title: Validation of the surgical fear questionnaire in adult patients waiting for elective surgery.
abstract: OBJECTIVE
  Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ.
  
  
  METHODS
  Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N = 3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis.
  
  
  RESULTS
  EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1-4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5-10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765-0.920 (SFQ-total), 0.766-0.877 (SFQ-s), and 0.628-0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity.
  
  
  CONCLUSIONS
  The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences.
authors: Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors: Maurice
authors: M
authors: Theunissen
authors: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
authors: Madelon L
authors: ML
authors: Peters
authors: Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
authors: Erik G W
authors: EG
authors: Schouten
authors: Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors: Audrey A A
authors: AA
authors: Fiddelers
authors: Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors: Mark G A
authors: MG
authors: Willemsen
authors: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors: Patrícia R
authors: PR
authors: Pinto
authors: Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors: Hans-Fritz
authors: HF
authors: Gramke
authors: Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesia/ICU, Pain and Palliative Care, Hamad Medical Corporation, Doha, Qatar.
authors: Marco A E
authors: MA
authors: Marcus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012307:Risk Factors; D057566:Self Report; D013514:Surgical Procedures, Operative / Q000523:psychology*; D011795:Surveys and Questionnaires