A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population

Background ms of this study were to: (1) evaluate the psychometric properties of a French Canadian version of the Hospital Anxiety and Depression Scale (HADS-FC) in a large population of primary care patients in Quebec, Canada; (2) conduct a transcultural validation of the original HADS in a subsample of English-speaking patients; (3) explore HADS properties in subgroups with or without multimorbidity. s le of 14,833 adults recruited in 64 primary care clinics completed the HADS, including 3,382 patients at elevated risk of mental disorders that also completed the Composite International Diagnostic Interview-Simplified (CIDIS). The HADS’ internal consistency and discriminant validity were assessed, its factor structure was evaluated, and receiver operating characteristic (ROC) analyses were undertaken to evaluate its case finding abilities. s DS-FC had good reliability (Cronbach’s alphas ranging from 0.79 to 0.89 depending on language version and subscales) and discriminant validity, and a two-factor structure reflecting anxiety and depression factors. Results were similar in patient subgroups with or without multimorbidity. Optimal cut-off values were calculated: HADS: ≥16 (sensitivity 62%, specificity 77%), HADS-A: ≥10 (sensitivity 66%, specificity 73%) and HADS-D:≥7 (sensitivity 65%, specificity 75%). tions hort selection process and use of the CIDIS as a gold standard may have contributed to the limited case-finding performance of the HADS-FC. sions DS-FC and English HADS presented good psychometric properties in primary care patients, including patients with and without multimorbidity. However, its performance as a screening instrument in these settings with patients of varying clinical profiles requires more scrutiny.