Validation of Hospital Anxiety and Depression Scale in an Indonesian population: a scale adaptation study

• Published in: Family medicine and community health 2023-06, Vol.11 (2), p.e001775
• Main Authors: Tiksnadi, Badai Bhatara, Triani, Nurlita, Fihaya, Faris Yuflih, Turu’ Allo, Iswandy Janetputra, Iskandar, Shelly, Putri, Diba Artsiyanti Ediyana
• Format: Article
• Language: English
• Subjects: Adaptation; Adolescent; Adult; Anxiety; Anxiety - diagnosis; Community Medicine; Community Mental Health Services; Community Psychiatry; Cross-Sectional Studies; Data analysis; Data collection; Depression; Depression - diagnosis; Female; Hospitals; Humans; Indonesia; Interpreters; Language; Male; Medical screening; Mental depression; Original Research; Quantitative psychology; Questionnaires; Reproducibility of Results; Surveys and Questionnaires; Translations; Validation studies; Validity
• ISSN: 2305-6983; 2009-8774
• DOI: 10.1136/fmch-2022-001775

ObjectiveThis study aims to adapt the English-language Hospital Anxiety and Depression Scale (HADS) to the Indonesian language and evaluate the validity and reliability of the adapted version (ie, HADS-Indonesia).DesignA cross-sectional study was conducted between June and November 2018. First, a translation and back-translation process was conducted by a committee consisting of the researchers, a psychiatrist, a methodology consultant and two translators. Face and convergent validity and test–retest reliability evaluations were conducted. Next, structural validity and internal consistency analyses were performed. An intraclass correlation coefficient (ICC) test evaluated the scale’s test–retest reliability. A Spearman’s rank correlation coefficient was calculated to evaluate the correlation between HADS-Indonesia and Zung’s Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) for convergent validity evidence. Next, a structural validity analysis using exploratory factor analysis (EFA) and an internal consistency evaluation based on Cronbach’s alpha was conducted.SettingThis study was conducted in three villages in Jatinangor subdistrict, Sumedang Regency, West Java province, Indonesia; the villages were chosen based on their profiles.ParticipantsA total of 200 participants (male: n=91, 45.50% and female: n=109, 54.50%), with a mean age of 42.41 (14.25) years, were enrolled in this study using a convenience sampling method. The inclusion criteria were age ≥18 years old with basic Indonesian language literacy.ResultsThe overall HADS-Indonesia’s ICC value was 0.98. There was a significant positive correlation between HADS-Indonesia’s anxiety subscale and Zung’s SAS (rs=0.45, p=0.030) and between the depression subscale of HADS-Indonesia and Zung’s SDS (rs=0.58, p