An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in patients with breast cancer

BACKGROUND: To determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer and determine the suitability of the instrument for use with this clinical group. METHODS: A cross-sectional design was used. The study used a pooled data set from three breast cancer clinical groups. The dependent variables were HADS anxiety and depression sub-scale scores. Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 110 patients with breast cancer. Seven models were tested to determine model fit to the data. RESULTS: Both factor analysis methods indicated that three-factor models provided a better fit to the data compared to two-factor (anxiety and depression) models for breast cancer patients. Clark and Watson's three factor tripartite and three factor hierarchical models provided the best fit. CONCLUSION: The underlying factor structure of the HADS in breast cancer patients comprises three distinct, but correlated factors, negative affectivity, autonomic anxiety and anhedonic depression. The clinical utility of the HADS in screening for anxiety and depression in breast cancer patients may be enhanced by using a modified scoring procedure based on a three-factor model of psychological distress. This proposed alternate scoring method involving regressing autonomic anxiety and anhedonic depression factors onto the third factor (negative affectivity) requires further investigation in order to establish its efficacy

Race, Same-Sex Marriage, and White Privilege: The Problem with Civil Rights Analogies

February 2005 marked the one-year anniversary of what has been dubbed the Winter of Love. It has been impossible for me not to ruminate a bit on what was happening in San Francisco a year ago. There have been many moments when I have been very pleased that the National Center for Lesbian Rights is based in San Francisco. One of those moments was February 6, 2004 when I got a call from Mayor Gavin Newsom\u27s Chief of Staff informing me that on the following Monday morning the mayor was going to begin issuing marriage licenses to lesbian and gay couples in San Francisco. I would like to say that I was immediately ecstatic and supportive, but I was very concerned about the ramifications of the Mayor\u27s action- particularly for our colleagues in Massachusetts who were then dealing with the fallout from the recent Massachusetts Supreme Judicial Court ruling. My colleagues in Massachusetts and across the country shared my reservations and concerns, but many were also enamored with the idea. And to the legal and political activists in Massachusetts, the idea held great allure. Finally, that state would not be the lone front on which the right to marry was being contested