Reliability and validity of the Ethiopian version of the hospital anxiety and depression scale (HADS) in HIV infected patients

PLoS One. 2011 Jan 25;6(1):e16049. doi: 10.1371/journal.pone.0016049.


Background: The hospital anxiety and depression scale (HADS) is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language) version of HADs among HIV infected patients.

Methods: The translated scale was administered to 302 HIV/AIDS patients on follow up for and taking anti-retroviral treatment. Consistency assessment was conducted using Cronbach's alpha, test-retest reliability using intra-class correlation coefficients (ICC). Construct validity was examined using principal components analysis (PCA). Parallel analysis, Kaiser's criterion and the scree test were used for factor extraction.

Results: The internal consistency was 0.78 for the anxiety, 0.76 for depression subscales and 0.87 for the full scale of HADS. The intra-class correlation coefficient (ICC) was 80%, 86%, and 84% for the anxiety and depression subscales, and total score respectively. PCA revealed a one dimensional scale.

Conclusion: This preliminary validation study of the Ethiopian version of the HADs indicates that it has promising acceptability, reliability and validity. The adopted scale has a single underlying dimension as indicated by Razavi's model. The HADS can be used to examine psychological distress in HIV infected patients. Findings are discussed and recommendations made.

Publication types

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

MeSH terms

  • Adult
  • Anxiety Disorders / diagnosis*
  • Depressive Disorder / diagnosis*
  • Ethiopia
  • Female
  • HIV Infections / psychology*
  • Hospitals
  • Humans
  • Male
  • Principal Component Analysis
  • Psychiatric Status Rating Scales / standards*
  • Reproducibility of Results
  • Surveys and Questionnaires