Validity and reliability of the Danish version of the Hospital Anxiety and Depression Scale (HADS) in patients with major lower extremity amputations: A psychometric study.

Background: Patients undergoing major lower extremity amputation (LEA) due to vascular disease face an increased risk of post-surgery anxiety and depression. The Hospital Anxiety and Depression Scale (HADS), widely used to identify anxiety and depressive symptoms, has been translated into Danish, but its content validity has not previously been tested in LEA patients. This study aims to test the validity and reliability of HADS in this population.

Method: This methodological study involved cognitive interviews with 10 major LEA patients to assess content validity and HADS responses from 100 patients to evaluate the floor and ceiling effects, construct validity, and internal consistency reliability. Data were collected from seven orthopedic departments across Denmark.

Results: In this hospital-based study, 20% had anxiety symptoms and 18% had depressive symptoms before discharge. Patients found the questionnaire relevant but had concerns about the one-week timeframe and the comprehensibility of certain items ("butterflies in the stomach" in item 9 and the term "things" in items 2 and 12). Floor effects were present across all items, with no ceiling effects. Confirmatory factor analysis supported both the original two-factor and a three-factor structure. Internal consistency reliability was good for both subscales.

Conclusion: This study supports the validity and reliability of the Danish version of HADS for assessing anxiety and depression in patients with major lower extremity amputation (LEA). The questionnaire serves as a valuable tool for addressing psychosocial challenges, enabling patients to reflect on their mental health and recognize potential symptoms needing medical attention in the future.