The development and validation of Huaxi Emotional-distress Index (HEI): a Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings

Abstract Background Depression and anxiety among general hospital patients are common and under-recognized in China. This study aimed towards developing a short questionnaire for screening depression and anxiety in non-psychiatric clinical settings, and to test its reliability and validity. Methods The item pool which included 35 questions about emotional distress was drafted through a comprehensive literature review. An expert panel review and the first clinical test with 288 general hospital patients were conducted for the primary item selection. The second clinical test was performed to select the final item in 637 non-psychiatric patients. The reliability and validity of the final questionnaire were tested in 763 non-psychiatric patients, in which 211 subjects were interviewed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). Multiple data analysis methods including Principal Components Analysis (PCA), Item Response Theory (IRT), and Receiver Operating Characteristic (ROC) curve were used to select items and validate the final questionnaire. Results The series selection of items resulted in a 9-item questionnaire, namely Huaxi Emotional-distress Index (HEI). The cronbach's α coefficient of HEI was 0.90. The PCA results showed a unidimensional construct. The area under the ROC curve (AUC) was 0.88 when compared with MINI interview. Using the optimal cut-off score of HEI (11/12), the sensitivity and specificity were 0.880 and 0.766, respectively. Conclusions The HEI is considered as a reliable and valid instrument for screening depression and anxiety, which may have substantial clinical value to detect patients' emotional disturbances especially in the busy non-psychiatric clinical settings in China.