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Development and psychometric validity of the perioperative anxiety scale-7 (PAS-7)

BMC Psychiatry volume 21, Article number: 358 (2021) Cite this article

Abstract

Background

Preoperative anxiety is a common psychological reaction in perioperative patients. The absence of a valid measurement tool hinders the evaluation of interventions to treat preoperative anxiety in China. This study aims to develop the Perioperative Anxiety Scale-7 (PAS-7) and test its reliability, validity, and cut-off value.

Methods

A total of 280 patients over 16 years old (M = 55.1, SD = 14.3) who were undergoing elective surgery were recruited to complete the PAS-7 and the Generalized Anxiety Disorder-7 scale (GAD-7) one day before surgery.

Results

The PAS-7 included seven items divided into two dimensions: mental anxiety and somatic anxiety. These two dimensions could explain 74.294% of the population variance. The internal consistency of each dimension ranged from 0.761–0.933. The confirmatory factor analysis showed that the model fit of the scale was good (χ2= 34.798, df = 13, χ2/df = 2.677, CFI = 0.949, TLI = 0.918, SRMR = 0.057, RMSEA = 0.115). The correlations between the GAD-7 and each dimension and the scale’s total score were significant (0.711–0.789). A cut-off score of 8, maximizing the Youden Index, yielded a sensitivity of 75% and a specificity of 84.6% (95% CI: 0.88 ~ 0.97).

Conclusions

The PAS-7 had good reliability and validity and could be used as an effective tool to evaluate preoperative anxiety.

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Background

Preoperative anxiety is a common psychological reaction among perioperative patients [1]; the incidence of this reaction is high both domestically, at approximately 50% [2, 3], and abroad, at 40% ~ 80% [4, 5]. Individual trait anxiety, understanding of operation-related information, and other factors affect patients’ level of preoperative anxiety [6]. Psychological nursing and music intervention are widely used in the intervention at present [7, 8].

The high incidence of preoperative anxiety has been suggested to be associated with many adverse effects for patients, including the following: increased postoperative pain and postoperative analgesic requirements [9, 10]; increased heart rate, blood pressure, and epinephrine levels [11, 12]; increased postoperative nausea, vomiting and delirium [13, 14]; and increased recovery times and hospital stays [15, 16]. Thus, given the high frequency and adverse outcomes of preoperative anxiety, a statistically valid assessment and timely intervention for preoperative anxiety have been significant issues for anesthetists and psychologists [17].

Currently, preoperative anxiety measurement tools exist in two categories: universal anxiety scales and specific anxiety scales [18]. Universal anxiety scales include the State-Trait Anxiety Inventory (STAI) [19,20,21], the Self-Rating Anxiety Scale (SAS) [22, 23], and the Hamilton Anxiety Scale (HAMA) [24, 25]. These anxiety scales are widely suitable for both patients and healthy respondents; however, their limitations include low sensitivity and less assessment of preoperative anxiety. The most common specific anxiety scales are the Generalized Anxiety Disorder-7 scale (GAD-7) [26, 27] and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) [28, 29]. The GAD-7 is applied simply and widely, but it has specific restrictions on the applicable population. For example, it is necessary to exclude patients with physical symptoms, and its discriminant validity is not high among elderly patients. The APAIS is specifically used to evaluate surgical patients and has been proven effective in preoperative anxiety assessment in China [30]. However, due to being developed in another country, certain cultural differences, and a lack of items related to physical anxiety, its use in China also has certain limitations.

The absence of a proper and easily applied measurement tool in preoperative settings hinders evaluating interventions to treat preoperative anxiety among patients in China. Therefore, the purpose of this study was to develop an effective scale, namely, the Perioperative Anxiety Scale-7 (PAS-7), for the assessment of mental and somatic symptoms of preoperative anxiety.

Methods

Participants

A total of 280 participants who underwent an elective operation under general anesthesia from March 1st, 2019 to May 31st, 2019 were recruited from a comprehensive hospital in Shanghai. The inclusion criteria were as follows: (1) older than 16 years old; (2) undergoing elective operation under general anesthesia; (3) Chinese native speakers; (4) no history of psychiatric drug use; (5) completed the scale independently or with the doctor’s help. The participants were excluded if (1) they had poor medical conditions or (2) they could not correctly understand the meaning of the scale. A total of 280 questionnaires were sent to the participants on the day before their operation, and 256 questionnaires were completed. The information on the questionnaires mainly included the medical record number, gender, age, educational background, American Society of Anesthesiologists (ASA) grade, etc. Specifically, 109 men and 147 women completed the survey, and their ages ranged from 16 to 91 years old (M = 55.1, SD = 14.3). Twenty-eight participants completed primary school or below (10.94%), 75 completed junior high school (29.30%), 78 completed special secondary or senior high school (30.47%), and 75 had a college degree or above (29.30%). According to the ASA grade, 107 were grade I (41.80%), 138 were grade II (53.91%), 20 were grade III (3.91%), and 1 was grade IV (0.39%). Informed consent was obtained from all individual participants included in the study.

