Psychometric properties of the Urdu version of the Hospital Anxiety and Depression Scale (HADS) among pregnant women in Abbottabad, Pakistan

Fahad Saqib Lodhi; Aymen M Elsous; Saadia Irum; Adeel Ahmed Khan; Unaib Rabbani

doi:10.1136/gpsych-2020-100276

Psychometric properties of the Urdu version of the Hospital Anxiety and Depression Scale (HADS) among pregnant women in Abbottabad, Pakistan

Gen Psychiatr. 2020 Aug 24;33(5):e100276. doi: 10.1136/gpsych-2020-100276. eCollection 2020.

Authors

Fahad Saqib Lodhi^{1

2}, Aymen M Elsous^{3

4}, Saadia Irum⁵, Adeel Ahmed Khan⁶, Unaib Rabbani⁷

Affiliations

¹ Community Medicine Department, Women Medical College, Abbottabad, Pakistan.
² School of public Health, Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
³ Unit of Planning and Policy Formulation, Ministry of Health, Gaza Strip, Palestine.
⁴ Assistant professor, College of medical sciences, Israa university, Gaza strip, Palestine.
⁵ Department of Gynecology and Obstetrics, Ayub Medical College, Abbottabad, Pakistan.
⁶ Ministry of Health, Saudi Board Preventive Medicine, Mecca, Saudi Arabia.
⁷ Ministry of Health, Family Medicine Academy, Qassim, Saudi Arabia.

Abstract

Background: The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument to measure anxiety and depression symptoms.

Aims: This study aimed to translate, validate and test the applicability of the Urdu version of the Hospital Anxiety and Depression Scale (HADS/UV) among pregnant women.

Methods: The original English version of the HADS was translated into Urdu by three bilingual experts and retranslated to English using the forward-backward approach. The questionnaire was administered to a sample of 200 pregnant women availing obstetrics and gynaecology services for routine prenatal check-ups of Ayub Teaching Hospital, Abbottabad, Pakistan. Psychometric properties of the instrument, including reliability (internal consistency, test-retest analysis and interitems correlation), were tested. Face and content validity were also assessed. Content Validity Index (CVI) was determined using the average approach and Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI) were calculated accordingly. Construct validity was examined through exploratory factor analysis.

Results: Cronbach's alpha coefficient has been found to be 0.82 for the anxiety subscale and 0.64 for the depression subscale, while overall alpha of the HADS/UV is 0.84. The Urdu version is content valid, and the S-CVI of anxiety subscale, depression subscale and HADS/UV are 0.947, 948 and 0.947, respectively. Test-retest reliability is 0.884 and 0.934 as measured by Pearson correlation and intraclass correlation, respectively. HADS/UV items correlated positively with the whole scale (p<0.001). Factor analysis with varimax rotation revealed that two factors explained 42.75% of the variance. Items' distribution was quite similar to the original HADS.

Conclusion: The HADS/UV is a psychometrically sound instrument with satisfactory measurement, including good internal consistency. The instrument shows promise to be a sound tool to assess anxiety and depression in pregnancy.

Keywords: anxiety; depression.