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UBC Theses and Dissertations

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UBC Theses and Dissertations

Exploring response processes validity evidence of the hospital anxiety and depression scale for individuals with traumatic brain injuries Glazewski, Karla Marlene


Anxiety and depressive disorders are commonly experienced after a traumatic brain injury (TBI). Hence, it is necessary to have screening tools for these disorders that allow test users to make inferences from test scores that are reliable and valid. One screening tool, the Hospital Anxiety and Depression Scale (HADS), has limited and inconsistent reliability and validity evidence for use with individuals with TBIs. Therefore, the purpose of this study was to explore response processes validity evidence of the HADS anxiety subscale (HADS-A) and depression subscale (HADS-D) for use with individuals with TBIs. Participants included 22 individuals who ranged in age from 22 to 63 years old and who had sustained one or more TBIs in adulthood. A cognitive interview was conducted in order to collect data on the response processes used during the completion of the HADS. Descriptive results revealed that the HADS-A showed ‘adequate’ and the HADS-D showed ‘poor’ response processes validity evidence (78.0% and 64.3%, respectively, of item scores coded as valid). Results from the thematic analysis revealed problematic interpretations of particular items, such as 72.7% of participants expressing that Item #8D: “I feel as if I am slowed down” was asking about TBI symptoms, rather than a symptom of depression. The response processes validity evidence findings from this study is discussed within the context of the extant validity evidence of the HADS for use with individuals with TBIs presented in the literature, and it is not recommended that HADS-A and HADS-D scores are used to make inferences about anxiety and depressive symptomatology among individuals with TBIs, as it is currently written. Therefore, the findings from this study were used to make specific recommendations about modifications to the instructions and items on the HADS for use with individuals with TBIs. The results of this study should be relayed to various professionals (e.g., counsellors, psychologists, and healthcare professionals) in order to inform the extent to which it is appropriate to interpret scores from the HADS to infer anxiety and depressive symptomatology for persons with TBIs.

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