Measures

Generalized anxiety Disorder-7 (GAD-7)

The GAD-7 is a convenient and straightforward self-reported anxiety scale with good reliability and validity [31] widely used in scientific research and clinical practice. It has a total of seven items. Higher scores indicate more severe anxiety symptoms. Some Chinese researchers believe that the cut-off score for it in China should be adjusted to 6 points, rather than the cut-off of 10 points recommended by the developers of the scale [32, 33].

Perioperative anxiety Scale-7 (PAS-7)

For the PAS-7, preoperative anxiety was defined as mental and somatic anxiety among adult patients who underwent elective operation under general anesthesia. The original items of the PAS-7 were from three sources: (1) relevant references of the existing preoperative anxiety scales, such as the APAIS, GAD-7, STAI, SAS, and HAMA; (2) items from an open questionnaire survey, combined with investigation and interviews to collect the information; and (3) new items from theory structures. In the process of developing the PAS-7, a team of psychiatrists, anesthesiologists, surgeons, and other related clinical experts conducted analyses and evaluations of the structure of the scale to identify inappropriate or duplicate items and to improve the scale.

To investigate the applicability of the original items of the PAS-7, we conducted a preliminary investigation of 80 patients from a hospital in Shanghai who underwent elective operation under general anesthesia. According to the panel discussion of the initial analysis, 14 items were eventually identified in the first draft of the PAS-7. Responses are rated on a 5-point Likert scale and range from 0 (not at all) to 4 (very obvious). A higher score represents more severe preoperative anxiety. The items are shown below.

  1. ①.

    I’m worried about the effect of the operation.

  2. ②.

    I’m worried about accidents during the operation.

  3. ③.

    I’m worried about my life getting worse after the operation.

  4. ④.

    I’m worried about the pain caused by the operation.

  5. ⑤.

    Thinking about the operation makes me more nervous and worried than usual.

  6. ⑥.

    Thinking about the operation makes me easily distracted.

  7. ⑦.

    Thinking about the operation makes my hands tremble.

  8. ⑧.

    Thinking about the operation makes me lose my appetite or makes my stomach uncomfortable.

  9. ⑨.

    Thinking about the operation makes me use the toilet more often.

  10. ⑩.

    Thinking about the operation makes my face become hot and blushed, and my hands and feet sweat.

  11. ⑪.

    I feel fear about the operation from time to time.

  12. ⑫.

    I’m worried about the aftereffects of anesthesia repeatedly (such as intelligence and memory impairment).

  13. ⑬.

    Thinking about the surgery makes my heartbeat increasing.

  14. ⑭.

    Thinking about the surgery makes my breathing difficult.

Statistical analyses

SPSS 22.0 and AMOS 22.0 were used to analyze the data as follows. (1) A correlation analysis and exploratory factor analysis were conducted by using half of the data. In the exploratory factor analysis, principal component analysis was used to extract the common factors and obtain the initial load matrix; then, VARIMAX was used to obtain the ultimate factor load matrix. The value of Kaiser-Meyer-Olkin (KMO) and Bartlett’s test were used to determine the appropriateness of the factor analysis and to perform the scree test; the number of factors was then determined based on the above results. (2) The reliability and validity of PAS-7 were conducted by using the other half of the data. The internal consistency reliability was examined by Cronbach’s α and the reasonable acceptability criterion of which is ≥0.70. The construct validity was examined by confirmatory factor analysis. We used the maximum likelihood method and found that the two-factor model was fitted for PAS-7 to assess the goodness-of-fit of the factor structure. Models with χ2 Liberty Ratio (χ2 / df) < 5, comparative fit index (CFI) > 0.9, Tucker-Lewis index (TLI) > 0.9, standardized root mean square residual (SRMR) < 0.1, and root mean square error of approximation (RMSEA) < 0.1 were regarded as a good fit [34]. The criterion validity was examined by the correlations between the GAD-7 and each dimension and the scale’s total score, the reasonable acceptability criterion of which is ≥0.70. (3) The Receiver-Operating Characteristic (ROC) curve was used to validate the PAS-7 against GAD-7, compare the sensitivity and specificity of PAS-7 under different cut-off scores, and determine the cut-off and predictive values of the PAS-7 in certain groups.

