Version Of Hospital Anxiety And Depression Scale Research Articles

Psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults

ObjectivesThe Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city.MethodsIn total, 1190 inhabitants ≥ 70 (range 70 – 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed “HUNT4 70 + ” in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity.ResultsThe original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6D (“I feel cheerful”) along with a correlated error term between item 2D (“I still enjoy the things I used to enjoy”) and 12D (“I look forward with enjoyment to things”) improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable.ConclusionsThe HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.

The influence of family support during endoscopic submucosal dissection on patient's anxiety.

Psychological problems may promote peptic ulcers. Ulcer-like wounds can be formed after gastric endoscopic submucosal dissection (ESD). The influence of family support on the healing of gastric ESD-induced ulcers remains largely undetermined. In the present study, we aimed to assess the Hospital Anxiety and Depression Scale (HADS) scores and the incidence of post-ESD complications in patients with family support in the care process and those in the non-relative group. A total of 191 patients aged between 30 and 70 years who received gastric ESD were evaluated with the Chinese version of HADS. Differences in depression and anxiety between the two groups were compared using the chi-square test and t-test. Multivariable logistic regression models were used to examine whether anxiety and depression were the risk factors for post-ESD complications. The mean values of HADS-A (4.61 ± 2.89 vs. 5.56 ± 3.07, p = 0.042) and HADS-D (4.14 ± 3.03 vs. 4.97 ± 2.61, p = 0.048) scores were significantly lower in patients with accompanying relatives compared with those in the non-relative group. Besides, through the pre-ESD and post-ESD self-contrast, the scores of anxiety and depression in the relative-group were 0.57 and 0.56, respectively (p < 0.001), while those in the non-relative group were increased by 1.43 and 1.49, respectively (p < 0.001). Multivariable logistic regression analysis revealed that HADS-A, HADS-D scores, and age were significantly correlated with post-ESD abdominal pain (P < 0.05). The occurrence and degree of adverse emotions such as psychological anxiety and depression in patients who received gastric ESD with accompanying relatives during hospitalization may were reduced, and the incidence of gastric post-ESD abdominal pain may was also decreased.

Psychometric properties of the Arabic version of the hospital anxiety and depression scale in hemodialysis patients

ABSTRACT The literature lacks a rigorous psychometric evaluation of the Arabic version of Hospital Anxiety and Depression Scale (HADS) in hemodialysis (HD) patients. This study aims to evaluate reliability, determine the underlying factor structure of the Arabic version of HADS and assess its suitability as screening tool for depression and anxiety among Arabic HD patients. A sample of 370 HD patients were recruited from all health districts in Kuwait. Reliability for HADS (all items) and its subscales HADS-A (anxiety) and HADS-D (depression) were estimated using Cronbach’s alpha and item analysis was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to extract and test the factor structure for the Arabic version of HADS. Eight models were tested using CFA to determine goodness-of-fit. The Cronbach α for the Arabic HADS (all items), HADS-A and HADS-D were 0.884, 0.852 and 0.764, respectively. Pearson correlation coefficient between HADS-A and HADS-D subscales indicated significant correlation (r = +0.69, PV < 0.001). EFA indicated two factors with eigenvalues >1, which accounted for 48.5% of the total variance. CFA revealed the one-factor model had the poorest fit, the two-factor models with acceptable fit, and three-factor models showed good fit. The Arabic HADS has good reliability and internal consistency, which warrants its use in screening for anxiety and depression among Arabic HD patients. Furthermore, the three-factor structure has shown a better fit which warrants further exploration in HD patients with the advancement in theory of psychological models for anxiety and depression.

Prevalence of anxiety and depression in dizzy patients using Arabic hospital anxiety and depression scale

