title: Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study.
abstract: BACKGROUND
  Depression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient's general prognosis. But screening for these potential comorbidities in a hospital's accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia.
  
  
  METHODS
  This cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity.
  
  
  RESULTS
  We found the Arabic version of the HADS to be acceptable for 95% of the subjects. We used Cronbach's alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales.
  
  
  CONCLUSIONS
  The HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.
authors.affiliation: Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia. zalaseri@ksu.edu.sa.
authors.forename: Zohair A
authors.initials: ZA
authors.lastname: Al Aseri
authors.affiliation: Fellow Community Health, College of Medicine, University of Saskatchewan, 107, Wiggins Road, S7N 5E5, Saskatoon, Canada. muo110@mail.usask.ca.
authors.forename: M Owais
authors.initials: MO
authors.lastname: Suriya
authors.affiliation: Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia. hoshos_630@yahoo.com.
authors.forename: Hosam A
authors.initials: HA
authors.lastname: Hassan
authors.affiliation: Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia. mujidr@gmail.com.
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Hasan
authors.affiliation: Department of Family and Community Medicine, College of Medicine King Khalid University Hospital KSU, PO Box 230155, Riyadh, 11321, Kingdom of Saudi Arabia. shaffiahamed786@gmail.com.
authors.forename: Shaffi Ahmed
authors.initials: SA
authors.lastname: Sheikh
authors.affiliation: Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia. aaltammimi@ksu.edu.sa.
authors.forename: Adel
authors.initials: A
authors.lastname: Al Tamimi
authors.affiliation: Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia. malshathri@ksu.edu.sa.
authors.forename: Mashhoor
authors.initials: M
authors.lastname: Alshathri
authors.affiliation: Cardiff and Vale University Health Board, Cardiff, UK. najeeb12@sky.com.
authors.forename: Najeeb
authors.initials: N
authors.lastname: Khalid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012529:Saudi Arabia / Q000453:epidemiology; D055815:Young Adult