Results

Item analysis

The participants were sorted by the total score. Participants with the highest 27% of scores were defined as the high group, and those with the lowest 27% were low. The t-test revealed that there were significant differences between the two groups on all items (p < 0.001) (Table 1), which indicated that each item could distinguish different levels of anxiety.

Table 1 Item analysis of the Preoperative Anxiety Scale
Full size table

Exploratory factor analysis

Exploratory factor analysis was carried out. Bartlett’s test showed that the KMO = 0.910, p < 0.001; thus, the scale was suitable for exploratory factor analysis. The scree test was also performed (see Supplementary Material for details). Through exploratory factor analysis, the authors extracted the common factors and then deleted items if any of the following criteria were met: (1) the factor loadings are close in two or more common factors; (2) only one item is under a factor; (3) the maximum factor loading is less than 0.5 on the common factor, and (4) classification is inappropriate items. Finally, using these criteria combined with the experts’ opinions, seven items were deleted, including item-3, 6, 8, 9, 11, 12, and 13. Then, exploratory factor analysis with VARIMAX was carried out on the remaining seven items. The study found two factors that explained 74.294% of the variance: F1-mental anxiety (item-1, 4, 2, 5) refers to excessive preoperatively worry and stress about the surgery and its effects, accidents, and pain; F2-somatic anxiety (item-7, 14, 10) refers to the muscle, respiratory and sensory symptoms caused by preoperative anxiety (Table 2).

Table 2 Exploratory factor loading matrix of the Preoperative Anxiety Scale (n = 128)
Full size table

Reliability analysis

Cronbach’s αs were calculated to measure the internal consistency of the scale. The Cronbach’s α was 0.933 for F1, 0.761 for F2, and 0.885 for PAS-7, showing that the scale had good internal consistency and reliability.

Validity analysis

Confirmatory factor analysis

AMOS 22.0 was used for confirmatory factor analysis, and the path diagram is shown in Fig. 1. The model fitting of the scale was ideal. In detail, the fit indices were χ2= 34.798, df = 13, χ2/df = 2.677<5, showing that the model had a good fit. CFI was 0.949 > 0.9, TLI was 0.918 > 0.9, and SRMR was 0.057 <0.1. All fit indices were acceptable. RMSEA was also acceptable at 0.115, which is nearly 0.1 (The inter-item correlation matrix was also analyzed and could be seen in Supplementary Material).

Fig. 1
figure 1

Confirmatory factor analysis path diagram for the Preoperative Anxiety Scale (n = 128). MA: Mental anxiety; SA: Somatic anxiety

Full size image

Criterion validity

We determined the correlation of the PAS-7 by regarding GAD-7 as the criterion. The correlation coefficients between the GAD-7 and mental anxiety, somatic anxiety, and total score of the PAS-7 were 0.711, 0.719, and 0.789 (p < 0.01), indicating that the PAS-7 had good criterion validity.

The ROC curve

The GAD-7 score was used as a standard. We used six scores as the dividing point and divided participants into the high-anxiety group and low-anxiety group. When the Youden index was maximum, we obtained a cut-off score of 8 (with 75% sensitivity and 84.6% specificity. The area under the ROC curve (AUC) was 0.89 for the PAS-7 (95%, CI: 0.88 ~ 0.97) (Fig. 2).

Fig. 2
figure 2

ROC curve (n = 256). Abscissa=1-specificity, ordinate=sensitivity

Full size image

Discussion

This research mainly focused on developing a preoperative anxiety scale that can be widely used during preoperative evaluations in general hospitals in China (Table 3). Based on theory and research from previous scholars, the final scale includes seven items and is suitable for patients over 16 years old. Confirmatory factor analysis revealed that preoperative anxiety was divided into two dimensions: mental anxiety and somatic anxiety. Specifically, the mental anxiety factor had four items, and the somatic anxiety factor had three items. The internal consistency coefficients between the two factors ranged from 0.761–0.933, showing that the PAS-7 had good internal consistency and reliability. The ideal confirmatory factor analysis model indicated that the PAS-7 had good construct validity.

