Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong
Open accessAbstract
PURPOSE: The 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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.
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The Chinese version of HADS shows satisfactory psychometric properties.
“The Chinese version of the HADS shows satisfactory psychometric properties.34”
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Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
Nunnally, J. C. 1.-1., & Bernstein, I. H. (1994) · Cited by 9,365 · see citing works
Structural model evaluation and modification: An interval estimation approach
Steiger, J. H. (1990) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2502_4 · Cited by 7,408 · see citing works
Structural Equation Modeling: Concepts, Issues, and Applications.
Smith, M. D., & Hoyle, R. H. (1996) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2988418 · Cited by 6,868 · see citing works
Book Review: Structural Equation Modeling: Concepts, Issues, and Applications
Rigdon, E. E., & Hoyle, R. H. (1997) · Journal of Marketing Research · doi:10.2307/3151904 · Cited by 4,085 · see citing works
Prevalence and development of psychiatric disorders in childhood and adolescence
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.8.837 · Cited by 4,035 · see citing works
Herrmann, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00216-4 · Cited by 2,885 · see citing works
Corrections to test statistics and standard errors in covariance structure analysis.
Satorra, A., & Bentler, P. M. (1994) · Cited by 2,388 · see citing works
SPINHOVEN, P., ORMEL, J., SLOEKERS, P. P. A., KEMPEN, G. I. J. M., SPECKENS, A. E. M., & HEMERT, A. M. V. (1997) · Psychological Medicine · doi:10.1017/s0033291796004382 · Cited by 2,158 · see citing works
Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.9.1548 · Cited by 1,566 · see citing works
The structural equation modeling approach: Basic concepts and fundamental issues.
Hoyle, R. H. (1995) · Cited by 1,095 · see citing works
Life course outcomes of young people with anxiety disorders in adolescence
WOODWARD, L. J., & FERGUSSON, D. M. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200109000-00018 · Cited by 1,051 · see citing works
Mykletun, A., Stordal, E., & Dahl, A. A. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.179.6.540 · Cited by 908 · see citing works
International Journal of Adolescent Medicine and Health
(2011) · International Journal of Adolescent Medicine and Health · doi:10.1515/ijamh · Cited by 686 · see citing works
Moorey, S., Greer, S., Watson, M., Gorman, C., Rowden, L., Tunmore, R., Robertson, B., & Bliss, J. M. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.2.255 · Cited by 654 · see citing works
Psychiatric Disorder, Impairment, and Service Use in Rural African American and White Youth
Angold, A. C., Erkanli, A., Farmer, E. M. Z., Fairbank, J. A., Burns, B. J., Keeler, G. P., & Costello, E. J. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.10.893 · Cited by 537 · see citing works
Screening for Adjustment Disorders and Major Depressive Disorders in Cancer In-Patients
Razavi, D., Delvaux, N., Farvacques, C., & Robaye, E. (1990) · British Journal of Psychiatry · doi:10.1192/bjp.156.1.79 · Cited by 514 · see citing works
Lewinsohn, P. M., Rohde, P., Seeley, J. R., Klein, D. N., & Gotlib, I. H. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.10.1584 · Cited by 458 · see citing works
Leung, C. M., Wing, Y. K., Kwong, P. K., & Shum, A. L. K. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb10897.x · Cited by 407 · see citing works
Self-citationRelation between anxiety and depressive disorders in childhood and adolescence
Axelson, D., & Birmaher, B. B. (2001) · Depression and Anxiety · doi:10.1002/da.1048 · Cited by 366 · see citing works
Validation of the Hospital Anxiety and Depression Scale for use with adolescents
White, D., Leach, C., Sims, R., Atkinson, M. A., & Cottrell, D. J. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.175.5.452 · Cited by 352 · see citing works
(1993) · PubMed · Cited by 349 · see citing works
Identifying depression in primary care: a literature synthesis of case-finding instruments
Williams, J. W., Pignone, M. P., Ramı́rez, G., & Stellato, C. P. (2002) · General Hospital Psychiatry · doi:10.1016/s0163-8343(02)00195-0 · Cited by 288 · see citing works
Test–retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR
Leung, P. W. L., Kwong, S., Tang, C. P., Ho, T. P., Hung, S. F., Lee, C., Hong, S. L., Chiu, C. M., & Liu, W. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2005.01570.x · Cited by 271 · see citing works
Mennella, J. A., & Mennella, J. A. (1997) · Nutrition Today · doi:10.1097/00017285-199707000-00003 · Cited by 264 · see citing works
Groggel, D. J., & Papoulis, A. (1992) · Technometrics · doi:10.2307/1269266 · Cited by 236 · see citing works
Debaprasanna Biswas Biswas, D. (2009) · Cited by 220 · see citing works
Rao, U., Hammen, C. L., & Daley, S. E. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199907000-00022 · Cited by 215 · see citing works
Dunbar, M., Ford, G., Hunt, K., & Der, G. (2000) · British Journal of Clinical Psychology · doi:10.1348/014466500163121 · Cited by 178 · see citing works
Friedman, S., Samuelian, J., Lancrenon, S., EVEN, C., & Chiarelli, P. (2001) · Psychiatry Research · doi:10.1016/s0165-1781(01)00309-2 · Cited by 175 · see citing works
Assessment of the structure of the Hospital Anxiety and Depression Scale in musculoskeletal patients
Pallant, J., & Bailey, C. M. (2005) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-3-82 · Cited by 166 · see citing works
A longitudinal analysis of anxiety and depressive symptoms.
