Rasch analysis of the hospital anxiety and depression scale in patients with chronic fatigue syndrome, 2025, Bartholomew, Chalder et al

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Journal of Psychosomatic Research
Available online 3 September 2025, 112370
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Rasch analysis of the hospital anxiety and depression scale in patients with chronic fatigue syndrome​


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Emerson J. Bartholomew a, Oleg N. Medvedev b, Keith J. Petrie a, Trudie Chalder c
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https://doi.org/10.1016/j.jpsychores.2025.112370
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Highlights​

  • •
    Rasch analysis validated the HADS in patients with CFS.
  • •
    Content preserved, subtests resolved local dependence issues without item deletion.
  • •
    Ordinal-to-interval conversion, 45 % reduction in measurement error.
  • •
    No differential item functioning across gender and age groups detected.

Abstract​

Background​

The Hospital Anxiety and Depression Scale (HADS) is widely utilized for assessing psychological distress in medical populations, yet its clinimetric properties in chronic fatigue conditions remain underexplored. Given the complex symptom presentation in chronic fatigue syndrome (CFS), rigorous clinimetric validation is essential for accurate clinical assessment.

Objective​

This study aimed to evaluate the clinimetric properties of the HADS using Rasch methodology in patients with CFS, with particular emphasis on dimensionality, item functioning, and measurement precision.

Methods​

Rasch analysis was conducted on HADS responses from 286 participants diagnosed with CFS. The Partial Credit Rasch model was applied to assess overall model fit, item performance, unidimensionality and differential item functioning.

Results​

Initial analysis revealed suboptimal model fit, necessitating subtest modifications to address local response dependence. The subtest solution demonstrated acceptable fit to the Rasch model with evidence of strict unidimensionality, high reliability (PSI = 0.87), and no differential item functioning by demographic variables. Rasch-converted interval scores showed improved measurement precision compared to ordinal scoring. Interval scoring yielding a significantly higher mean (M = 22.55, SD = 3.78) compared to unconverted scoring (M = 20.30, SD = 6.87), t(275) = −19.54, p < .001, indicating that ordinal scoring systematically underestimates the latent trait level. Interval scores showed a 45 % reduction in measurement error demonstrated by the substantial reduction in standard error.

Conclusions​

The HADS demonstrated acceptable measurement properties in patients with CFS. The development of ordinal-to-interval conversion tables enhances the scale's precision, supporting its continued use in clinical and research contexts.

Keywords​

Chronic fatigue syndrome
Invariance
Measurement
Rasch analysis
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How on earth do you validate a scale without checking if you’re actually measuring what you think it measures? Or if non-anxiety or -depression traits might influence the measurements?

Saying «this person is fatigued, less able to do things they enjoy and worried about their future, so the are depressed/have anxiety» is completely inappropriate when applied to people that are sick in general.
 
See also

By Emerson J Bartholomew

Which fatigue scale should I use? A Rasch analysis of two fatigue scales in inflammatory conditions​


pubmed.ncbi.nlm.nih.gov

Which fatigue scale should I use? A Rasch analysis of two fatigue scales in inflammatory conditions - PubMed

The BRAF-MDQ and CFQ are valid, reliable tools for fatigue assessment. Psychometric indices and content factors suggest the CFQ is suited to measuring general fatigue, particularly when response burden is a concern, while the BRAF-MDQ should be used in clinical presentations where other symptoms...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Trish said:
I notice 3 of the authors are at New Zealand universities, and Chalder is still at King's in London. Does this mean anything?
Click to expand...

https://profiles.waikato.ac.nz/oleg.medvedev seems to focus on the methodology inc eg Rasch analysis

Emerson Bartholomew seems to be a pyschometrician, also focusing on validating eg scales.

https://us.sagepub.com/en-us/nam/author/keith-j-petrie seems to focus on research into health psychology including placebo and nocebo and how perceptions of treatment influence outcomes. https://keith-petrie.blogs.auckland.ac.nz/

He seems to have appeared on the following paper/research with Chalder in 2022 on allopurinol: https://pubmed.ncbi.nlm.nih.gov/35169055/

and also has a paper on cfs from back in 1995 with Moss-Morris: https://pubmed.ncbi.nlm.nih.gov/7760301/

The following page lists common co-authors for him: https://www.researchgate.net/scientific-contributions/Keith-J-Petrie-14221085

I don't know what the norm is output-wise but I filtered by the last 5yrs and 43 papers came up for him: https://pubmed.ncbi.nlm.nih.gov/?term=Petrie KJ&filter=datesearch.y_5&page=4


There is the following from Chalder in 2024 which is about New Zealand (cortisol in hair during the pandemic) with different NZ-based authors: https://pubmed.ncbi.nlm.nih.gov/38404507/

but she also seems to have produced a lot of papers in the last few years with non-New Zealand authors: https://www.researchgate.net/profile/Trudie-Chalder
 
bobbler said:
there also seems to be this paper from them: https://kclpure.kcl.ac.uk/ws/portal...fatigue_scale_should_I_use_ERJ_1_Jan_2025.pdf which compares the CFQ with the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)
Click to expand...
BRAD-MDQ stood out because Bristol. It was developed by University of West England UWE and it is a PROM

Rheumatoid arthritis fatigue research - MAMBO | UWE Bristol

Rheumatoid arthritis fatigue research from the Centre for Health and Clinical Research (CHCR) at UWE Bristol.
www.uwe.ac.uk www.uwe.ac.uk
 
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