ObjectivesTo develop an Arabic version of the hospital anxiety and depression scale (HADS) to detect and measure anxiety and depression prevalence in dizzy patients.BackgroundDizziness is a common complaint that has many causes and may be related to psychiatric disorders like anxiety and depression. Early detection of anxiety and depression in dizzy patients helps in proper management and a better outcome. The HADS is a valid screening tool, and having an Arabic version will be of great help.Patients and methodsThe original English HADS was translated following the cross-cultural adaptation guidelines into Arabic. The final Arabic version of HADS was administered to samples of 100 healthy control persons, 30 anxious patients, and 30 depressed patients. Reliability and validity of the translated Arabic HADS were examined. The prevalence of anxiety and depression in dizzy patients were assessed through 100 dizzy patients who were asked to complete the validated Arabic HADS.ResultsThe translated Arabic HADS was found to be reliable with strong internal consistency (Cronbach's alpha was 0.811 for the anxiety group and 0.758 for the depression group). The test–retest reliability was high (Spearman's correlation was 0.980 for the anxiety group and 0.928 for the depression group). There was a good correlation between psychiatric assessment and HADS for anxiety and depression using the Mann–Whitney test, indicating its validity. We performed the receiver operating characteristics curve, and the most sensitive cutoff point for HADS anxiety subscale was 8.5 and for HADS depression subscale was 9.5. In the dizzy group, 32% gave positive HADS scores for anxiety subscale and 22% gave positive HADS scores for depression subscale.ConclusionsThis version of the Arabic HADS is a reliable and valid psychological screening tool for anxiety and depression. The anxiety and depression prevalence in the dizzy patients was 32% and 22%, respectively.

Validation of the Malay Version of the Hospital Anxiety and Depression Scale among Patients with Traumatic Brain Injury

Introduction: Depression and anxiety are common complications associated with traumatic brain injury (TBI) patients but screening tools which are validated to assess these complications in the TBI population are scarce. This study investigated the validity of the Malay version of Hospital Anxiety and Depression Scale (HADS) to screen for depression and anxiety among Malaysian TBI patients. Materials and Methods: This cross -sectional study recruited 101 TBI patients in which they were administered the Malay version of HADS and the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorder 4th Edition (DSM-IV) for Axis I Disorders (SCID-I) (as comparison tool). Internal consistency (Cronbach’s α) and concurrent validity (using receiver operating characteristics) of the Malay version of HADS were evaluated. Results: The total Malay version of HADS score and its anxiety subscale exhibited good internal consistency of 0.80 and 0.78 respectively, but the internal consistency of its depressive subscale was low at 0.57. The depressive subscale of the Malay version of HADS exhibited high area under the curve (AUC) of 0.86, specificity of 82%, sensitivity of 76% and negative predictive value of 91% but its positive predictive value was 58%, at cut-off point of 8/9. While the anxiety subscale also demonstrated high AUC of 0.88, specificity of 71%, sensitivity of 93% and negative predictive value of 98% its positive predictive value was only 34%. Conclusion: The Malay version of HADS is a valid screening tool for depression and anxiety among Malaysian TBI population.

Factor structure and reliability of Persian version of hospital anxiety and depression scale in patients with breast cancer survivors

IntroductionAnxiety and depression are significant concerns in breast cancer patients, and it may remain for a long term after primary treatments. The hospital anxiety and depression scale (HADS) is widely used to measure depressive and anxiety symptoms in clinical practices. The purpose of this study was to assess the psychometric properties of the Persian version of this scale in Iranian breast cancer survivors.MethodsA total of 305 patients with breast cancer, refered to Cancer Hospital in northen Iran and completed the primary treatments were enrolled in. All patients responded to a 14-item HADS. We performed confirmatory factor analysis (CFA) to examine the factor structure of HADS and the item-scale analysis in order to estimate the item reliability and consider the Cronbach’s alpha as a measure of internal consistency.ResultsWith a threshold of ≥8, the prevalence of anxiety and depression symptoms (moderate/severe) was 78.9 and 66.9%, respectively. The Cronbach’s alpha coefficients for anxiety and depression were 0.81 and 0.78, respectively. The CFA confirmed the two-factor structure model for HADS, indicating a good fitting summary indexes (χ2/df = 2.83, NFI = 0.88, RFI = 0.82, IFI = 0.92, CFI = 0.92, and RMSEA = 0.078).ConclusionThe CFA and item reliability analysis have indicated an excellent psychometric property of the Persian version of HADS to measure depressive and anxiety symptoms in breast cancer survivors. Thus, HADS is a useful screening tool to identify post-breast cancer anxiety and depressive disorders.

The hospital anxiety and depression scale, in patients with multiple sclerosis.

