Correction to: Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study.

The original article [1] contains an incorrect affiliation.

Internet Websites for Chest Pain Symptoms Demonstrate Highly Variable Content and Quality.

OBJECTIVE: Chest pain is a common symptom with causes that range from benign to serious. We assess the content and quality of websites about chest pain symptoms that describe its causes and when to seek care. METHODS: We used five search engines (Google, Bing, Yahoo, Ask, AOL) using the term "chest pain" and assessed the first 30 websites that resulted from each search. We excluded websites that were diagnosis-driven, intended for physicians, patient blogs, advertisements, news, or videos. For included websites, we assessed for the presence of content potentially useful to patients with chest pain symptoms; website quality with three instruments (DISCERN, HONcode, and JAMA benchmark criteria); readability using four validated scores, accessibility, usability, and reliability using the LIDA instrument; and popularity using the Alexa tool. RESULTS: In 27 included websites, 96 and 81% mentioned cardiac and noncardiac causes of chest pain, respectively, while 85% described when to seek emergency care. Only 51% of websites mentioned potential tests that might be used to diagnose symptoms, 22% described potential treatments, and 11% mentioned consequences if treatment is delayed or avoided. The median website DISCERN score was 23 (interquartile range [IQR] = 18-32) out of a possible 45 points, which can be interpreted as low to medium quality. A total of 44% of websites had HONcode certification, and only 11% fulfilled all four JAMA benchmark criteria. Average reading scores demonstrated that half of websites were above the eighth to ninth grade reading level. With LIDA, the average scores were "medium" for accessibility at 83% and usability at 59% and "low" for reliability at 43%. CONCLUSIONS: Many websites that provide health information for patients about chest pain symptoms are not reliable. There is highly variable content and quality, and the average website is difficult to read for patients with low health literacy.

Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study.

BACKGROUND: Depression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient's general prognosis. But screening for these potential comorbidities in a hospital's accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia. METHODS: This cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity. RESULTS: We found the Arabic version of the HADS to be acceptable for 95% of the subjects. We used Cronbach's alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales. CONCLUSION: The HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.