title: Reliability and Validity of a Nepali-language Version of the Hospital Anxiety and Depression Scale (HADS).
abstract: BACKGROUND
  In several languages and settings, the Hospital Anxiety and Depression Scale (HADS) has demonstrated reliable and valid screening properties in psychiatry.
  
  
  OBJECTIVE
  To develop a Nepali version of HADS with acceptable reliability and construct validity for use among hospital patients and in the general population.
  
  
  METHODS
  The original English version was translated into Nepali using a forward-backward translation protocol. Psychometric properties were tested by factor analysis and Cronbach's alpha. The translated scale was administered to three groups of adult in-patients in a university hospital in three trials, and to a sample of adults from the community in a fourth trial. Some of the 14 items were reworded reiteratively to achieve viable semantic and statistical solutions.
  
  
  RESULTS
  The two-factor solution with anxiety and depression subscales eventually explained 40.3% of the total variance. Cronbach's alpha was 0.76 for anxiety (HADS-A) and 0.68 for depression (HADS-D). All seven HADS-A items showed at least acceptable item-to-factor correlations (range 0.44-0.74), and full construct validity was achieved for this subscale. Item-to-factor correlations for six HADS-D items were also at least acceptable (range 0.42-0.70); one item (D4) had persistently low correlations throughout all trials, although construct validity was still satisfactory.
  
  
  CONCLUSIONS
  Reiterated rewording of items guided by statistical testing resulted in a Nepali version of HADS with satisfactory psychometric properties.
authors.affiliation: Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Neuroscience Norwegian University.
authors.forename: A
authors.initials: A
authors.lastname: Risal
authors.affiliation: Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. Department of Neuroscience Norwegian University.
authors.forename: K
authors.initials: K
authors.lastname: Manandhar
authors.affiliation: Department of Neuroscience Norwegian University of Science and Technology Trondheim, Norway. Norwegian Advisory Unit on Headaches St Olavs University Hospital Trondheim, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Linde
authors.affiliation: Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
authors.forename: R
authors.initials: R
authors.lastname: Koju
authors.affiliation: Department of Neuroscience Norwegian University of Science and Technology Trondheim, Norway. Division of Brain Sciences Imperial College London, London, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Steiner
authors.affiliation: Department of Neuroscience Norwegian University of Science and Technology Trondheim, Norway. Pain Unit, St Olavs University Hospital Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Holen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007802:Language; D008297:Male; D009390:Nepal; D011594:Psychometrics; D015203:Reproducibility of Results; D012111:Residence Characteristics; D011795:Surveys and Questionnaires / Q000592:standards*; D014175:Translating