADS using Rasch methodology in patients with CFS, with particular emphasis on dimensionality, item functioning, and measurement precision.

Methods

Rasch analysis was conducted on HADS responses from 286 participants diagnosed with CFS. The Partial Credit Rasch model was applied to assess overall model fit, item performance, unidimensionality and differential item functioning.

Results

Initial analysis revealed suboptimal model fit, necessitating subtest modifications to address local response dependence. The subtest solution demonstrated acceptable fit to the Rasch model with evidence of strict unidimensionality, high reliability (PSI = 0.87), and no differential item functioning by demographic variables. Rasch-converted interval scores showed improved measurement precision compared to ordinal scoring. Interval scoring yielding a significantly higher mean (M = 22.55, SD = 3.78) compared to unconverted scoring (M = 20.30, SD = 6.87), t(275) = −19.54, p < .001, indicating that ordinal scoring systematically underestimates the latent trait level. Interval scores showed a 45 % reduction in measurement error demonstrated by the substantial reduction in standard error.

Conclusions

The HADS demonstrated acceptable measurement properties in patients with CFS. The development of ordinal-to-interval conversion tables enhances the scale's precision, supporting its continued use in clinical and research contexts.

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慢性疲劳综合征患者住院焦虑抑郁量表的Rasch分析

医院焦虑抑郁量表（HADS）被广泛用于评估医疗人群的心理困扰，但其在慢性疲劳条件下的临床特性仍未得到充分研究。鉴于慢性疲劳综合征（CFS）的复杂症状表现，严格的临床验证对于准确的临床评估至关重要。目的本研究旨在利用Rasch方法评估CFS患者HADS的临床特性，特别强调维度，项目功能和测量精度。方法对286例CFS患者的HADS应答进行问卷调查分析。采用部分信用Rasch模型评估整体模型拟合、项目绩效、单项性和差异项目功能。结果初步分析显示模型拟合欠佳，需要修改子测试以解决局部响应依赖性。子测试解决方案显示出可接受的拟合Rasch模型与证据严格的单维性，高可靠性（PSI = 0.87），没有差异项目功能的人口统计变量。与顺序评分相比，rasch转换间隔评分显示出更高的测量精度。间隔计分产生的均值（M = 22.55, SD = 3.78）显著高于未转换计分（M = 20.30, SD = 6.87）， t(275) = - 19.54, p < 0.001，表明顺序计分系统性地低估了潜在性状水平。间隔分数显示测量误差减少了45%，这可以通过标准误差的大幅减少来证明。结论HADS在CFS患者中具有可接受的测量特性。序数到间隔转换表的开发提高了该量表的精度，支持其在临床和研究环境中的持续使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.