The Arabic Hospital Anxiety and Depression Scale: validation in a sample of Lebanese patients with cancer

Middle East Current Psychiatry - Tập 30 Số 1
Nour Ibrahim1, Dahlia Yamout2, Maya Bizri1, Alì Taher3
1Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
2Department of Psychology, Maudsley Health, Abu Dhabi, United Arab Emirates
3Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

Tóm tắt

Abstract Background Depression and anxiety are common comorbid psychological disorders among patients with cancer. Despite the wide use of the Arabic Hospital and Anxiety Scale (HADS) in oncological settings, it has not been yet validated among Lebanese patients with cancer. We aimed to assess the reliability and validity of the HADS in a sample of Lebanese patients with cancer. One-hundred one Lebanese patients diagnosed with cancer presenting to the Ambulatory Care Center in the Hematology Oncology Department at the American University of Beirut Medial Center filled the Arabic version of the HADS. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire 9-Item Scale (PHQ-9) were used to assess its concurrent validity in capturing anxiety and depression, respectively. Results Reliability analysis using Cronbach’s alpha (α) coefficient revealed good internal consistency for the Arabic HADS (α = 0.89) and both subscales (α = 0.86 for depression and α = 0.78 for anxiety). Correlations between HADS with both GAD-7 and PHQ-9 were statistically significant and strong for both depression (r = 0.795; p < 0.0001) and anxiety (r = 0.727; p < 0.0001). Confirmatory factor analysis revealed that the observed data fits the two-factor model of depression and anxiety (Kaiser–Meyer–Olkin = 0.86; Tucker Lewis Index = 0.879; root-mean-square error of approximation = 0.08). Depression and anxiety rates were approximately 52% and 25%, respectively. Conclusion We conclude that the Arabic version of the HADS is a credible and valid tool for clinical assessment of psychological distress (anxious and depressive states) among Lebanese patients with cancer.

Từ khóa


Tài liệu tham khảo

Salhab HA, Fares MY, Khachfe HH, Khachfe HM (2019) Epidemiological study of lung cancer incidence in Lebanon. Medicina (Lithuania) 55:217. https://doi.org/10.3390/medicina55060217

Khachfe HH, Rahal Z, Sammouri J et al (2020) Cancer in Lebanon: a review of incidence rates from 2008 to 2015 and projections till 2025. South Asian J Cancer 09:147–152. https://doi.org/10.1055/s-0040-1721291

Weir HK, Thompson TD, Soman A et al (2015) The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer 121:1827–1837. https://doi.org/10.1002/cncr.29258

Khachfe HH, Salhab HA, Fares MY, Khachfe HM (2020) Probing the colorectal cancer incidence in Lebanon: an 11-year epidemiological study. J Gastrointest Cancer 51:805–812. https://doi.org/10.1007/s12029-019-00284-z

Globocan (2021) Lebanon (Source: Globocan 2020). https://gco.iarc.fr/today/data/factsheets/populations/422-lebanon-fact-sheets.pdf

Carlson LE, Angen M, Cullum J et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304. https://doi.org/10.1038/sj.bjc.6601887

Eskelinen M, Korhonen R, Selander T, Ollonen P (2017) Beck Depression Inventory as a predictor of long-term outcome among patients admitted to the Breast Cancer Diagnosis Unit: a 25-year cohort study in Finland. Anticancer Res 37:819–824. https://doi.org/10.21873/anticanres.11383

International Psycho-Oncology Society (IPOS) (2010) Statement on standards and clinical practice guidelines in cancer care. https://www.ipos-society.org/about/quality. Accessed 18 Sep 2021

UICC The Union for International Cancer Control

Donovan KA, Jacobsen PB (2013) Progress in the implementation of NCCN guidelines for distress management by member institutions. J Natl Compr Canc Netw 11:223–226. https://doi.org/10.6004/jnccn.2013.0029

Hayek S, Dakroub A, Beaini H, et al (2021) Psycho‐oncology in the Arab world: the time is now. Psycho-Oncology pon.5778. https://doi.org/10.1002/pon.5778

Bultz BD, Cummings GG, Grassi L et al (2014) 2013 President’s Plenary International Psycho-oncology Society: embracing the IPOS standards as a means of enhancing comprehensive cancer care. Psychooncology 23:1073–1078. https://doi.org/10.1002/pon.3618

Abdel-Khalek AM (1998) Internal consistency of an Arabic adaptation of the Beck Depression Inventory in four Arab countries. Psychol Rep 82:264–266. https://doi.org/10.2466/pr0.1998.82.1.264

Obeid S, Abi Elias Hallit C, Haddad C et al (2018) Validation of the Hamilton Depression Rating Scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients. L’Encéphale 44:397–402. https://doi.org/10.1016/j.encep.2017.10.010

Hallit S, Haddad C, Hallit R et al (2019) Validation of the hamilton anxiety rating scale and state trait anxiety inventory A and B in Arabic among the Lebanese population. Clin Epidemiol Global Health 7:464–470. https://doi.org/10.1016/j.cegh.2019.02.002

Sawaya H, Atoui M, Hamadeh A et al (2016) Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res 239:245–252. https://doi.org/10.1016/j.psychres.2016.03.030

