Preoperative anxiety is a common psychological reaction among perioperative patients (Kiecolt-Glaser et al.,1998); the incidence of this reaction is high both domestically, at approximately 50% (Yang et al., 2016; Luo et al., 2017), and abroad, at 40%~80% (Renouf et al., 2014; Aust et al., 2016).
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 (Ali et al., 2014; Raichle et al., 2015); increased heart rate, blood pressure and epinephrine levels (Wolf et al., 2003; Orbach-Zinger et al., 2012); increased postoperative nausea, vomiting and delirium (Kain et al., 2004; Hak et al., 2014); and increased recovery times and hospital stays (Rn and Ruey-Hsia, 2010; Dekker et al., 2016). Thus, given the high frequency and adverse outcomes of preoperative anxiety, a statistically valid assessment and a timely intervention for preoperative anxiety have been important issues for anesthetists and psychologists (Vetter et al., 2013).
Currently, preoperative anxiety measurement tools exist in two categories: universal anxiety scales and specific anxiety scales (Le et al., 2017). Universal anxiety scales include the State-Trait Anxiety Inventory (STAI) (Spielberger et al., 1970, 1983; Zheng et al., 1993), the Self-Rating Anxiety Scale (SAS) (Zung, 1971; Zhang, 2005), and the Hamilton Anxiety Scale (HAMA) (Hamilton, 1959; Wang et al., 2011). 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) (Zigmond and Snaith, 1983; Hicks and Jenkins, 1988) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) (Moerman et al., 1996; Wu et al., 2016). The GAD-7 is applied easily and widely, but it has certain 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 to be effective in preoperative anxiety assessment in China (Jia et al., 2015). 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 valid measurement tool that could be easily applied in preoperative settings hinders the evaluation of interventions to treat preoperative anxiety among patients in China. 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.