ArticleAmerican journal of critical care : an official publication, American Association of Critical-Care Nurses2021
Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients.
Article in American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Rethinking Regret: Reappraisal Tendencies Buffer Regret for ICU Surrogates Following Patient Death.Western journal of nursing research · 2025Trial
- Assessing adult attachment after out-of-hospital cardiac arrest: an exploratory analysis and construct validation of the ECR-RS.Resuscitation plus · 2026Article
- Development and Validation of a Nomogram Prediction Model for Key Symptoms of Post-Intensive Care Syndrome-Family in Family Members of Critically-Ill Patients: Focusing on Sleep Disturbance, Fatigue, Anxiety, and Depression.Risk management and healthcare policy · 2025Article
- Parental Self-Efficacy and Personal Time Help Explain Impact of Parent-Staff Interactions on Parental Distress and Bonding in the Neonatal Intensive Care Unit.The Journal of pediatrics · 2025Article
- Sociocultural Moderators of Emotion Regulation in Family Members of the Critically Ill.Western journal of nursing research · 2022Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined.
objectiveTo examine the structural validity of the HADS.
methodsThis study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis.
resultsThe bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items.
conclusionConfirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.