Structural ambiguity of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Health Qual Life Outcomes. 2006 Jan 26;4:6. doi: 10.1186/1477-7525-4-6.


Background: The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool designed as a case detector for clinically relevant anxiety and depression. Recent studies of the HADS in coronary heart disease (CHD) patients in European countries suggest it comprises three, rather than two, underlying sub-scale dimensions. The factor structure of the Chinese version of the HADS was evaluated in patients with CHD in mainland China.

Methods: Confirmatory factor analysis (CFA) was conducted on self-report HADS forms from 154 Chinese CHD patients.

Results: Little difference was observed in model fit between best performing three-factor and two-factor models.

Conclusion: The current observations are inconsistent with recent studies highlighting a dominant underlying tri-dimensional structure to the HADS in CHD patients. The Chinese version of the HADS may perform differently to European language versions of the instrument in patients with CHD.

Publication types

  • Validation Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / epidemiology
  • China / epidemiology
  • Coronary Disease / psychology*
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Factor Analysis, Statistical
  • Female
  • Hospitals, University / statistics & numerical data*
  • Humans
  • Inpatients / psychology*
  • Interview, Psychological
  • Language*
  • Male
  • Middle Aged
  • Models, Structural
  • Outpatients / psychology*
  • Psychiatric Status Rating Scales / standards*
  • Psychometrics / instrumentation*
  • Surveys and Questionnaires