Wetherell, J. L., Gatz, M., & Pedersen, N. L. (2001) · Psychology and Aging · doi:10.1037/0882-7974.16.2.187 · Cited by 161 · see citing works
Suicidal Ideation and Behaviors Among Youths in Juvenile Detention
Abram, K. M., Choe, J. Y., Washburn, J. J., Teplin, L. A., King, D. C., & Dulcan, M. K. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e318160b3ce · Cited by 139 · see citing works
Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion
Leung, P. W. L., Hung, S., Ho, T., Lee, C., Liu, W.-S., Tang, C.-P., & Kwong, S. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-0687-7 · Cited by 131 · see citing works
Jörngården, A., Mattsson, E., & von Essén, L. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.05.031 · Cited by 120 · see citing works
Caci, H. M., Bayle, F., Mattei, V., Dossios, C., Robert, P. H., & Boyer, P. (2003) · Psychiatry Research · doi:10.1016/s0165-1781(03)00044-1 · Cited by 114 · see citing works
Child and adolescent mental health service use in Finland
Sourander, A., Helstelä, L., Ristkari, T., et al. (2001) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270170047 · Cited by 100 · see citing works
Mosing, M. A., Gordon, S. D., Medland, S. E., Statham, D. J., Nelson, E. C., Heath, A. C., Martin, N. G., & Wray, N. R. (2009) · Depression and Anxiety · doi:10.1002/da.20611 · Cited by 99 · see citing works
Barth, J., & Martin, C. R. (2005) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-3-15 · Cited by 83 · see citing works
Wickrama, K. A. S., Wickrama, T., & Lott, R. E. (2009) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2009.04.018 · Cited by 78 · see citing works
Validation of the Hungarian Translation of Hospital Anxiety and Depression Scale
Muszbek, K., Szekely, A., Balogh, É. M., Molnár, M., Rohánszky, M., Ruzsa, Á., Varga, K., Szöllosi, M., & Vadász, P. (2006) · Quality of Life Research · doi:10.1007/s11136-005-3627-8 · Cited by 72 · see citing works
Arving, C., Glimelius, B. L. G., & Brandberg, Y. (2007) · Quality of Life Research · doi:10.1007/s11136-007-9275-4 · Cited by 62 · see citing works
Martin, C. R., Thompson, D. R., & Chan, D. S. K. (2004) · Psychiatry Research · doi:10.1016/j.psychres.2004.06.012 · Cited by 60 · see citing works
Developmental stage and the expression of depressive disorders in children: An empirical analysis
Kovács, M., & Paulauskas, S. L. (1984) · New Directions for Child and Adolescent Development · doi:10.1002/cd.23219842606 · Cited by 36 · see citing works
Wang, W., López, V., Thompson, D. R., & Martin, C. R. (2006) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-4-6 · Cited by 36 · see citing works
Adolescent suicide attempters in Hong Kong and the United States
Stewart, S. M., Felice, E., Claassen, C., et al. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.01.005 · Cited by 28 · see citing works
Symptoms of affective disorder in pre-adolescentvs. adolescent inpatients
BORCHARDT, C. M., & Meller, W. H. (1996) · Journal of Adolescence · doi:10.1006/jado.1996.0015 · Cited by 14 · see citing works
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Research works printed but not linked: 1
- [44]Freud, S. (1921). Group Psychology and Analysis of the Ego. XVII (2nd ed.), Hogarth Press, 1955.
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Collins, R. N., & Kishita, N. (2020) · Ageing and Society · doi:10.1017/s0144686x19000527 · Cited by 244 · see citing works
Chen, I.-H., Pakpour, A. H., Leung, H., Potenza, M. N., Su, J.-A., Lin, C.-Y., & Griffiths, M. D. (2020) · Journal of Behavioral Addictions · doi:10.1556/2006.2020.00023 · Cited by 213 · see citing works
Liang, X., Guo, Q., Luo, J., Li, F., Ding, D., Zhao, Q., & Hong, Z. (2016) · BMC Neurology · doi:10.1186/s12883-016-0712-2 · Cited by 53 · see citing works
Wu, A. M. S., Li, J., Lau, J. T. F., Mo, P. K. H., & Lau, M. M. C. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.06.011 · Cited by 47 · see citing works
Huang, X., Tang, D., Sun, S., & Li, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-080863 · Cited by 3 · see citing works
- Authors
- Chan, Y.-F., Leung, D. Y. P., Fong, D. Y. T., Leung, C.-M., & Lee, A. M.
- Affiliations
- University of Hong Kong (HK)
- Chinese University of Hong Kong (HK)
- Queen Mary Hospital (CN)
- Corresponding author
- Lee, Antoinette M.
- Venue
- Quality of Life Research
- Published
- 2010-04-07
- Volume
- 19
- Issue
- 6
- Pages
- 865-873
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- PMC
- PMC2892613
- OpenAlex
- W2023927034
- Cited by
- 135
- References
- 50
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 10 · 2022: 7 · 2021: 23 · 2020: 15 · 2019: 15 · 2018: 11 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 7 · 2013: 11 · 2012: 9
- FWCI
- 9.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Quality of Life Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Hong Kong
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Education › Health Education and Validation
- Keywords
- Hospital Anxiety and Depression Scale, adolescents, anxiety, depression, psychometric properties, Chinese version, factor structure, reliability statistics, concurrent validity, suicidal ideation, screening tool, Hong Kong adolescents
- MeSH terms
- Adolescent, Anxiety Disorders, Child, Depressive Disorder, Female, Hong Kong, Hospitals, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Schools, Sex Factors, Reproducibility of Results, Young Adult
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