title: Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong.
abstract: OBJECTIVE
  The Hospital Anxiety and Depression Scale (HADS) is widely used in adult populations; however, its usefulness with adolescents has been explored less. This study sought to evaluate the reliability, validity, and factor structure of the Chinese version of HADS in a community sample of adolescents residing in Hong Kong.
  
  
  METHODS
  A prospective cohort of 5,857 students recruited from 17 secondary schools completed the HADS. Internal consistency and concurrent validity were examined. Confirmatory factor analysis was applied to test the relative fits of six factor structures of the HADS. The best fitting model was further cross-validated by male, female, split-half samples, and age subgroups.
  
  
  RESULTS
  The HADS possessed adequate internal consistency, especially for the anxiety subscale. Significant concurrent intercorrelations with self-reported suicidal thoughts and the Youth Self Report Anxious/Depressed subscale were discovered and found to be stronger for females. The cross-validation supported a two-factor model, where anxiety item 7, "I can sit at ease and feel relaxed", was placed in the depression subscale.
  
  
  CONCLUSIONS
  The HADS showed satisfactory psychometric properties as a screening instrument in assessing anxious and depressive states as two correlated but distinct factors in adolescents. Study implications and recommendations for future research were discussed.
authors.affiliation: Department of Nursing Studies, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Doris Y P
authors.initials: DY
authors.lastname: Leung
authors.forename: Daniel Y T
authors.initials: DY
authors.lastname: Fong
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Leung
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012574:Schools; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult