Authors (including presenting author) :
Choi YY
Affiliation :
Occupational Therapy Department, Kowloon Hospital
Introduction :
Common mental disorders (CMD), such as depression, generalized anxiety disorders, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and social anxiety disorder, are increasingly prevalent in Hong Kong. CMD is associated with significant long-term disability, morbidity, and healthcare utilization. Behavioral Activation (BA) is one of the evidence-based interventions for mood disorders. Therapists focus on the activation of behavior, control of aversive stimuli, and avoidance of behavior in depression. The Behavioral Activation for Depression Scale (BADS) (Kanter et al., 2006) is a client-self-reported instrument to track when and how clients become activated throughout behavioral activation intervention. No local research has culturally adapted the BADS for evaluation in clinical settings.
Objectives :
This validation study involved translation of the BADS into Chinese (C-BADS) and examination of its psychometric properties. The aims of this study included 1) to translate and adapt the English version of the BADS into Traditional Chinese (C-BADS); 2) to explore the factor structure and construct validity testing of the C-BADS, including the investigation of convergent validity of C-BADS with other instruments; and 3) to evaluate the internal consistency, test-retest reliability of C-BADS.
Methodology :
Our method for validating the C-BADS was comprehensive and rigorous. We adopted a complete linguistic validation process, including forward and backward translation, expert review, and cognitive debriefing. Three expert reviewers evaluated the semantic equivalence and content validity. The translated Chinese version of C-BADS was completed by 103 local adult patients with CMD in the Occupational Therapy Department at Kowloon Hospital. Confirmatory factor analysis (CFA) was conducted to examine structural validity; construct validity was assessed by the correlations between the C-BADS with the Chinese Short Warwick-Edinburg Mental Wellbeing Scale (C-SWEMWES), the Chinese Depression Anxiety Stress Scale (C- DASS), the Chinese Work and Social Adjustment Scale (C-WSAS), and the Chinese Ruminative Response Scale (C-RRS). Test-retest reliability and internal consistency were examined using Spearman’s correlation coefficient and Cronbach’s alpha. This thorough method ensured the credibility and reliability of our results.
Result & Outcome :
Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology was adopted, and the C-BADS was assessed with good semantic equivalence and content validity obtained. The psychometric properties were tested, and the result showed that the proposed 4-factor model fit the local data. The goodness of fit test indicated good to excellent fit indices (CFI =0.985, TLI= 0.985, RMSEA= 0.032 (C.I. 0.011, 0.052). Correlation for the four subscales was found to be significant (p< .001). The C-BADS total score showed a highly significant correlation with mental wellbeing, mood symptoms, work and social function, and rumination response, which ranged from r= -0.866 to r= -0.706. Internal consistency was good to excellent with total score α = 0.870, Activation (α= 0.944), Avoidance/Rumination (α = 0.880), Work/School Impairment (α = 0.946), and Social Impairment (α = 0.903). Test-retest reliability was assessed using Spearman’s correlation coefficient among 96 participants who returned for a second administration 2 to 5 weeks after the initial assessment. The overall test-retest reliability was tested to be good (r = 0.748). The translated C-BADS was tested and found to have satisfactory psychometric properties. This outcome confirms that the C-BADS is a reliable and valid tool to assess and monitor the level of BA intervention among people with common mental disorders in Hong Kong. The positive results of this study suggest C-BADS's potential as a valuable instrument in clinical practice.
