The validity of the Hospital Anxiety and Depression Scale: An updated literature review

Study objective: The aim of this paper is to systematically review and analyse the validity and reliability of Antonovsky’s life orientation questionnaire/sense of coherence scale (SOC). Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992–2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: The SOC questionnaire has been used in at least 33 languages in 32 countries with at least 15 different versions of the questionnaire. In 124 studies using SOC-29 the Cronbach’s α ranges from 0.70 to 0.95. The α values in 127 studies using SOC-13 range from 0.70 to 0.92, and in 60 studies using a modified SOC scale range from 0.35 to 0.91. Test-retest correlation show stability and range from 0.69 to 0.78 (1 year), 0.64 (3 years), 0.42 to 0.45 (4 years), 0.59 to 0.67 (5 years) to 0.54 (10 years). The means of SOC-29 range 100.50 (SD 28.50) to 164.50 (SD 17.10) points and SOC-13 from 35.39 (SD 0.10) to 77.60 (SD 13.80) points. After 10 years SOC seems to be comparatively stable, but not as stable as Antonovsky initially assumed. SOC tends to increase with age. The factorial structure of SOC seems rather to be multidimensional than unidimensional. SOC predicts a positive outcome in a long term perspective, although there are divergent findings reported. The SOC scale seems to be a reliable, valid, and cross culturally applicable instrument measuring how people manage stressful situations and stay well.

https://jech.bmj.com/content/jech/59/6/460.full.pdf

Validity of Antonovsky’s sense of coherence scale: a systematic review

Study objective: The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions. Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992–2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people’s health but does not alone explain the overall health. Conclusion: SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.

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Antonovsky’s sense of coherence scale and the relation with health: a systematic review

Background The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.

Aims To examine the psychometric properties of the HAD scale in a large population.

Method All inhabitants aged 20-89 years ( n =92 100) were invited to take part in The Nord-Trondelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms ( n =51 930) formed the basis for the psychometric examinations.

Results Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both subscales were found to be internally consistent, with values of Cronbach's coefficient (α) being 0.80 and 0.76, respectively.

Conclusions Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.

/pdf/hospital-anxiety-and-depression-had-scale-factor-structure-5bqc4y8uz0.pdf

Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population.

The aim of this paper is to synthesise findings on the salutogenic concept, sense of coherence (SOC), and its correlation with quality of life (QoL). This study is descriptive and analytic, with a systematic integration of the contemporary knowledge base on the salutogenic research published in 1992–2003. This review includes 458 scientific publications and 13 doctoral theses on salutogenesis. In all, 32 papers had the main objective of investigating the relationship between SOC and QoL. This study is based on scientific publications in eight authorised databases, doctoral theses and available books. The SOC seems to have an impact on the QoL; the stronger the SOC, the better the QoL. Furthermore, longitudinal studies confirm the predictive validity of the SOC for a good QoL. The findings correspond to the core of the Ottawa Charter—that is, the process of enabling people to live a good life. Therefore, a certain possibility to modify and extend the health construct is becoming discernible, implicating a construct including salutogenesis and QoL. The SOC concept is a health resource, influencing QoL.

/pdf/antonovsky-s-sense-of-coherence-scale-and-its-relation-with-k8bhm1wzvr.pdf

Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review

. The paper proposes that Antonovsky's salutogenic orientation and his sense of coherence (SOC) concept provide a sound theoretical basis for the study and strengthening of the caring component in clinical practice. In order to study the operational utility of the concept, the 29-item SOC questionnaire (in two formats) was administered to five Swedish samples (3 groups of nurses, patients in a hospital emergency department, and a general population sample). Psychometric data are provided which test the internal and test-retest reliability of the SOC scale. A Self-Motivation Inventory (SMI) and the Karolinska Scales of Personality (KSP) were used to test the relation between the SOC concept and personality traits. The results revealed that those with strong SOC also scored as having more general motivation and less Somatic and Psychic Anxiety as well as less Hostility. In addition the data, though in some part modest in sample size, consistently supported the view that the SOC scale is a robust instrument. Particular note is taken of its crosscultural character and of its potential utility in clinical work.

The sense of coherence concept and its relation to personality traits in Swedish samples.

The paper presents reference values of the questionnaires Sense of Coherence scale (SOC), measuring self-rated prerequisite for coping ability, and Sickness Impact Profile (SIP), measuring self-rated functional status. The sample used is randomly selected from a Swedish urban population consisting of 145 individuals (75 women, 70 men), divided into three age groups, 26–40, 41–55 and 56–70 years.

