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

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.