Skip to main content
Log in

The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability

  • Supportive Care International
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals of work

The aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit.

Patients and methods

The scale was translated with the “forward-backward” procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S).

Main results

Factor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbach’s alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale.

Conclusions

These psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abiafun OA (1994) A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria. Br J Psychiatry 35:257–264

    Google Scholar 

  2. Bottomley A (1998) Depression in cancer patients: a literature review. Eur J Cancer 7:181–191

    Article  CAS  Google Scholar 

  3. Constantini M, Musso M, Viterbori P, Bonci F, DelMastro L, Garrone O, Venturini M, Morasso G (1999) Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression scale. Support Care Cancer 7:121–127

    Article  PubMed  Google Scholar 

  4. Cronbach LJ (1951) Coefficient alpha and the internal structure of test. Psychometrica 16:297–334

    Google Scholar 

  5. El Rufaie OE, Albar AA, al Dabal BK (1988) Identifying anxiety and depressive disorders among primary care patients: a pilot study. Acta Psychiatr Scand 77:280–282

    PubMed  Google Scholar 

  6. Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale. A review of validation data and clinical results. J Psychosom Res 42:17–41

    Article  CAS  PubMed  Google Scholar 

  7. Keedwell P, Snaith RP (1996) What do anxiety scales measure? Acta Psychiatr Scand 93:177–180

    CAS  PubMed  Google Scholar 

  8. Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG (1996) Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. Br J Psychiatry Suppl 30:17–30

    PubMed  Google Scholar 

  9. Klein DF (1974) Endogenomorphic depression. Arch Gen Psychiatry 31:447–454

    CAS  PubMed  Google Scholar 

  10. Lowe B, Sitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78(2):131–140

    Article  PubMed  Google Scholar 

  11. Malasi TH, Mirza IA, el Islam MF (1991) Validation of the Hospital Anxiety and Depression Scale in Arab patients. Acta Psychiatr Scand 84:323–326

    CAS  PubMed  Google Scholar 

  12. Moffic HS, Paykel ES (1975) Depression in medical in-patients. Br J Psychiatry 126:346–353

    CAS  PubMed  Google Scholar 

  13. Mumford DB, Tareen IA, Bajwa MA, Bhatti MR, Karim R (1991) The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression scale. Acta Psychiatr Scand 83:81–85

    CAS  PubMed  Google Scholar 

  14. Nunnally J, Bernstein I (1994) Psychometric theory. McGraw-Hill, New York

  15. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    CAS  PubMed  Google Scholar 

  16. Ormel J, Oldenhinkel AJ, Goldberg DP, Hadiamont PPG, Wilmink FW, Bridges K (1995) The structure of common psychiatric symptoms: how many dimensions of neurosis? Psychol Med 25:521–530

    CAS  PubMed  Google Scholar 

  17. Razavi D, Stiefel F (1994) Common psychiatric disorders in cancer patients. Adjustment disorders and depressive disorders. Support Care Cancer 2:223–232

    CAS  PubMed  Google Scholar 

  18. Sartorius N, Ustun TB, Lecrubier Y, Wittchen HU (1996) Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry Suppl (30):38–43

    Google Scholar 

  19. Sensky T (1988) Measurement of the quality of life in end-stage renal failure. N Engl J Med 319:1353

    CAS  Google Scholar 

  20. Snaith RP (1993) What do depression scales measure? Br J Psychiatry 163:293–298

    CAS  PubMed  Google Scholar 

  21. Snaith RP (2003) The Hospital Anxiety and Depression scale. Health Qual Life Outcomes 1:29

    Article  PubMed  Google Scholar 

  22. Snaith RP, Baugh SJ, Clayden AD, Hussain A, Sipple M (1982) The Clinical Anxiety scale: a modification of the Hamilton Anxiety scale. Br J Psychiatry 141:518–523

    CAS  PubMed  Google Scholar 

  23. Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual of the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA

  24. Underwood MJ, Firmin RK, Jehn D (1993) Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting. Br Heart J 69:383–384

    Google Scholar 

  25. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression scale (validity and reliability). Acta Psychiatr Scand 67:361–370

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kyriaki Mystakidou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mystakidou, K., Tsilika, E., Parpa, E. et al. The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability. Support Care Cancer 12, 821–825 (2004). https://doi.org/10.1007/s00520-004-0698-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-004-0698-y

Keywords

Navigation