Translation, reliability, and structural validity of the Hospital Anxiety and Depression Scale (HADS) in the general population of Mongolia

Abstract

Various psychological, biological, and social factors make people vulnerable to mental health problems. These precursory factors as mental distress, are not sufficient alone for diagnosing a mental disorder but are recognised as risks to mental health. There has been no screening tool available in Mongolia that is adequately validated for mental health screening and neuropsychiatric functions of the brain. Therefore, we aimed to translate and validate the hospital anxiety and depression scale (HADS) to identify potential mental distress in healthy people. The HADS is reliable, valid, and practical for identifying the most common psychological disturbances. This nationwide comparative observational study for the validity of a self-reported measure was conducted between June and December 2020. One thousand ninety-four participants were randomly selected, aged 13-75, mean age was 37.7±13.7 years old, 60.9% were females, 63.9% were married. HADS total score was 13.0±5.7, HADS anxiety (HADS-A) score was 6.8±3.6, and HADS depression (HADS-D) score was 6.0±3.1 for the original two-factor model. The external reliability was good in the whole scale, and both subscales using the Intraclass Correlation Coefficient (0.872, 0.837, and 0.801 for the HADS-T, HADS-A, and HADS-D, respectively). Cronbach's alpha value was 0.776, 0.756, and 0.582, respectively, for the HADS-T, HADS-A, and HADS-D, indicating an acceptable internal consistency for the entire scale but marginal reliability for the HADS-D subscale. The reliability of both the two-factor and three-factor structures of the HADS was confirmed using confirmatory factor analysis with a satisfactory model fit on a separate sample. In conclusion, the Mongolian version of the HADS can be considered a valid and reliable measurement tool for various scientific and clinical practices in the general population.

The Brain Overwork Scale: A Population-Based Cross-Sectional Study on the Psychometric Properties of a New 10-Item Scale to Assess Mental Distress in Mongolia

“…Among fourteen items, seven of them are for anxiety (HADS-A subscale), and the remaining seven are for depression (HADS-D subscale). The Mongolian version of HADS demonstrated evidence of good validity and reliability for the general population [ 38 ]. Each item is rated on 4-point scale for a total score between 0 and 21 for each subscale.…”

Psychometric properties of the Mongolian version of the Pittsburgh Sleep Quality Index

“…The ranges of scores for cases on each subscale are 0-7 or normal, 8-10 or mild disorder, 11-14 or moderate disorder, and 15-21 or severe disorder (Zigmond & Snaith, 1983). The two-factor Mongolian version of the HADS had been validated in the general population (Tumurbaatar et al, 2021b).…”

Anxiety, depression, and brain overwork in the general population of Mongolia

“…Scores falling within the range of 0–7 are classified as normal, scores between 8 and 10 indicate a mild abnormality, scores ranging from 11 to 14 denote a moderate abnormality, and scores from 15 to 21 represent severe abnormality for each subscale. We determined the psychometric properties of the HADS in the general population in our previous study, which demonstrated that the Mongolian version of HADS has good validity and reliability for assessing anxiety and depression 18 .…”

“…It comprises of 14 Likert-scale items that represent two latent domains: anxiety and depression. In a previous study, we translated and evaluated the psychometric properties of the Mongolian version of the HADS in the general population, demonstrating good validity and reliability for assessing mental distress 18 .…”