Factor structure and use of the Hospital Anxiety and Depression Scale in the homeless and socially marginalised

The homeless have been identified as a group at risk of significant anxiety and depression and screening is therefore highly desirable to identify those needing psychological and psychiatric support. However, the psychometric properties of routine screening instruments have yet to be established in this group. This study sought to determine the psychometric properties of the widely used Hospital Anxiety and Depression Scale in this group. Using a cross-sectional design, 314 clients presenting at homelessness units (shelters) supported by The Salvation Army were administered the HADS. Confirmatory factor analysis revealed three-factor models offered the best fit to the data (best-fit model CFI = .98, RMSEA = .06, WRMR = .87). This investigation confirms contemporary research findings that the HADS comprises an underlying tri-dimensional factor structure. However, the internal consistency of the HADS anxiety (alpha = .81) and depression (alpha = .90) sub-scales was excellent. The findings of the current study suggest that the HADS is a suitable screening tool in this group.

Keywords: Anxiety; depression; HADS; homelessness; psychometrics