Validation of the Polish version of the Hospital Anxiety and Depression Scale in three populations of gynecologic patients

Introduction: We analyzed the psychometric properties of the Polish version of the Hospital Anxiety and Depression Scale (HADS) in gynecologic patients. Material and methods: A total of 252 patients, consisting of three subgroups endocrinologic gynecology (n = 67), high-risk pregnancy (n = 124), and outpatient gynecologic clinic (n = 61) responded to the HADS, the 12-item Well-being Questionnaire (W-BQ12), the Spielberger State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory-II (BDI-II), and the Hamilton Depression Scale (HAMD). Socio-demographic data were obtained by self-report and interviews. Results: The HADS presented good internal consistency with Cronbach's alpha at 0.84 and 0.78 for depression and anxiety subscales, respectively, and 0.88 for the whole questionnaire. The principal component analysis with Eigenvalues > 1 revealed a three-factor structure. Factors 1 (depression), and 2 (anxiety), as well as the separate Factor 3, explained 23.48%, 21.42%, and 12.07% of the variance, respectively. The items with shared loadings were A1, A3, and A6. The HADS scores correlated strongly with other depression and well-being scales, but not with STAI-X1/X2. Conclusions: The Polish HADS revealed a three-factor structure, and 3/7 HADS-A items showed ambiguous factor loadings. All other psychometric properties were satisfactory. The HADS seems to be suitable for use in gynecologic patients, preferentially as an indicator for global psychological distress.