General distress and symptoms of anxiety and depression: A factor analysis in two cohorts of dialysis patients

Robbert W. Schouten, Els Nadort, Wouter van Ballegooijen, Wim L. Loosman, Adriaan Honig, Carl E.H. Siegert, Yvette Meuleman, Birit F.P. Broekman

Research output: Contribution to journalArticleAcademicpeer-review


Objective: Depression and anxiety often coexist in patients with end-stage-kidney disease. Recently, studies showed that a composite ‘general distress score’ which combines depression and anxiety symptoms provides a good fit in dialysis and oncology patients. We aim to investigate if the three most frequently used self-report questionnaires to measure depression and anxiety in dialysis patients are sufficiently unidimensional to warrant the use of such a general distress score in two cohorts of dialysis patients. Methods: This study includes two prospective observational cohorts of dialysis patients (total n = 749) which measured depression and anxiety using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses was used to investigate both a strictly unidimensional model and a multidimensional bifactor model that includes a general distress, depression and anxiety factor. The comparative fit index (CFI) and The Root Mean Square Error of Approximation (RMSEA) were used as model fit indices. Results: Factor analysis did not show a good fit for a strictly unidimensional general distress factor for both the BDI/BAI and HADS (CFI 0.690 and 0.699, RMSEA 0.079 and 0.125 respectively). The multidimensional model performed better with a moderate fit for the BDI/BAI and HADS (CFI 0.873 and 0.839, RMSEA 0.052 and 0.102). Conclusions: This data shows that the BDI/BAI and HADS are insufficiently unidimensional to warrant the use of a general distress score in dialysis patients without also investigating anxiety and depression separately. Future research is needed whether the use of a general distress score might be beneficial to identify patients in need of additional (psychological) support.

Original languageEnglish
Pages (from-to)91-99
Number of pages9
JournalGeneral hospital psychiatry
Publication statusPublished - 1 Jul 2020


  • Anxiety
  • BAI
  • BDI
  • Confirmatory factor analysis
  • Depression
  • Dialysis
  • General distress
  • HADS

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