Cross-cultural adaptation into Punjabi of the English version of the Hospital Anxiety and Depression Scale

BMC Psychiatry. 2007 Jan 26;7:5. doi: 10.1186/1471-244X-7-5.


Background: We wanted to use a Punjabi version of the Hospital Anxiety and Depression Scale (HADS) to enable non-English speaking patients to participate in a clinical trial. The aim of the study was to translate and validate the Hospital Anxiety and Depression Scale into Punjabi.

Methods: The HADS was translated into Punjabi by a multidisciplinary team, verified against the original version, and administered to 73 bilingual patients attending an outpatient clinic.

Results: One sample t-tests and the Bland-Altman plots demonstrated acceptable linguistic agreement between the two versions of the HADS. Spearman's rank-order correlation coefficients (p < 0.0001) demonstrate excellent conceptual agreement between each item and its corresponding subscale score, for both versions. Concordance rates revealed that the Punjabi HADS adequately identified borderline cases of anxiety (80.8%), definite cases of anxiety (91.8%) and depression (91.8%), but was less reliable in identifying borderline cases of depression (65.8%). Cronbach alpha coefficients revealed high levels of internal consistency for both the Punjabi and English versions (0.81 and 0.86 for anxiety and 0.71 and 0.85 for depression, respectively).

Conclusion: The Punjabi HADS is an acceptable, reliable and valid measure of anxiety and depression among physically ill Punjabi speaking people in the United Kingdom.

Publication types

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

MeSH terms

  • Adult
  • Anxiety / diagnosis*
  • Anxiety / ethnology
  • Clinical Trials as Topic
  • Cross-Cultural Comparison
  • Depression / diagnosis*
  • Depression / ethnology
  • Female
  • Humans
  • India / ethnology
  • Language
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales*
  • Reproducibility of Results