Table 3 Perioperative Anxiety Scale-7 (PAS-7). Instructions: This scale will assess your attitudes and feelings about your operation. Please carefully read each item, and then, according to your state in the past few days, circle the appropriate response
Full size table

Our research adopted the GAD-7 as the criterion to evaluate the validity. We also regarded the GAD-7 as the “gold standard” for using ROC curves to determine the cut-off values, and we found that when the cut-off was 8, the PAS-7 had the largest value of screening, with a sensitivity of 75% and a specificity of 84.6%. In previous studies, the HAMA, STAI, and MINI-International Neuropsychiatric Interview [35, 36] were used as the standards to obtain cut-off values. However, there are too many items in these scales, which might impose a heavy burden on perioperative patients who suffer somatic pain. In addition, rating scales are more time-consuming for non-clinical psychological staff in general hospitals. Considering that assessments among general anesthesia patients should be short and convenient and that the general hospital lacks professionally trained evaluators, self-reported scales are the most suitable. Therefore, we adopted the GAD-7 as the criterion. Even so, the possible bias of this choice cannot be ignored. There is no consensus regarding the cut-off point for the Chinese version of the GAD-7. Although we used the cut-off value of 6 points that Chinese researchers recommended, those researchers assessed patients in the Department of Psychology of general hospitals, different from the subjects we recruited. This option might impact the currently determined cut-off value of the PAS-7. Follow-up studies could include other criteria to draw ROC curves and compare the differences to determine the best cut-off value.

Compared with other perioperative anxiety scales, the items in this study started from the core symptoms of anxiety disorders and innovatively introduced the “somatic anxiety” factor, which made anxiety assessment more complete. In patients with physical diseases, the somatic reaction to anxiety is often confused with their other physical symptoms or is easy to ignore, making treatment even more difficult. The differentiation of somatic anxiety increased the recognition of patients with preoperative anxiety, which can better prompt doctors to make corresponding treatment plans to improve such patients’ psychological feelings and prognosis [37].

Although this study established an ideal psychometric tool of perioperative anxiety, it also had some limitations. Firstly, all participants were patients who had surgery under anesthesia from the same general hospital, which might have led to selection bias, thus limiting the generalizability of our findings. Future studies should increase the sample size and increase the diversity of samples, such as patients under local anesthesia, patients undergoing ambulatory surgery, and patients using outpatient anesthesia [38]. Secondly, the sample size included in this study was limited. Not only were there not enough samples for CFA estimation, but also it was easy to cause a low fitting index, which had an impact on the results, such as RMSEA = 0.115 > 0.1. However, although it was greater than 0.1, it was very close. Considering other indexes, we concluded that the model was acceptable. Therefore, if possible, we could expand the sample size to verify again. Additionally, a previous study reported that patients with preoperative anxiety were concerned with psychological characteristics and demographic variables [39, 40]. Our study did not collect much information in this category and thus did not profoundly explore the relation between gender, education level, or other related factors. Increasing the amount of information collected from patients during clinical assessment should be considered in the future.

Conclusion

In conclusion, this study established the Perioperative Anxiety Scale-7 and proved its validity, thus enriching this assessment tool. Compared with the current evaluation of preoperative anxiety in China, the new PAS-7 was well-targeted, easy to use, had fewer items, and needed less time. It also assessed somatic anxiety, thus making the assessment more comprehensive. In addition, the PAS-7 was suitable for Chinese patients.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PAS-7:

Perioperative anxiety scale-7

GAD-7:

Generalized anxiety disorder-7 scale

APAIS:

Amsterdam preoperative anxiety and information scale

STAI:

State-trait anxiety inventory

HAMA:

Hamilton anxiety scale

ROC:

Receiver-operating characteristic curve

AUC:

Area under the curve

References

  1. Kiecolt-Glaser JK, Page GG, Marucha PT, Maccallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998;53(11):1209–18. https://doi.org/10.1037/0003-066X.53.11.1209.

    Article  CAS  PubMed  Google Scholar 

  2. Yang Y, Ma H, Wang M, Wang A. Assessment of anxiety levels of patients awaiting surgery for suspected thyroid cancer: a case-control study in a Chinese-Han population. Asia Pac Psychiatry. 2017;9(4):e12245.

  3. Haiyan L, Fan Y, Guoying W, Qiong L, Ling T. Preoperative anxiety status and influencing factors in 119 patients with primary glaucoma. J Nurs. 2017;24(2):41–4.

    Google Scholar 

  4. Renouf T, Leary A, Wiseman T. Do psychological interventions reduce preoperative anxiety? Br J Nurs. 2013;23(22):1208–12.

