Assessment of Construct Validity and Reliability of the Hospital Anxiety and Depression Scale in Greek Couples With Infertility Undergoing In Vitro Fertilization Cycles.

INTRODUCTION

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument created to assess anxiety and depression symptoms during the experience of various health problems. It has also been increasingly applied to populations facing infertility. The current cross-sectional study aimed to assess the construct validity and reliability of the HADS in a sample of Greek participants undergoing in vitro fertilization (IVF) cycles.

MATERIALS AND

METHODS

This study included 90 couples with infertility referred to an assisted reproduction unit in Heraklion, Greece, and an infertility center in Athens, Greece. To validate the scale, confirmatory factor analyses (CFA) were performed. Several goodness-of-fit indices were utilized including the comparative fit index (CFI), the root mean squared error of approximation (RMSEA), the standardized root mean square residual (SRMR), and normed chi-square index with the degree of freedom (c2/df). The reliability analysis was conducted by calculating Cronbach's alpha.

RESULTS

The confirmatory factor analysis revealed that all of the four fitness indexes were good (x2/df=1.489, CFI=0.943, RMSEA=0.052, SRMR=0.055). Based on the item-scale correlation coefficients, reliability was very good for the anxiety factor (alpha = 0.808), good for the depression factor (alpha = 0.707), and very good for the total questionnaire (alpha = 0.858).

CONCLUSION

The results of confirmatory factor analyses and reliability analyses proved that HADS met the criteria of construct validity and reliability, making it suitable for use with couples undergoing an IVF cycle. Examining negative emotions, such as anxiety and depression, during the period of fertility problems and its treatment is important to evaluate the psychological maladjustment of couples with infertility and to create psychological interventions by health professionals that help individuals with infertility manage distress during IVF.