Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients

Indian J Med Res. 2005 Nov;122(5):395-9.


Background & objective: The hospital anxiety and depression scale (HADS) has been widely used on cancer patients as an indicator of psychological morbidity. Though the scale has been used in India, no reports are available on translation of HADS in any Indian language and testing the reliability. The present study describes the translation process of HADS into Malayalam and testing its reliability and validity on psychological morbidity in cancer patients.

Methods: The English version of the HADS was translated into Malayalam and was used in this study. The questionnaire was administered to 240 cancer patients and statistical analysis was carried out using Chronbach's alpha to test the internal consistency of the HADS scale while confirmatory factor analysis was carried out using principal axis factoring with equimax rotation and Kaiser Normalization to test its construct validity.

Results: The Cronbach's alpha was found to be 0.81 for the HADS anxiety subscale, 0.71 for the HADS depression subscale, and 0.85 for HADS tool. Confirmatory factor analysis (CFA) indicated two depression items (i.e., enjoyment and anhedonia) loading onto the anxiety subscale. Clinical caseness for anxiety was observed in 8 per cent, while 11 per cent of the patients had borderline mood disorder. Clinical caseness for depression was identified in 7.6 and 13 per cent of patients were found to have borderline mood disturbances.

Interpretation & conclusion: This preliminary validation study of the Malayalam version of the HADS showed it as an acceptable, and reliable measure of psychological morbidity among cancer patients. The prevalence of anxiety and depression in Indian population was low and enjoyment and anhedonia might present as anxiety initially.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / diagnosis*
  • Depression / diagnosis*
  • Factor Analysis, Statistical
  • Hospitalization
  • Humans
  • India
  • Neoplasms / psychology*
  • Psychiatric Status Rating Scales*
  • Reproducibility of Results
  • Surveys and Questionnaires