PurposeMultiple sclerosis (MS) is a long-lasting disabling disease with psychological implications. Hospital Anxiety and Depression Scale (HADS) is a questionnaire developed to screen anxiety and depression among patients in hospital settings. The objective of this report was to study the metric properties of the Portuguese version of HADS regarding MS.Materials and methodsThis was a cross-sectional study. Three hundred and eighty individuals with a diagnosis of MS, according to the revised McDonald criteria, were recruited from an outpatient Neuroimmunology Clinic of the city of Porto. Participants had a mean age of 40.04 years (SD =10.86), 63.9% of them were female. HADS consists of two subscales – anxiety and depression – scored separately, with seven items each.ResultsThe results of our study show the appropriateness of HADS for the identification of mood changes in people with MS and show good metric properties.ConclusionIt seems to be a useful tool for the scrutiny of mood disorders in Portuguese patients with MS. The questionnaire is also sensitive to disease when compared to people with other severe illnesses, and with people without the disease.

Assessment of the Hospital Anxiety and Depression Scale for cancer patients.

Depression and anxiety are common in patients with cancer. To adapt and validate the Hospital Anxiety and Depression Scale (HADS) for adult Chilean cancer patients, and to provide information about their prevalence of anxiety and depression. Two hundred fifteen patients with cancer answered an adapted version of HADS for Chilean population. The language adjustment of the scale was carried out with the opinions of 10 expert linguists and with a pilot study on 17 cancer patients. The Depression and Anxiety subscales of the DASS-21 were also applied to verify the convergent validity of HADS: Results: The confirmatory factor analysis indicated that the data fits the model of two correlated factors (anxiety and depression), χ2 = 98.608; df = 76;p < 0.05; χ2/df= 1.23, RMSEA = 0.037; CFI = 0.99; TLI = .98. Reliability analysis showed an adequate internal consistency of both subscales (.76 for anxiety and .84 for depression) and the general scale (.87). Correlations between HADS and DASS-21 scores were significant for both anxiety (r =.514, p < 0.001) and depression (r = 0.600, p < 0.001). Prevalence rates were approximately 30% for depression (actual = 12%, possible = 22.8%) and approximately 20% for anxiety (actual = 7%, possible = 8.4%). We conclude that HADS is a reliable and valid instrument for screening clinically relevant anxiety and depression symptoms in Chilean cancer patients.

Rasch analysis of the hospital anxiety and depression scale among Chinese cataract patients.

PurposeTo analyze the validity of the Hospital Anxiety and Depression Scale (HADS) among Chinese cataract population.MethodsA total of 275 participants with unilateral or bilateral cataract were recruited to complete the Chinese version of HADS. The patients' demographic and ophthalmic characteristics were documented. Rasch analysis was conducted to examine the model fit statistics, the thresholds ordering of the polytomous items, targeting, person separation index and reliability, local dependency, unidimentionality, differential item functioning (DIF) and construct validity of the HADS individual and summary measures.ResultsRasch analysis was performed on anxiety and depression subscales as well as HADS-Total score respectively. The items of original HADS-Anxiety, HADS-Depression and HADS-Total demonstrated evidence of misfit of the Rasch model. Removing items A7 for anxiety subscale and rescoring items D14 for depression subscale significantly improved Rasch model fit. A 12-item higher order total scale with further removal of D12 was found to fit the Rasch model. The modified items had ordered response thresholds. No uniform DIF was detected, whereas notable non-uniform DIF in high-ability group was found. The revised cut-off points were given for the modified anxiety and depression subscales.ConclusionThe modified version of HADS with HADS-A and HADS-D as subscale and HADS-T as a higher-order measure is a reliable and valid instrument that may be useful for assessing anxiety and depression states in Chinese cataract population.

Reliability and Validity of a Nepali-language Version of the Hospital Anxiety and Depression Scale (HADS).

In several languages and settings, the Hospital Anxiety and Depression Scale (HADS) has demonstrated reliable and valid screening properties in psychiatry. To develop a Nepali version of HADS with acceptable reliability and construct validity for use among hospital patients and in the general population. The original English version was translated into Nepali using a forward-backward translation protocol. Psychometric properties were tested by factor analysis and Cronbach's alpha. The translated scale was administered to three groups of adult in-patients in a university hospital in three trials, and to a sample of adults from the community in a fourth trial. Some of the 14 items were reworded reiteratively to achieve viable semantic and statistical solutions. The two-factor solution with anxiety and depression subscales eventually explained 40.3% of the total variance. Cronbach's alpha was 0.76 for anxiety (HADS-A) and 0.68 for depression (HADS-D). All seven HADS-A items showed at least acceptable item-to-factor correlations (range 0.44-0.74), and full construct validity was achieved for this subscale. Item-to-factor correlations for six HADS-D items were also at least acceptable (range 0.42-0.70); one item (D4) had persistently low correlations throughout all trials, although construct validity was still satisfactory. Reiterated rewording of items guided by statistical testing resulted in a Nepali version of HADS with satisfactory psychometric properties.