    Article  Google Scholar 

  5. Aust H, Rüsch D, Schuster M, Sturm T, Brehm F, Nestoriuc Y. Coping strategies in anxious surgical patients. BMC Health Serv Res. 2016;16(1):1-10.

  6. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Ba Ndeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2010;45(3):298–307.

    Article  Google Scholar 

  7. Hongmei L, Fan H, Hospital JN. Effect of psychological nursing and health education on preoperative stress in hypertension patients complicated with fracture. J Clin Med Pract. 2013;17(014):162.

  8. Pittman S, Kridli S. Music intervention and preoperative anxiety: an integrative review. Int Nurs Rev. 2011;58(2):157–63. https://doi.org/10.1111/j.1466-7657.2011.00888.x.

    Article  CAS  PubMed  Google Scholar 

  9. Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth. 2014;28(2):222–7. https://doi.org/10.1007/s00540-013-1712-7.

    Article  PubMed  Google Scholar 

  10. Raichle KA, Osborne TL, Jensen MP, Ehde DM, Robinson LR. Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation. Clin J Pain. 2015;31(8):699–706. https://doi.org/10.1097/AJP.0000000000000150.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wolf DL, Desjardins PJ, Black PM, Francom SR, Mohanlal RW, Fleishaker JC. Anticipatory anxiety in moderately to highly-anxious oral surgery patients as a screening model for anxiolytics: evaluation of alprazolam. J Clin Psychopharmacol. 2003;23(1):51–7. https://doi.org/10.1097/00004714-200302000-00009.

    Article  CAS  PubMed  Google Scholar 

  12. Orbach-Zinger S, Ginosar Y, Elliston J, Fadon C, Abu-Lil M, Raz A, et al. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing caesarean delivery. Br J Anaesth. 2012;6:943–9.

    Article  Google Scholar 

  13. Kain ZN, Caldwell-Andrews AA, Maranets I, Mcclain B, Gaal D, Mayes LC, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004;99(6):1648–54, table of contents. https://doi.org/10.1213/01.ANE.0000136471.36680.97.

    Article  PubMed  Google Scholar 

  14. Hak RY, Sik GH, Hwan KJ, Pyo NK, Ho LY, Hyun BG. Factors associated with postoperative nausea and vomiting in patients undergoing an ambulatory hand surgery. Clin Orthop Surg. 2014;6(3):273–8.

    Article  Google Scholar 

  15. Lin LY, Wang RH. Abdominal surgery, pain and anxiety: preoperative nursing intervention. J Adv Nurs. 2010;51(3):252–60.

    Article  Google Scholar 

  16. Dekker AP, Salar O, Karuppiah SV, Edward B. Anxiety and depression predict poor outcomes in arthroscopic subacromial decompression. J Shoulder Elbow Surg. 2016;25(6):873-80.

  17. Vetter T, Ivankova R, Nataliya V, Pittet J-F. Patient satisfaction with anesthesia. Anesthesiology. 2013;119(2):245-7.

  18. Xiao L, TIYU Z, Wan K. Research progress of preoperative anxiety scale. J Nurs. 2017;24(9):26–30.

    Google Scholar 

  19. Spielberger CD, Gorsuch RL, Lushene RE. State trait anxiety inventory manual. Palo Alto, CA: Consulting Psychologists Press; 1970.

    Google Scholar 

  20. Spielberger CD. Manual for the state-trait anxiety inventory (form Y) (self-evaluation questionnaire). Palo Alto, CA: Consulting Psychologists Press; 1983.

    Google Scholar 

  21. Xiaohua Z, Liang S, Ailin Z. Test report of state trait anxiety in Changchun. Chin J Ment Health. 1993;7(2):60–2.

    Google Scholar 

  22. William WKZMD. A rating instrument for anxiety disorders. Psychosom. 1971;12(6):371–9.

    Article  Google Scholar 

  23. Zuozhi Z. Handbook of behavioral medicine scale. Beijing: China medical electronic audio visual publishing house; 2005.

    Google Scholar 

  24. Hamilton MA. The assessment of anxiety by rating scale. Brit J Med Psychol. 1959;32(2):50–5.

    Article  CAS  Google Scholar 

  25. Chun W, Yanmin C, Yalin Z. Study on the factor structure of Hamilton anxiety scale. J Clin Psychiatry. 2011;21(5):299–31.

