The translation of the Hospital Anxiety and Depression Scale (HADS) into Urdu was undertaken by the authors in committee. After examining initial drafts by 6 independent translators, an agreed Urdu text was given to 6 back-translators, and subsequently modified further. The evaluation of the new translation was performed in 3 stages: evaluation of linguistic equivalence of items in a bilingual population; evaluation of conceptual equivalence by examining item-subscale correlations: and evaluation of scale equivalence by 2-way classification of high and low scorers. Satisfactory results at each stage suggest that the Urdu version is a reliable and valid translation of the HADS for use in Pakistan.