Concordance between Hopkins Symptom Checklist (HSCL-10) and Pakistan Anxiety and Depression Questionnaire (PADQ), in a rural self-motivated population in Pakistan
Open accessAbstract
BACKGROUND: There have been no previous studies conducted in Pakistan comparing the concordance of any well established Western anxiety/depression screening instrument with an indigenous scale, in a community based setting. METHODS: Participants (n = 1040) in the present study were recruited from the six villages of our interest from the district Gujarat of Pakistan, using a convenient sampling technique. Interview versions of the Hopkins Symptom Checklist 10-item version (HSCL-10) and the Pakistani Anxiety and Depression Questionnaire (PADQ) were used to observe the pattern of anxiety and depression among the participants. RESULTS: The internal consistency of HSCL-10 and PADQ were 0.86 and 0.84 respectively. Exploratory factor analysis found evidence for both a one-dimensional (distress) and a two-dimensional (anxiety and depression) solution for the HSCL-10, but only a one-dimensional (distress) solution for the PADQ. The HSCL-10 and PADQ found to be moderately to highly correlated (r = 0.62, p < 0.0001, 0.73 after correction for attenuation). CONCLUSION: HSCL-10 has shown good screening abilities in a rural setting in Pakistan, and moderate to good concordance with an indigenous instrument measuring psychological distress. The HSCL-10 can therefore be used as a screening instrument, both in clinical and epidemiological settings in Pakistan, and for Pakistani immigrants living in Western societies.
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The HSCL-25 has been applied transnationally.
“This is a shortened version of the HSCL-25 which has been applied transnationally [23, 24].”
From A qualitative study of Filipina immigrants’ stress, distress and coping: the impact of their multiple, transnational roles as women (2017) · cites this paper as [24]
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“According to the prevailing information from the mental health studies conducted in Pakistan, the most important commonly used mental health screening instruments in Pakistan were: Bradford Somatic Inventory (BSI) [4-10], Self-Reporting Questionnaire (SRQ) [11-17], General Health Questionnaire (GHQ) [18,19], Personal…”
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“According to the prevailing information from the mental health studies conducted in Pakistan, the most important commonly used mental health screening instruments in Pakistan were: Bradford Somatic Inventory (BSI) [4-10], Self-Reporting Questionnaire (SRQ) [11-17], General Health Questionnaire (GHQ) [18,19], Personal…”
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“According to the prevailing information from the mental health studies conducted in Pakistan, the most important commonly used mental health screening instruments in Pakistan were: Bradford Somatic Inventory (BSI) [4-10], Self-Reporting Questionnaire (SRQ) [11-17], General Health Questionnaire (GHQ) [18,19], Personal…”
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“This is a shortened version of the HSCL-25 which has been applied transnationally [23, 24].”
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“The HSCL-10 was translated into Urdu and performed well among a sample of poor, rural Pakistanis with low education levels (Syed, Zachrisson, Dalgard, Dalen, & Ahlberg, 2008), therefore, it was chosen for use among this population who share some similarities with the Syed et al. (2008) sample.”
MethodValidation of mental health screening instruments in the Kashmir Valley, India
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“However, where transcultural validation has occurred, cut points have varied significantly across contexts (Oruc et al., 2008; Shoeb, Weinstein, & Mollica, 2007; Syed et al., 2008; Ventevogel et al., 2007), which underscores the importance of validation to establish culturally relevant cut points.”
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“and an Arabic translation already exists. Finally, there are no reports on the factor structure of the HSCL-25 [”
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“Although some studies report adequate cross-cultural equivalence of many assessment methods used [16,17],”
ResultRoberts, L. R., & Montgomery, S. (2016) · PubMed · Cited by 19 · see citing works
Roberts, L. R., & Montgomery, S. (2016) · Issues in Mental Health Nursing · doi:10.1080/01612840.2016.1236864 · Cited by 19 · see citing works
Yang, M. S., & Mutchler, J. E. (2019) · Journal of Aging and Health · doi:10.1177/0898264319844088 · Cited by 19 · see citing works
“We also conducted a sensitivity analysis based on a dichotomous coding of depression, using a cutoff of 1.85 or higher HSCL-10 score as being symptomatic of depression (see Haavet, Sirpal, Haugen, & Christensen, 2011, and Syed et al., 2008) for discussion of this cutoff.”
MethodInfluentialAye, W. T., Lien, L., Stigum, H., Schei, B., Sundby, J., & Bjertness, E. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037936 · Cited by 18 · see citing works
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“This is in line with earlier research on HSCL-10 (Schmalbach et al., 2019; Syed et al., 2008).”
