Health Psychology Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
PLoS One. 2013 Aug 9;8(8):e70975. doi: 10.1371/journal.pone.0070975. eCollection 2013.
The Hospital Anxiety and Depression Scale (HADS) is widely used to screen for anxiety and depression. A large literature is citable in support of its validity, but difficulties are increasingly being identified, such as inexplicably discrepant optimal cutpoints and inconsistent factor-structures. This article examines whether these problems could be due to the construction of the HADS that poses difficulties for translation and cross-cultural use.
Authors' awareness of difficulties translating the HADS were identified by examining 20% of studies using the HADS, obtained by a systematic literature search in Pubmed and PsycINFO in May 2012. Reports of use of translations and validation studies were recorded for papers from non-English speaking countries. Narrative and systematic reviews were examined for how authors dealt with different translations.
Of 417 papers from non-English speaking countries, only 45% indicated whether a translation was used. Studies validating translations were cited in 54%. Seventeen reviews, incorporating data from diverse translated versions, were examined. Only seven mentioned issues of language and culture, and none indicated insurmountable problems in integrating results from different translations.
Initial decisions concerning item content and response options likely leave the HADS difficult to translate, but we failed to find an acknowledgment of problems in articles involving its translation and cross-cultural use. Investigators' lack of awareness of these issues can lead to anomalous results and difficulties in interpretation and integration of these results. Reviews tend to overlook these issues and most reviews indiscriminately integrate results from studies performed in different countries. Cross-culturally valid, but literally translated versions of the HADS may not be attainable, and specific cutpoints may not be valid across cultures and language. Claims about rates of anxiety and depression based on integrating cross-cultural data or using the same cutpoint across languages and culture should be subject to critical scrutiny.
医院焦虑抑郁量表（HADS）被广泛用于焦虑和抑郁的筛查。大量文献支持其有效性，但越来越多的问题被发现，例如不合理的最佳截断值和不一致的因子结构。本文探讨了这些问题是否可能是由于 HADS 的构建给翻译和跨文化使用带来了困难。
通过对 2012 年 5 月在 Pubmed 和 PsycINFO 上进行的系统文献检索中获得的使用 HADS 的 20%的研究进行检查，发现了作者在翻译 HADS 时遇到的困难。记录了来自非英语国家的论文中使用翻译和验证研究的报告。对叙述性和系统性综述进行了检查，以了解作者如何处理不同的翻译。
在来自非英语国家的 417 篇论文中，只有 45%的论文表明是否使用了翻译。验证翻译的研究被引用了 54%。共检查了 17 篇综述，其中纳入了来自不同翻译版本的数据。只有 7 篇综述提到了语言和文化的问题，但没有一篇综述表明在整合来自不同翻译的结果时存在无法克服的问题。
最初关于项目内容和反应选项的决策可能使得 HADS 难以翻译，但我们没有发现文章在翻译和跨文化使用中存在问题的承认。研究人员对这些问题缺乏认识，可能导致异常结果，以及在解释和整合这些结果时遇到困难。综述往往忽略了这些问题，并且大多数综述不加区分地整合了来自不同国家的研究结果。HADS 的跨文化有效但直译版本可能无法实现，并且特定的截断值可能在不同的文化和语言中无效。基于整合跨文化数据或在语言和文化上使用相同的截断值来声称焦虑和抑郁的发生率应该受到严格审查。
