A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

J Clin Nurs. 2009 Jul;18(13):1908-15. doi: 10.1111/j.1365-2702.2008.02736.x.


Aim: To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease (CHD) in Xian, China.

Background: There is considerable evidence that anxiety and depression are common in patients with CHD and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation.

Design: A single group, cross-sectional study.

Method: Measurement performance was tested on 314 Chinese patients with CHD and repeated on 173 of them two weeks later.

Results: The Chinese version of HADS (C-HADS) had acceptable internal consistency and test-retest reliability, with a Cronbach's alpha of 0.85 and intraclass correlation coefficient of 0.90, respectively. There was acceptable concurrent validity with significant (p < 0.05) correlations between the anxiety and depression subscales of the C-HADS and CHD patients' perceived health status as measured by the Chinese-Mandarin version of the Short Form-36 health survey (CM:SF-36). Principal components analysis revealed a three-factor solution accounting for 53% of the total variance. The three underlying sub-scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C-HADS was also satisfactory with significant correlation between the changes in the C-HADS score and the changes in the mental health domain of the CM:SF-36 (p < 0.01). Finally, over one-third of the patients demonstrated psychological distress.

Conclusion: Empirical data support the C-HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese-speaking patients with CHD. A tri-dimensional scoring approach should be considered as potentially clinically useful for this group of patients.

Relevance to clinical practice: The C-HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.

MeSH terms

  • Anxiety / psychology*
  • Coronary Disease / psychology*
  • Cross-Sectional Studies
  • Depression / psychology*
  • Hong Kong
  • Humans
  • Psychometrics*
  • Surveys and Questionnaires