Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong

Y.-F. Chan, Yin Ping Leung, D.Y.T. Fong, C.-M. Leung, A.M. Lee

Research output: Journal article publicationJournal articleAcademic researchpeer-review

95 Citations (Scopus)


Purpose: 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, splithalf 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.
Original languageEnglish
Pages (from-to)865-873
Number of pages9
JournalQuality of Life Research
Issue number6
Publication statusPublished - 1 Aug 2010
Externally publishedYes


  • Adolescent
  • Anxiety
  • Depression
  • HADS
  • Psychometric properties

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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