Assessing anhedonia in Chinese healthy and depressed adolescents: reliability, validity, and clinical utility of the anhedonia scale for adolescent

BACKGROUND: Anhedonia, a core symptom of adolescent depression, is often difficult to assess, the 14-item Anhedonia Scale for Adolescents (ASA) was developed to address this need. This study aimed to evaluate the reliability and validity of the ASA among healthy and depressed adolescents in China. METHODS: In Study 1, a large community sample of 1,448 adolescents (female = 855; mean age = 14.61 years) from middle schools across eastern, western, and central China were recruited between October 2022 to April 2023 to evaluate the psychometric properties of the ASA in general population. To validate the factor structure, confirmatory factor analysis was employed. Internal consistency (Cronbach's α) and test-retest reliability at six-month intervals (Intraclass Correlation Coefficient, ICC) were also assessed. In Study 2, a clinical sample of 168 adolescents with major depressive disorder (MDD), 121 with subthreshold depression (SD), and 149 healthy controls (HC) were recruited between April 2023 to April 2024, to examine the construct validity, discriminative ability, and clinical applicability and divergent validity of the ASA. One-way analyses of variance (ANOVAs) were conducted to analysis the group difference. RESULTS: In Study 1, validity assessments confirmed that a three-factor model - (1) Enjoyment, Excitement, Emotional Flattening; (2) Enthusiasm, Connection, Purpose; (3) Effort, Motivation, Drive-provided a good fit. Reliability assessments demonstrated strong internal consistency (Cronbach's α = 0.733 to 0.883) and test-retest reliability (ICC = 0.749). In study 2, the ASA exhibited acceptable reliability and validity within the MDD group. Crucially, ANOVA results revealed significant group differences in ASA scores, with MDD patients scoring the highest, followed by SD groups, and then HCs (MDD > SD >HC, ps < 0.001), demonstrating strong discriminative ability. CONCLUSIONS: These results indicate that the ASA demonstrates acceptable construct validity, reliability, discriminative ability and shows promise as a useful tool for assessing anhedonia in Chinese adolescents for both research and clinical settings with Chinese adolescents.