Validation of the Hamilton Anxiety and Depression Rating Scales in Oral Lichen Planus: A Multicenter Study by the Italian Society of Oral Pathology and Medicine

Objective: To assess the psychometric performance of the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) in patients with oral lichen planus (OLP) according to clinical phenotype. Methods: This multicenter SIPMO case-control study included 395 participants: 132 patients with keratotic OLP (K-OLP), 131 with non-keratotic OLP (NK-OLP), and 132 healthy controls (HCs). Internal consistency was assessed with Cronbach's alpha and item discrimination with item-total correlations. HAM-A and HAM-D scores were compared between OLP patients and HCs; phenotype-specific hierarchical regressions identified variables associated with anxiety and depressive symptoms. Results: HAM-A and HAM-D showed satisfactory internal consistency in K-OLP and NK-OLP patients (HAM-A α = 0.877 and 0.858; HAM-D α = 0.768 and 0.766, respectively). Patients with OLP had significantly higher HAM-A and HAM-D scores than age- and sex-matched controls without oral mucosal disease (p = 0.018 and p = 0.002, respectively). The strongest item-total correlations involved depressed mood, tension, insomnia, and somatic symptoms. Poor sleep quality was independently associated with psychological burden, and pain intensity independently predicted anxiety severity in NK-OLP patients. Conclusions: HAM-A and HAM-D showed satisfactory psychometric performance in OLP and may support psychological assessment. Somatic and sleep-related symptoms were closely associated with psychological distress.