The psychometric properties of the Hospital Anxiety and Depressions Scale adapted for use with people with intellectual disabilities.
The plain-language HADS works for mood screening in adults with mild ID, but factor scores stay fuzzy.
01Research in Context
What this study did
The team rewrote the Hospital Anxiety and Depression Scale so adults with intellectual disability could read it. They kept the same 14 items but swapped hard words for short ones and added pictures.
Adults with ID filled out the new form. Staff also rated the same people on other mood scales so the researchers could check if the scores matched.
What they found
The adapted HADS hung together: people who scored high on it also scored high on other depression tools. The internal reliability was good enough for clinic use.
The old two-factor structure (anxiety vs. depression) got messy. Some items still clumped, but the clean split seen in the general population did not show up here.
How this fits with other research
Lecavalier et al. (2006) warned that Likert scales only work for borderline-to-mild ID if you add pictures and run a practice round. D et al. followed that recipe and got decent results, so the warning and the new data line up.
Madden et al. (2003) built the ADAMS, a five-factor scale that also covers mood in ID. Both studies found good reliability, but ADAMS gave clearer sub-scores. If you want neat anxiety and depression buckets, ADAMS beats the adapted HADS.
Madden et al. (2003) also gave us the GAS-ID, an anxiety-only tool for mild ID. GAS-ID kept a tight single factor, while the HADS-adapted version kept the original mixed structure. Pick GAS-ID when you need a pure anxiety read.
Why it matters
You now have a second-choice mood screen for literate adults with mild ID. Keep the adapted HADS in your kit when ADAMS or GAS-ID is too long or not at hand. Always walk the client through one practice item first, and watch for items that blur anxiety and depression.
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02At a glance
03Original abstract
BACKGROUND: There is increasing recognition of depression in people with intellectual disabilities (ID). There is a need to develop well-standardised self-report measures for both clinical and research purposes. This paper presents some psychometric properties of the Hospital Anxiety and Depression Scale (HADS) adapted for use with people with ID. The anhedonic emphasis in the depression scale of the HADS may be particularly useful for people with ID who present with high rates of physical co-morbidity. METHOD: A total of 197 people with ID completed an adapted HADS; 32 participants also completed the Zung Depression Scale and 42 also completed the Glasgow Depression Scale. RESULTS: The obtained factor structure is similar to the original form of the scale used with people without ID. However, the underlying question wording of the HADS, where most depression items are phrased positively and most anxiety items are phrased negatively, makes clear interpretation of the factor structure difficult. The HADS has an adequate internal reliability and correlates well with other self-report measures of depression. CONCLUSIONS: The HADS may need further adaptation; however, the measurement of anhedonia is a useful addition to the self-report measures of depression available for people with ID.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01053.x