Is the hospital anxiety and depression scale (HADS) a reliable screening tool in early pregnancy?

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Abstract
The factor structure and internal reliability of the Hospital Anxiety and Depression Scale (HADS) was investigated to determine the suitability of the instrument for screening during early pregnancy. The study used a cross-sectional design with all observations taken at the antenatal booking clinic. Confirmatory factor analysis (CFA) of the HADS revealed that a three-factor solution offered the most parsimonious account of the data. However, the CFA further revealed that none of the factor models tested provided a consistent and good fit to the data. It was concluded that the HADS does not reliably assess distinct domains of anxiety and depression in early pregnancy. These findings suggest that the HADS is not a suitable screening tool for symptoms of anxiety and depression in this clinical group.