title: Rasch analysis of the hospital anxiety and depression scale in patients with chronic fatigue syndrome

authors: Bartholomew, Emerson J.

subjects: Chronic fatigue syndrome

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.

text: Rasch analysis of the hospital anxiety and depression scale in patients with chronic fatigue syndrome 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.

year: 2025

title: Introduction: Changing times, changing places

authors: Coleborne, Catharine

subjects: mental health

abstract: This history of Tokanui Hospital and mental health services in the Waikato is  a collection of the different stories of the many members of that community. We have chosen to tell these stories through the eyes  of several writers, with some of them perhaps even competing perspectives, hoping to capture close to the full range of responses to and experiences of mental health in the Waikato over time. Tokanui Hospital- for a time, the main focus of mental health services in the region - was itself plural and complex. Through our collectively authored history, we show how the closure of Tokanui impacted upon its many residents and staff and the wider community around the hospital, and how the dispersal of mental health functions into the community has continued to evoke resounding memories of Tokanui.

text: Introduction: Changing times, changing places This history of Tokanui Hospital and mental health services in the Waikato is  a collection of the different stories of the many members of that community. We have chosen to tell these stories through the eyes  of several writers, with some of them perhaps even competing perspectives, hoping to capture close to the full range of responses to and experiences of mental health in the Waikato over time. Tokanui Hospital- for a time, the main focus of mental health services in the region - was itself plural and complex. Through our collectively authored history, we show how the closure of Tokanui impacted upon its many residents and staff and the wider community around the hospital, and how the dispersal of mental health functions into the community has continued to evoke resounding memories of Tokanui.

year: 2012

title: Tihei Mauri Ora: A Māori response to health disparities

authors: Waitoa, Alieta Jei

subjects: Maori

abstract: Māori bear a disproportionate burden of health problems which, in concert with other factors (e.g. poor housing, low socio-economic status and low education attainment), contribute to and maintain low health status. It is noted that there have been multiple attempts to reduce health inequities – however, such attempts have been largely unsuccessful. Barriers to success include government reticence, restrictions on Māori participation in determining health directions/solutions, current contract paradigms and a reluctance to engage in meaningful partnerships with Māori. Those barriers occur within a cultural framework which defines (and therefore prioritises) the health of an individual over the needs of the collective.

The hypothesis of this research is that Māori health disparities are best addressed via the development and delivery of Māori health models by services which are oriented to kaupapa Māori principles. Utilising a case study approach, this thesis looks at the outcomes generated when a kaupapa Māori service applies key Māori principles to health service delivery. The case study, in tandem with focus group interviews identifies the key elements necessary to developing services which are responsive to the needs of Māori.

This study identified the importance of promoting change (and ultimately improve Māori health status) that encompasses the formation of a framework which considers collective benefit over individualism, encompasses Māori values, acknowledges and accepts Māoricentric clinical interventions. In addition, the thesis asserts that Māori health status will improve once Māori are active participants rather than recipients of health services.

text: Tihei Mauri Ora: A Māori response to health disparities Māori bear a disproportionate burden of health problems which, in concert with other factors (e.g. poor housing, low socio-economic status and low education attainment), contribute to and maintain low health status. It is noted that there have been multiple attempts to reduce health inequities – however, such attempts have been largely unsuccessful. Barriers to success include government reticence, restrictions on Māori participation in determining health directions/solutions, current contract paradigms and a reluctance to engage in meaningful partnerships with Māori. Those barriers occur within a cultural framework which defines (and therefore prioritises) the health of an individual over the needs of the collective.

The hypothesis of this research is that Māori health disparities are best addressed via the development and delivery of Māori health models by services which are oriented to kaupapa Māori principles. Utilising a case study approach, this thesis looks at the outcomes generated when a kaupapa Māori service applies key Māori principles to health service delivery. The case study, in tandem with focus group interviews identifies the key elements necessary to developing services which are responsive to the needs of Māori.

This study identified the importance of promoting change (and ultimately improve Māori health status) that encompasses the formation of a framework which considers collective benefit over individualism, encompasses Māori values, acknowledges and accepts Māoricentric clinical interventions. In addition, the thesis asserts that Māori health status will improve once Māori are active participants rather than recipients of health services.

year: 2014