A study from Sahlgrenska University Hospital in Sweden has validated the Hospital Anxiety and Depression Scale (HADS) for assessing depression and anxiety among women undergoing breast reduction surgery. This research, published in BMC Plastic and Reconstructive Surgery, highlights the importance of addressing psychological symptoms in patients with breast hypertrophy, or macromastia, who often experience chronic pain and psychological distress.
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The study, led by Emma Hansson alongside Catrin Wessman and Anna Paganini, involved 276 women referred for breast reduction within Sweden’s publicly financed health care system. Participants were selected based on Swedish national criteria, including a body mass index under 30 and a minimum breast volume of over 800 millilitres. Each participant filled out the HADS questionnaire before surgery, with some completing it again after two weeks or twelve months post-operation to assess stability and changes in psychological symptoms.
HADS was chosen because many traditional depression measures were designed for psychiatric populations, while the emotional distress experienced by these women is linked to their physical condition rather than primary psychiatric disorders. The questionnaire's structure excludes symptoms that overlap with physical illness and focuses on anxiety and depression.
Rigorous psychometric analyses confirmed the validity of HADS within this specific population, demonstrating both satisfactory fit for the underlying structures and strong internal consistency. The reliability scores—0.85 for anxiety and 0.87 for depression—exceeded accepted thresholds, indicating the questionnaire accurately measures emotional symptoms.
Additionally, the study found that HADS was responsive; twelve months after surgery, patients reported significant decreases in anxiety and depression symptoms. The research emphasizes that a standardized, validated tool like HADS can enhance the assessment of psychological outcomes in this patient group and aid in documenting the emotional indications for surgery.
While the study's authors acknowledge limitations in generalizability due to the sample's characteristics and the cultural context, they argue that their findings provide a substantial contribution to the field. The validation of HADS offers a reliable method for both pre-operative evaluation and post-operative outcome assessment, helping to clarify the emotional benefits of breast reduction surgery.
This work underscores the need for standardized assessments in clinical practice, as a consistent approach can improve comparisons across studies and support the psychological justification for surgeries often perceived as purely cosmetic.