{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T11:50:51Z","timestamp":1782215451033,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T00:00:00Z","timestamp":1579651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Oral Pathology Medicine"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To validate the Hospital Anxiety and Depression Scale (HADS) and the 10\u2010item Perceived Stress Scale (PSS\u201010) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross\u2010sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The validity and reliability of the HADS and PSS\u201010 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate\u2010to\u2010high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS\u201010 and bivariate analyses, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A bi\u2010factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS\u201010 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate\u2010to\u2010high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The HADS and PSS\u201010 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jop.12991","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T05:52:07Z","timestamp":1578635527000},"page":"260-270","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Validation of the HADS and PSS\u201010 and a cross\u2010sectional study of psychological status in patients with recurrent aphthous stomatitis"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2340-517X","authenticated-orcid":false,"given":"Paswach","family":"Wiriyakijja","sequence":"first","affiliation":[{"name":"UCL Eastman Dental Institute London UK"},{"name":"Department of Oral Medicine Faculty of Dentistry Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Porter","sequence":"additional","affiliation":[{"name":"UCL Eastman Dental Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9006-9412","authenticated-orcid":false,"given":"Stefano","family":"Fedele","sequence":"additional","affiliation":[{"name":"UCL Eastman Dental Institute London UK"},{"name":"NIHR University College London Hospitals Biomedical Research Centre London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Eastman Dental Hospital UCLH Foundation NHS Trust London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roddy","family":"McMillan","sequence":"additional","affiliation":[{"name":"Eastman Dental Hospital UCLH Foundation NHS Trust London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Shephard","sequence":"additional","affiliation":[{"name":"Eastman Dental Hospital UCLH Foundation NHS Trust London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richeal","family":"Ni Riordain","sequence":"additional","affiliation":[{"name":"UCL Eastman Dental Institute London UK"},{"name":"Department of Oral Medicine Cork University Dental School and Hospital Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cden.2013.12.002"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-0825.2005.01143.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.2011.01102.x"},{"issue":"1","key":"e_1_2_10_5_1","first-page":"157","article-title":"Psychological status and recurrent aphthous ulceration","volume":"36","author":"Picek P","year":"2012","journal-title":"Coll Antropol"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.12726"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.64.1.131"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(01)00296-3"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-017-1765-4"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jop.12059"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2007.07.201"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.05.044"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.5144\/0256-4947.2019.48"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20543"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.03.012"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/10705519909540118"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.02.006"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2014.05.005"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073191117715731"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/5269856"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2011.12.024"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.5152\/tao.2018.3242"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000196973"},{"issue":"7","key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1590\/S1807-59322009000700007","article-title":"Psychological stress and recurrent aphthous stomatitis","volume":"64","author":"Gallo Cde B","year":"2009","journal-title":"Clinics (Sao Paulo)"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10024-1646"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jop.12148"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.13220"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2009.02659.x"}],"container-title":["Journal of Oral Pathology &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jop.12991","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jop.12991","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jop.12991","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T06:44:00Z","timestamp":1694069040000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jop.12991"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,22]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1111\/jop.12991"],"URL":"https:\/\/doi.org\/10.1111\/jop.12991","archive":["Portico"],"relation":{},"ISSN":["0904-2512","1600-0714"],"issn-type":[{"value":"0904-2512","type":"print"},{"value":"1600-0714","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,22]]},"assertion":[{"value":"2019-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}