The mean SOC score was 151 (SD 18) and was not related to gender or age. The total SIP score was low (median 0) as expected in a general population. However, again as expected, the results revealed the functional status being worse in the older group of individuals than in the younger ones. The results might give further validity to the test. The SOC scores were significantly correlated to the overall SIP scores and to the subscales of mental and social character and not to those of a physical nature. Thus, the weaker the SOC the worse the functional status. These findings are suggested to give the Sense of Coherence scale a discriminating validity.

A single item concerning general health was also rated by the individuals showing the better the general health the stronger the SOC and the less the dysfunction.

Coping ability and functional status in a Swedish population sample.

Background. Few studies, prospective or retrospective, exist that describe the quality of life of patients with oral or pharyngeal cancer. This study describes functional status, measured by the sickness impact profile (SIP), and coping, measured by the sense of coherence (SOC) scale, in a group of patients treated by surgery for oral or pharyngeal cancer.



Methods. Forty-two patients, divided into two groups, participated in the study. Twenty-seven patients completed SIP and SOC scale 12 months after treatment (the 12-month follow-up group), and 15 patients completed SIP and SOC scale before surgery and SIP 2-4 months and 12 months after treatment (the prospective group). The patients were also classified according to the extensiveness of their surgery: minor, moderate, or major.



Results. The psychosocial and physical functioning as well as the functions of recreation/pastimes, sleep/rest, home management, work, and eating were rated as being impaired 2-4 months and also 12 months after treatment. However, the obtained values were spread over a wide range, with large individual differences. Functional limitations were related to more extensive surgery and also to less successful coping.



Conclusion. This study reveals the need of individualized rehabilitation for these patients, and that the SIP and the SOC scale may serve as evaluation tools in a rehabilitation program.

Functional status and coping in patients with oral and pharyngeal cancer before and after surgery.

Major depression is a common illness, with a lifetime prevalence rate of 10-13% for men and 21-24% for women. The experience of having a serious illness such as major depression affects the individual's quality of life and requires significant adaptation in order to cope. The aim of this study was to explore sense of coherence and social support in patients treated for a first episode of major depression in a 1-year follow up. The study design was prospective and longitudinal. A total of 24 patients, aged 18 years or over, with a first episode of major depression were included. Semi-structured interviews and self-assessment questionnaires were used at baseline as well as in a 1-year follow up in order to measure the level of severity of the depression, social support, and sense of coherence. The result showed that 71% of the patients had recovered at follow up. The sense of coherence scores were low at baseline, although the patients who recovered increased their sense of coherence scores significantly. Another factor of importance for recovery was a significant increase in social support. Social support is an important cornerstone in the restoration of a person's sense of coherence. It can be used in interventions that include the patient's family or close social network in combination with support to assist the patient to view his/her situation as comprehensible, manageable, and meaningful, thereby promoting or improving health. Mental health nurses are in a key position to identify patients' strengths and weaknesses so that the support and interventions provided can be tailored to meet the needs of each patient.

Sense of coherence and social support in relation to recovery in first-episode patients with major depression : a one-year prospective study

The purpose of this study was to describe the perceived eating problems, general symptoms, and general health of a group of oral- and pharyngeal- cancer patients before surgery in order to facilitate nursing care planning. A total of 29 patients (20 men and nine women) participated. Two groups were formed: in group 1, 13 patients participated before and, in group 2, 16 patients participated after the presurgical radiotherapy. Questionnaires were used to collect data. Eating disabilities were evident in both groups. The patients who had had their radiation therapy experienced problems such as bad taste function, mouth dryness, difficulties in chewing, and mouth pain more frequently than those who had not been treated. Only five patients in group 2 ate solid food, compared with 10 in group 1. Shoulder and back pain and feelings of worry and anxiety were perceived as the most frequent general symptoms. Most of the patients perceived their general health as being rather good, but some indicated poor health, several symptoms, poor appetite, and/or severe eating problems. Patients with oral and pharyngeal cancer should be carefully assessed before surgery because of their disparity of symptoms and disabilities so as to identify those who need specific nursing interventions.

Ann Langius

Papers

The sense of coherence concept and its relation to personality traits in Swedish samples.

Coping ability and functional status in a Swedish population sample.

Functional status and coping in patients with oral and pharyngeal cancer before and after surgery.

Sense of coherence and social support in relation to recovery in first-episode patients with major depression : a one-year prospective study

Oral- and pharyngeal-cancer patients' perceived symptoms and health.