Development and validation of Arabic version of the Hospital Anxiety and Depression Scale.

Introduction:The Hospital Anxiety and Depression Scale (HADS) is widely used to predict and diagnose hospital anxiety and depression. It has been translated and validated in many languages, but the existing Arabic version was not validated in hospitalized patients. The aim was to translate, culturally adapt, and validate the HADS Questionnaire into Arabic language for in-patient use, especially for surgical wards.Methods:A systematic translation process was used to translate the original English HADS into Arabic. After the pilot study, we validated our version in surgical patients at two tertiary care centers. We tested the reliability of our version using internal consistency. We examined the validity by assessing construct validity, concurrent validity (by testing the associations between HADS, Generalized Anxiety Disorder 7-item scale [GAD-7], and Major Depression Inventory [MDI]), and face validity. The questionnaire was administered before and after surgery to examine responsiveness.Results:A total of 110 patients (22 men, 88 women) were included in the study. Cronbach's αs for the HADS anxiety subscale were 0.83 (95% confidence interval: 0.79– 0.88) and for the HADS depression subscale were 0.77 (0.7–0.83). Nearly 36% of the patients reported symptoms indicative of borderline or case anxiety before surgery, which decreased to 25% 1 week after surgery. HADS anxiety score was strongly correlated with GAD-7, and HADS depression score was strongly associated with MDI. Patients with higher American Society of Anesthesiologists Physical Status and those who remained hospitalized for more than 5 days were more likely to report depression symptoms. Most patients found the HADS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their hospital anxiety and depression.Conclusions:Our Arabic version of HADS is a reliable and valid tool to assess the mood states in hospitalized patients.

PMS15 - Psychological Distress In Chinese Patients With Rheumatoid Arthritis And Psychometric Validation Of Chinese Hospital Anxiety And Depression Scale

To validate the psychometric properties of Chinese Hospital Anxiety and Depression Scale (HADS) and investigate the psychological distress in patients with Rheumatoid Arthritis (RA) in Mainland China. The psychometric properties of HADS were validated by interviewing subjects with questionnaires containing the HADS, EQ-5D, and SF-12. Reliability was assessed by Cronbach's alpha and construct validity by assessing a priori hypotheses. Prevalence of anxiety and depression were summarized by region and ACR classification according to HADS scale cut-off values. Potential factors related to co-morbidities were analysed by fitting two mixed models Questionnaires were administered to a consecutive sample of 133 RA patients. Regarding the validation of HADS, Cronbach's alpha showed a strong reliability among all the items, achieving 0.872 for the anxiety subscale and 0.788 for the depression subscale. Construct validity was supported by achieving both a priori hypotheses based on correlations between the HAQ scores and scales of EQ-5D and SF-12. About the prevalence of psychological distress, majority of RA patients showed either doubtful (15.8%) or definite (38.3%) anxiety; and with doubtful (26.3%) or definite (36.1%) depression. Physical function loss due to RA was tested to be a significant factor for both anxiety and depression (P<0.05). The results are generally consistent between subgroups from north and south China. The Chinese version of HADS demonstrated good patient acceptability and psychometric properties (including internal consistency reliability, and construct validity) in RA patients from north and south of China supporting its use for routine screening in Chinese RA patients. Prevalence of psychological distress in Chinese RA patients, especially the ones with severe physical function loss due to RA, is high and need more efforts of screening and intervention.

The factorial structure and validity of the Hospital Anxiety and Depression Scale (HADS) in Polish adolescents.

AIM : The present study aimed to explore the factorial structure, validity and stability of the Hospital Anxiety and Depression Scale (HADS) in chronically ill and healthy Polish adolescents. 146 chronically ill (girls: 57.6%) and 309 healthy (girls: 45.9%) adolescents aged between 12 and 16 years (M = 14.03; SD = 1.3) filled in an adapted version of HADS (HADS-Teen) in hospital or school settings. The one-week test-retest reliability and construct validity was analyzed in two sub-samples of healthy adolescents. HADS-Teen showed a two-factor structure in the chronically ill sample and a three-factor structure in the healthy sample. The Anxiety scale had high internal reliability and stability and adequate correlation with another measure for generalized anxiety. Still, the Depression scale had good stability, but poor internal reliability in both samples. In the healthy sample, the Depression items split into two factors: depressed mood together with psychomotor retardation/agitation and anhedonia. The issues concerned with the factorial structure of HADS are replicated in Polish adolescents as well. HADS-Teen shows different structures in chronically ill versus healthy adolescents. Results indicate that a special attention must be paid when assessing depression symptoms in healthy adolescents using this instrument.

