Creating a standard for evaluation of symptoms of depression and anxiety in women undergoing reduction mammaplasty: validation and reliability of HADS

Abstract Background This study aimed to investigate the measurement properties of the Hospital Anxiety and Depression Scale (HADS) for patients with breast hypertrophy undergoing breast reduction in the public health care system. Depression and anxiety are two symptoms that can be taken into consideration when patients are evaluated for breast reduction and are part of the patient-reported outcomes (PROMs) used to measure the effect of an operation. Methods The HADS was administered to women both pre- and postoperatively. Confirmatory Factor Analysis, internal consistency, test–retest reliability, construct validity, and responsiveness were analysed. Results The study included 276 patients who completed pre-operative HADS assessments, with 52 undergoing test–retest analysis and 52 completing post-operative assessments. Internal consistency was acceptable (Cronbach’s α: HADS-A = 0.85, HADS-D = 0.87), and construct validity showed strong correlations with BDI and BAI and moderate negative correlation with BREAST-Q. Confirmatory factor analysis supported both two- and three-factor models, though the two-factor model was preferred. Test–retest reliability (ICC: HADS-A = 0.81, HADS-D = 0.75) and responsiveness were satisfactory. No floor or ceiling effects were observed. Conclusions HADS is a valid tool, with sound psychometric properties, for assessing depression and anxiety in women undergoing breast reduction. Trial registration ClinicalTrials.Gov Identifier NCT05233891.