Grassi L, Caruso R, Nanni MG (2013) Somatization and somatic symptom presentation in cancer: a neglected area. Int Rev Psychiatry 25:41–51. https://doi.org/10.3109/09540261.2012.731384

Ahmed E (2019) Antidepressants in patients with advanced cancer: when they’re warranted and how to choose therapy. Oncology (Williston Park) 33:62–68

McDermott CL, Bansal A, Ramsey SD et al (2018) Depression and health care utilization at end of life among older adults with advanced non–small-cell lung cancer. J Pain Symptom Manage 56:699-708.e1. https://doi.org/10.1016/j.jpainsymman.2018.08.004

Spiegel D, Butler LD, Giese-Davis J et al (2007) Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer. Cancer 110:1130–1138. https://doi.org/10.1002/cncr.22890

Naser AY, Hameed AN, Mustafa N, et al (2021) Depression and anxiety in patients with cancer: a cross-sectional study. Front Psychol 12:. https://doi.org/10.3389/fpsyg.2021.585534

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

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

Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52:69–77. https://doi.org/10.1016/S0022-3999(01)00296-3

Vodermaier A, Millman RD (2011) Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 19:1899–1908

Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

El-Rufaie OEFA, Absood G (1987) Validity study of the Hospital Anxiety and Depression Scale among a group of Saudi patients. Br J Psychiatry 151:687–688. https://doi.org/10.1192/bjp.151.5.687

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. https://doi.org/10.1111/j.1600-0447.1991.tb03153.x

El-Rufaie OEF, Absood GH (1995) Retesting the validity of the Arabic version of the Hospital Anxiety and Depression (HAD) Scale in primary health care. Soc Psychiatry Psychiatr Epidemiol 30:26–31. https://doi.org/10.1007/BF00784431

Terkawi A, Tsang S, Alkahtani G et al (2017) Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth 11:S11–S18. https://doi.org/10.4103/sja.SJA_43_17

Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S (2003) The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 1:14. https://doi.org/10.1186/1477-7525-1-14

Kaiser HF (1974) An index of factorial simplicity. Psychometrika 39:31–36. https://doi.org/10.1007/BF02291575

Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ (1999) Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods 4:272–299. https://doi.org/10.1037/1082-989X.4.3.272

Annunziata MA, Muzzatti B, Altoè G (2011) Defining Hospital Anxiety and Depression Scale (HADS) structure by confirmatory factor analysis: a contribution to validation for oncological settings. Ann Oncol 22:2330–2333. https://doi.org/10.1093/annonc/mdq750

Villoria E, Lara L (2018) Assessment of the Hospital Anxiety and Depression Scale for cancer patients. Rev Med Chil 146:300–307. https://doi.org/10.4067/s0034-98872018000300300

Thomas BC, Devi N, Sarita GP et al (2005) Reliability and validity of the Malayalam Hospital Anxiety and Depression Scale (HADS) in cancer patients. Indian J Med Res 122:395–399

Moorey S, Greer S, Watson M et al (1991) The factor structure and factor stability of the Hospital Anxiety and Depression Scale in patients with cancer. Br J Psychiatry 158:255–259. https://doi.org/10.1192/bjp.158.2.255

Sellick SM, Edwardson AD (2007) Screening new cancer patients for psychological distress using the Hospital Anxiety and Depression Scale. Psychooncology 16:534–542. https://doi.org/10.1002/pon.1085

Carroll BT, Kathol RG, Noyes R et al (1993) Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 15:69–74. https://doi.org/10.1016/0163-8343(93)90099-A

Farran N (2021) Mental health in Lebanon: tomorrow’s silent epidemic. Mental Health Prev 24:200218. https://doi.org/10.1016/j.mhp.2021.200218

Saliba AN, Taher AT (2021) The Lebanese healthcare sector: the point of exsanguination. American Journal of Hematology 96:. https://doi.org/10.1002/ajh.26331

El Sayed NM, Puffer ES, Sikkema KJ (2018) The ecology of resilience: predictors of psychological health in youth in Lebanon. Commun Psychol Global Perspect 4:136–149. https://doi.org/10.1285/i24212113v4i2p136

Doumit R, Afifi RA, Devon HA (2015) Serenity in political uncertainty. Holist Nurs Pract 29:78–86. https://doi.org/10.1097/HNP.0000000000000077

El Hayek S, Bizri M (2020) Beirut blast and mental health in Lebanon: finding ways out. Asian J Psychiatry 54:102458. https://doi.org/10.1016/j.ajp.2020.102458

Herrero MJ, Blanch J, Peri JM et al (2003) A validation study of the Hospital Anxiety and Depression Scale (HADS) in a Spanish population. Gen Hosp Psychiatry 25:277–283. https://doi.org/10.1016/S0163-8343(03)00043-4

Terol-Cantero MC, Cabrera-Perona V, Martín-Aragón M (2015) Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas. Anales de Psicología 31:494. https://doi.org/10.6018/analesps.31.2.172701

Thông tin
Thông tin xuất bản

Middle East Current Psychiatry

Tập 30 Số 1

Thông tin tác giả