Reliability and validity of a Chinese version of the HADS for screening depression and anxiety in psycho-cardiological outpatients

AimThe Hospital Anxiety and Depression Scale (HADS) has been used widely with cardiovascular patients. This study aims to examine the reliability and validity of a Chinese version of HADS among psycho-cardiological outpatients. MethodsOne hundred psycho-cardiological outpatients were asked to complete the Chinese version of HADS and were then interviewed according to the Mini International Neuropsychiatric Interview, Version 5 (MINI). ResultsAccording to the MINI, 38 outpatients were diagnosed with major depression and 15 outpatients were diagnosed with an anxiety disorder. Compared with the MINI diagnoses, the optimum cutoff value of the anxiety subscale (HADS-A) was six (6) with a sensitivity of 81.6%, specificity of 75.8%, positive predictive value (PPV) of 54.0% and negative predictive value (NPV) of 91.9%; at the optimum cutoff value of nine (9), the depression subscale (HADS-D) had a sensitivity of 80.0%, specificity of 92.9%, PPV of 52.2% and NPV of 96.1%. The Cronbach's alpha coefficients of the HADS-A and HADS-D subscales were 0.753 and 0.764, respectively. The areas under the ROC curves of the HADS-A and the HADS-D subscales, as compared to MINI diagnoses of anxiety and depression, were 0.81 (SE=0.05, 95%CI: [0.73, 0.90]) and 0.86 (SE=0.05, 95%CI: [0.77, 0.94]), respectively. ConclusionsThe HADS was found to be a reliable measurement tool for excluding depression and anxiety in psycho-cardiological outpatients.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong

PurposeThe Hospital Anxiety and Depression Scale (HADS) is widely used in adult populations; however, its usefulness with adolescents has been explored less. This study sought to evaluate the reliability, validity, and factor structure of the Chinese version of HADS in a community sample of adolescents residing in Hong Kong.MethodsA prospective cohort of 5,857 students recruited from 17 secondary schools completed the HADS. Internal consistency and concurrent validity were examined. Confirmatory factor analysis was applied to test the relative fits of six factor structures of the HADS. The best fitting model was further cross-validated by male, female, split-half samples, and age subgroups.ResultsThe HADS possessed adequate internal consistency, especially for the anxiety subscale. Significant concurrent intercorrelations with self-reported suicidal thoughts and the Youth Self Report Anxious/Depressed subscale were discovered and found to be stronger for females. The cross-validation supported a two-factor model, where anxiety item 7, “I can sit at ease and feel relaxed”, was placed in the depression subscale.ConclusionsThe HADS showed satisfactory psychometric properties as a screening instrument in assessing anxious and depressive states as two correlated but distinct factors in adolescents. Study implications and recommendations for future research were discussed.

THIS ARTICLE HAS BEEN RETRACTED A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease in Xian, China.Background. There is considerable evidence that anxiety and depression are common in patients with coronary heart disease (CHD) and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation.Design. A single group, cross‐sectional study.Method. Measurement performance was tested on 314 Chinese patients with coronary heart disease and repeated on 173 of them two weeks later.Results. The Chinese version of HADS (C‐HADS) had acceptable internal consistency and test‐retest reliability, with a Cronbach alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant (p &lt; 0·05) correlations between the anxiety and depression subscales of the C‐HADS and CHD patients’ perceived health status as measured by the Chinese Mandarin version of the Short Form‐36 health survey (CM:SF‐36). Principal components analysis revealed a three‐factor solution accounting for 53% of the total variance. The three underlying sub‐scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C‐HADS was also satisfactory with significant correlation between the changes in the C‐HADS score and the changes in the Mental Health domain of the CM:SF‐36 (p &lt; 0·01). Finally, over one‐third of the patients demonstrated psychological distress.Conclusion. Empirical data support the C‐HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese‐speaking patients with CHD. A tri‐dimensional scoring approach should be considered as potentially clinically useful for this group of patients.Relevance to clinical practice. The C‐HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.