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Addressing Stillbirth in India Must Include Men
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Effective rehabilitation of older people in a district rehabilitation centre
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Mental Health and Related Factors among Migrants from Myanmar in Thailand
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“In this study, we used a convenient sampling technique (e.g. Syad et al., 2008 [ 6 ]).”
MethodStillbirth and infant death: mental health among low-income mothers in Mumbai
Roberts, L. R., Renati, S. J., Solomon, S., & Montgomery, S. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03754-0 · Cited by 13 · see citing works
“[30], we used a cut-off score, with a mean of 1.”
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“This finding is consistent with previous research, according to which HSCL was originally developed for a Western population; therefore it is unclear if the items measure the constructs in other populations in a similar manner (Syed et al., 2008).”
ResultBratlien, U., Øie, M. G., Haug, E., Møller, P., Andreassen, O. A., Lien, L., & Melle, I. S. (2013) · Early Intervention in Psychiatry · doi:10.1111/eip.12102 · Cited by 9 · see citing works
“For the current study, we have used the ‘Anxiety’ and ‘Depression’ subscales in addition to the total mean score.(9,10) The Strengths and Difficulties Questionnaire (SDQ)(11,12) assesses the mental health status of children and adolescents in 25 items constituting five subscales: (i) emotional symptoms; (ii) conduct p…”
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“Hopkins Symptom Checklist (HSCL-10) A 10-item Likert-type scale measuring depression and anxiety symptomology has previously been used with Hindi- and Urdu-speaking populations.(31,34) Items are summed and divided by 10 for a score.”
Bramness, J. G., Hjellvik, V., Høye, A., Tesli, M., Haram, M., Nystad, W., & Krokstad, S. (2024) · BMC Public Health · doi:10.1186/s12889-024-18754-w · Cited by 5 · see citing works
“HSCL-10 consists of two factors – depression and [38, 39] anxiety.”
BackgroundAye, W. T., Lien, L., Stigum, H., & Bjertness, E. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045870 · Cited by 6 · see citing works
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“strates good sensitivity and specificity for detecting mental distress and is widely used, also in the Asian region [29, 30].”
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“85 to indicate distress (Syed et al., 2008).”
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Secure but depressed? Welfare participation and mental health in Hong Kong
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“In HSCL-10, depression is measured by responses to six questions (Syed et al. 2008): interviewees were asked to what degree, during the past week, they “blamed themselves for things,” “had difficulties falling or staying asleep,” “felt blue,” “experienced feelings of worthlessness,” “felt that…”
Exploring Mental Health during the Initial COVID-19 Lockdown in Mumbai: Serendipity for Some Women
Roberts, L. R., Solomon, S., Renati, S. J., & Montgomery, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312542 · Cited by 3 · see citing works
“[44], we used a mean cut-off score of 1.”
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The Effects of Food Insecurity on Mental Wellbeing in Monteverde Costa Rica
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Validation of the BDI-II in South Africa
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Aas, C. F., Vold, J. H., Gjestad, R., Skurtveit, S. O., Lim, A. G., Gjerde, K. V., Løberg, E.-M., Johansson, K. A., & Fadnes, L. T. (2021) · Figshare · doi:10.6084/m9.figshare.14130825
Conflict, mental health, and labor productivity: evidence from hired farm workers in Myanmar
Laitha, A., Fabry, A., Minten, B., & Meemken, E. (2026) · BMC Global and Public Health · doi:10.1186/s44263-026-00307-5
“As an additional robustness check, we also draw on the Hopkins Symptoms Checklist (HSCL-10) –] [70–72] as an alternative measure of mental distress, which is further described in the Supplementary Material 2.”
- Authors
- Syed, H. R., Zachrisson, H. D., Dalgard, O. S., Dalen, I., & Ahlberg, N.
- Affiliations
- Norwegian Institute of Public Health (NO)
- University of Oslo (NO)
- Corresponding author
- Syed, Hammad Raza
- Venue
- BMC Psychiatry
- Published
- 2008-07-22
- Volume
- 8
- Issue
- 1
- Pages
- 59-59
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC2500013
- OpenAlex
- W2131071057
- Cited by
- 56
- References
- 50
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 7 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 1 · 2012: 3
- FWCI
- 4.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- anxiety screening, depression screening, psychological distress, rural population, factor structure, internal consistency
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety Disorders, Catchment Area, Health, Cross-Sectional Studies, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Motivation, Pakistan, Surveys and Questionnaires, Rural Population, International Classification of Diseases
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