    Google Scholar 

  26. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

    Article  CAS  Google Scholar 

  27. Hicks JA, Jenkins JG. The measurement of preoperative anxiety. J R Soc Med. 1988;81(9):517–9. https://doi.org/10.1177/014107688808100907.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Moerman N, Van Dam FSAM, Muller MJ, Oosting H. The Amsterdam preoperative anxiety and information scale (APAIS). Anesth Analg. 1996;82(3):445–51. https://doi.org/10.1097/00000539-199603000-00002.

    Article  CAS  PubMed  Google Scholar 

  29. Hao W, Yanjun L, Zhengliang M. Reliability and validity of Amsterdam preoperative anxiety and information scale in Chinese version. Chin J Behav Med Brain Sci. 2016;25(2):179–82.

    Google Scholar 

  30. Zhen J, Lina G. Reliability of APAIS score in assessing preoperative anxiety in Chinese. Chin J Anesth. 2015;35(9):1107–9.

    Google Scholar 

  31. Hinz A, Klein AM, Brähler E, Glaesmer H, Hilbert A. Psychometric evaluation of the generalized anxiety disorder screener GAD-7, based on a large German general population sample. J Affect Disord. 2016;210:338.

    Article  Google Scholar 

  32. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.

    Article  PubMed  Google Scholar 

  33. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.

    Article  PubMed  Google Scholar 

  34. Livote EE, Wyka KE. Introduction to structural equation modeling using SPSS and AMOS. Struct Equ Model. 2009;16(3):556–60. https://doi.org/10.1080/10705510903008345.

    Article  Google Scholar 

  35. Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, et al. The MINI international neuropsychiatric interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI - ScienceDirect. Eur Psychiatry. 1997;12(5):224–31. https://doi.org/10.1016/S0924-9338(97)83296-8.

    Article  Google Scholar 

  36. Tianmei S, Liang S, Weimin D. Clinical reliability and validity of concise international neuropsychological interview in Chinese version. Chin Ment Health J. 2009;23(7):493–503.

    Google Scholar 

  37. Chunpeng XI, Keyi LI, Yanhui LI, Zhang B. The efficacy of cognitive-behavior intervention on anxiety and oral health-related quality of life in adult orthodontic patients. Chin J Behav Med & Brain Sci. 2014;23:797–800.

    Google Scholar 

  38. Ming Z. How to identify the selective bias of observation objects in medical research papers. J Editing. 1998;S1:52–3.

  39. Bing D, Mengzhao P. Analysis of the influence of gender and education on preoperative anxiety. Armed Police Med. 2000;11(12):705–6.

    Google Scholar 

  40. Yidan Z, Li C, Li L, Zhe L. A multifactor analysis of psychological characteristics and preoperative anxiety in 160 surgical patients. Chin J Ment Health. 2003;17(4):263–4.

    Google Scholar 

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Acknowledgments

We would like to thank Wenjie Gu for the suggestion of data analysis.

Funding

This study was supported by the grants from Shanghai Municipal Health Bureau (2017BR058, 2019ZB0201). The funder had no role in the study design, collection, analysis, or interpretation of the data.

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Author notes

  1. Chengjiao Zhang and Xitong Liu contributed equally to this work.

Authors and Affiliations

  1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chengjiao Zhang, Xitong Liu, Fei Zhang, Lingyi Pan & Zhen Wang

  2. Department of Anesthesia and Pain Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Tianran Hu & Yan Luo

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Contributions

CZ was responsible for data analysis and draft writing. XL led the statistical analysis correcting, draft revising, and manuscript writing. They contributed equally to this work and should be considered co-first authors. TH contributed to the data collection of pre and formal investigations. FZ and LP, as relevant experts, participated in the panel discussion and helped to confirm the items. YL was responsible for design and data collection arrangement. ZW was the funding acquisition, who contributed to the design and arrangement of the whole study. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Zhen Wang.

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Ethics approval and consent to participate

Ethical approval for this study was granted by the Institutional Review Board (IRB) of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Ethical approval reference number: KY2019–27). In addition, verbal informed consent was obtained from all individual participants included in the study and was approved by the ethics committee.

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Zhang, C., Liu, X., Hu, T. et al. Development and psychometric validity of the perioperative anxiety scale-7 (PAS-7). BMC Psychiatry 21, 358 (2021). https://doi.org/10.1186/s12888-021-03365-1

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  • DOI: https://doi.org/10.1186/s12888-021-03365-1

Keywords

BMC Psychiatry

ISSN: 1471-244X

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