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.