ArticleArchives of public health = Archives belges de sante publique2021
Detecting anxiety and depression among people with limited literacy living with chronic low back pain in Nigeria: adaptation and validation of the hospital anxiety and depression scale.
Article in Archives of public health = Archives belges de sante publique, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Depressive symptoms and its determinants among people living with HIV in Africa: systematic review and meta-analysis.BMC psychiatry · 2025Pooled it
- Health-related quality of life and associated factors among older adults attending primary care clinics in Nigeria: a cross-sectional study.BMC primary care · 2026Article
- Developing and pilot testing an intervention model to manage the burden of family caregivers of older adults with schizophrenia.BMC nursing · 2025Article
- Exploring the clinical utility of postural outcome tools for back and neck pain clinical outcomes: a systematic scoping review.F1000Research · 2025Article
- Anxiety and depression in primary knee osteoarthritis patients: are they related to clinical features and radiographic changes?Reumatologia · 2024Article
- Suicide Risk in Rheumatoid Arthritis Patients is Associated With Suboptimal Vitamin D Levels.Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases · 2022Article
- Mapping Network Connectivity Among Symptoms of Depression and Pain in Wuhan Residents During the Late-Stage of the COVID-19 Pandemic.Frontiers in psychiatry · 2022Article
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe Hospital Anxiety and Depression Scale (HADS) is one of the most popular measures of anxiety and depression. The original HADS is mostly used in Nigeria precluding people with limited literacy. This study aimed to cross-culturally adapt and psychometrically test the HADS for rural and urban Nigerian Igbo populations with chronic low back pain (CLBP) who have limited literacy.
methodsThe HADS was forward translated, back translated, and appraised. Face and content validity was ensured by pre-testing the translated measure among a convenience sample of twelve rural Nigerian dwellers with CLBP. Reliability utilising Cronbach's alpha, intraclass correlation coefficient, Bland-Altman plots and minimal detectable change were investigated amongst a convenience sample of 50 people living with CLBP in rural and urban Nigerian communities. Construct validity testing involving correlations between Igbo-HADS and Roland Morris Disability Questionnaire measuring self-reported back pain-specific disability, World Health Organisation Disability Assessment Schedule assessing generic self-reported disability, Fear Avoidance Beliefs Questionnaire measuring fear avoidance beliefs, and eleven-point box scale assessing pain intensity, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among a random sample of 200 adults with CLBP in rural Nigerian communities were conducted.
resultsIdioms and colloquialisms were difficult to adapt. Internal consistency was good (α = 0.78) and acceptable (α = 0.67) for anxiety and depression subscales respectively. Intraclass correlation coefficients were very good (ICC ≃ 0.8) for both subscales. Minimal detectable change was 6.23 and 5.06 for anxiety and depression subscales respectively. The Igbo-HADS and the anxiety subscale had strong correlations (≃ 0.7) with generic self-reported disability; moderate correlations (≃ 0.5-0.6) with pain intensity, self-reported back pain-specific disability, and fear avoidance beliefs. The depression subscale had the lowest correlations (≃ 0.3-0.4) with these outcomes. The EFA produced a two-factor structure with cross-loading of items. The CFA showed poor fit indices for the EFA structure, the original two-factor structure, and one-factor structure.
conclusionThe HADS may not be suitable for assessing anxiety and depression, or emotional distress in this population due to difficulty achieving cross-cultural equivalence with western idioms; and the expression of emotional distress through somatisation in this culture.
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