Validation and Reliability Testing of the Hamburg–Hannover Agitation Scale (H2A)

Abstract

Agitation is a common issue among individuals with mental disorders, yet most assessments rely on observer ratings and disorder-specific tools. The Hamburg–Hannover Agitation Scale (H2A) measures agitation as an independent construct using self-report. This study aimed to culturally adapt and validate the Indonesian version of H2A and examine factors associated with agitation. A total of 200 adults with mental disorders participated. Adaptation and validation followed COSMIN guidelines, including expert focus group discussions for content validity and confirmatory factor analysis (CFA) for construct validity. The Indonesian H2A demonstrated good construct validity (p = .020; GFI .936; NNFI .977; CFI .983; RMSEA .057; SRMR .037) and high internal consistency (Cronbach’s α = .93). The mean agitation score was 24 (of 60), influenced by age, gender, and diagnostic category (Axes I and II). This is the first validated self-report tool for agitation in Indonesian adults, offering patient-centered assessment.