Cultural validation of the Sinhala version of the Hospital Anxiety and Depression Scale (HADS-S) in Sri Lanka

Background: This study culturally adapted and validated the Hospital Anxiety and Depression Scale for Sri Lanka’s Sinhala-speaking population (HADS-S). Given the importance of culturally appropriate mental health screening tools, this adaptation aimed to ensure linguistic relevance while maintaining psychometric validity.
Aims: The primary objectives were to establish the HADS-S’s cultural appropriateness and evaluate its psycho-metric properties, including reliability, validity, sensitivity, and specificity for anxiety and depression screening.
Methods: A cross-sectional study at a Sri Lankan tertiary hospital medical outpatient clinic, recruited 154 Sinhala-speaking participants. Researchers assessed internal consistency (Cronbach’s α), factor structure, sensitivity, specificity, and clinical agreement (Kappa statistic). Correlation analysis examined the anxiety-depression relationship.
Results: The HADS-S demonstrated strong internal consistency for anxiety (α=0.803) but weaker performance for depression (α=0.563), with overall good reliability (α=0.775). Factor analysis confirmed two distinct domains, though some items loaded unexpectedly. The scale showed excellent anxiety screening performance (94.1% sensitivity, 86.4% specificity) and moderate depression sensitivity (82.9%). Clinical agreement was strong for anxiety (k=0.764) but moderate for depression (k=0.489). A moderate positive correlation existed between anxiety and depression scores.
Conclusion: The HADS-S proves reliable and valid for anxiety screening in Sinhala-speaking populations, though the depression subscale requires refinement. While clinically useful for anxiety detection, further deve-lopment of the depression items is recommended to improve psychometric properties. The tool shows promise for mental health screening in Sri Lankan clinical and research settings.