Translation and validation of the Hungarian Hospital Anxiety and Depression Scale using a large cancer patient sample

Objectives: The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument. The purpose of this study was to evaluate reliability and validity of the Hungarian translation. Methods: The English version of the HADS was translated using the 'forward-backward' procedure. The questionnaire was used in a large scale study of 678 Hungarian cancer patients along with other screening measures of psychological state and description of illness. Results: Translated items of the HADS questionnaire showed high internal consistency: Cronbach's alpha values for the subscales were 0.82 (anxiety) and 0.83 (depression). Factor analysis of the Hungarian version yielded an identical two-factor model to the English and German versions. Results of the known groups comparison showed that both subscales of the HADS discriminates well between sub-groups: decreasing performance status and more advanced disease stage showed significantly higher levels of anxiety and depression. Sufficient concurrent validity of the HADS depression subscale was found using the Hungarian version of the Beck Depression Scale (correlation was 0.8, p<0.0001).Conclusions: Based on a detailed analysis of results from a study of over 700 Hungarian cancer patients, we found the translated version of the HADS a reliable and valid self-assessment screening tool in medical practice.