Anxiety and depression symptoms are commonly experienced after traumatic brain injury (TBI). However, studies validating measures of anxiety and depression for this population are scarce. Using novel indices derived from symmetrical bifactor modeling, we evaluated whether the Hospital Anxiety and Depression Scale (HADS) reliably differentiated anxiety and depression in 874 adults with moderate-severe TBI. The results showed that there was a dominant general distress factor accounting for 84% of the systematic variance in HADS total scores. The specific anxiety and depression factors accounted for little residual variance in the respective subscale scores (12% and 20%, respectively), and overall, minimal bias was found in using the HADS as a unidimensional measure. Further, in a subsample of 184 participants, the HADS subscales did not clearly discriminate between formal anxiety and depressive disorders diagnosed via clinical interview. Results were consistent when accounting for degree of disability, non-English speaking background, and time post-injury. In conclusion, variance in HADS scores after TBI predominately reflects a single underlying latent variable. Clinicians and researchers should exercise caution in interpreting the individual HADS subscales and instead consider using the total score as a more valid, transdiagnostic measure of general distress in individuals with TBI.

创伤性脑损伤（TBI）后通常会出现焦虑和抑郁症状。然而，验证该人群焦虑和抑郁措施的研究很少。使用源自对称双因素模型的新指数，我们评估了医院焦虑和抑郁量表 (HADS) 是否能够可靠地区分 874 名患有中重度 TBI 的成人的焦虑和抑郁。结果表明，一般痛苦因素占主导地位，占 HADS 总分系统方差的 84%。特定的焦虑和抑郁因素在各自的子量表分数中几乎没有造成残余方差（分别为 12% 和 20%），总体而言，使用 HADS 作为一维测量时发现了最小的偏差。此外，在 184 名参与者的子样本中，HADS 分量表没有清楚地区分通过临床访谈诊断的正式焦虑症和抑郁症。考虑到残疾程度、非英语背景和受伤后时间，结果是一致的。总之，TBI 后 HADS 评分的方差主要反映了单个潜在的潜在变量。临床医生和研究人员在解释个体 HADS 分量表时应谨慎行事，而应考虑使用总分作为 TBI 个体一般痛苦的更有效的跨诊断指标。