A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease (CHD) in Xian, China. There is considerable evidence that anxiety and depression are common in patients with CHD and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. A single group, cross-sectional study. Measurement performance was tested on 314 Chinese patients with CHD and repeated on 173 of them two weeks later. The Chinese version of HADS (C-HADS) had acceptable internal consistency and test-retest reliability, with a Cronbach's alpha of 0.85 and intraclass correlation coefficient of 0.90, respectively. There was acceptable concurrent validity with significant (p < 0.05) correlations between the anxiety and depression subscales of the C-HADS and CHD patients' perceived health status as measured by the Chinese-Mandarin version of the Short Form-36 health survey (CM:SF-36). Principal components analysis revealed a three-factor solution accounting for 53% of the total variance. The three underlying sub-scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C-HADS was also satisfactory with significant correlation between the changes in the C-HADS score and the changes in the mental health domain of the CM:SF-36 (p < 0.01). Finally, over one-third of the patients demonstrated psychological distress. Empirical data support the C-HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese-speaking patients with CHD. A tri-dimensional scoring approach should be considered as potentially clinically useful for this group of patients. The C-HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.

Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations

BackgroundThe Hospital Anxiety and Depression Scale (HADS) is a common screening instrument excluding somatic symptoms of depression and anxiety, but previous studies have reported inconsistencies of its factor structure. The construct validity of the Japanese version of the HADS has yet to be reported. To examine the factor structure of the HADS in a Japanese population is needed.MethodsExploratory and confirmatory factor analyses were conducted in the combined data of 408 psychiatric outpatients and 1069 undergraduate students. The data pool was randomly split in half for a cross validation. An exploratory factor analysis was performed on one half of the data, and the fitness of the plausible model was examined in the other half of the data using a confirmatory factor analysis. Simultaneous multi-group analyses between the subgroups (outpatients vs. students, and men vs. women) were subsequently conducted.ResultsA two-factor model where items 6 and 7 had dual loadings was supported. These factors were interpreted as reflecting anxiety and depression. Item 10 showed low contributions to both of the factors. Simultaneous multi-group analyses indicated a factor pattern stability across the subgroups.ConclusionThe Japanese version of HADS indicated good factorial validity in our samples. However, ambiguous wording of item 7 should be clarified in future revisions.

Screening of somatization disorder in primary health care. Results from a pilot study

There are no population based studies of Somatoform Disorders (SD) in Portugal, despite the fact that a high prevalence has been reported in other countries, mainly when less restrictive criteria are used for diagnosis. This study represents the first step to know the impact of this pathology in the community. To evaluate the psychometric properties of a Portuguese version of SOMS-2 (Screening for Somatoform Disorders) in primary health care (PHC) and studying its relationship with depression and anxiety. All persons attending an urban PHC unit aged 18 years or more and knowing how to read and write were invited to participate in this study undertaken during 2 days in January, 2007. All participants filled a socio-demographic questionnaire and a translated version of a screening instrument for Somatization Disorder (SD) (SOMS-2), including a list of 53 somatic symptoms and 15 questions to evaluate the severity and presence of other somatoform disorders. A measure of anxiety and depression was also obtained using the Portuguese version of HADS (Hospital Anxiety and Depression Scale). The 122 participants, 16% out of the 760 contacted, had on average 46.5 years (sd = 16.3) and 63% were woman. After applying criteria for frequency (> 10%) and discriminative power in terms of incapacity, 19 symptoms were included in the final scale. Using as standard the number and the specific symptoms for the presence of Somatization Disorder from the DSM-IV-TR, a cut-off point of at least 8 symptoms was estimated. The sensitivity and specificity were 94.1% and 89.5%, respectively. This cut off warranted 22.1% of individuals to be referred for further examination. The relative risk of anxiety and depression in a somatizer were 3.4 (95%CI: 2 to 6) and 4.3 (95%CI: 1.6 to 11.6), respectively. The results obtained with this Portuguese version of the SOMS-2 including 19 symptoms indicate it might be helpful for the screening of SD in PHC, though further clinical validation will be needed for establishing differential diagnosis.

Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample

BackgroundThe Hospital Anxiety and Depression Scale (HADS) has been used in several languages to assess anxiety and depression in general hospital patients with good results.MethodsThe HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens). The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were used as 'gold standards' for depression and anxiety respectively.ResultsThe HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression) and stability (test-retest intraclass correlation coefficient 0.944). Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749).ConclusionThe Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.