Background/Purpose: Despite the common appearance changes in patients with systemic sclerosis (SSc), and the potential adverse psychosocial impact of such changes, research in this area is limited. This may be, in part, because there are few validated measures evaluating the psychosocial impact of disease-related appearance changes in SSc. Thus, the goal of the present study was two-fold: 1) to evaluate the psychometric properties of the Social Appearance Anxiety Scale (SAAS), a measure that assesses fear of situations in which one’s appearance will be evaluated, in a sample of SSc patients, and 2) to determine if scores from the SAAS can be meaningfully compared across limited and diffuse SSc subtypes.

Methods: The sample included SSc patients (N = 600; 59% limited, 41% diffuse) enrolled in the Scleroderma Patient-centered Intervention Network Cohort. Confirmatory factor analysis (CFA) was used to examine the structural validity of the measure; a one-factor model was hypothesized. Once the model with adequate fit was identified, multiple-group CFA was used to evaluate measurement invariance of the SAAS across limited and diffuse SSc patients. Internal consistency reliability was examined using Cronbach’s coefficient alpha. Convergent validity was examined via Pearson product-moment correlations with the SAAS and a measure of depression, body image dissatisfaction, and two measures of social anxiety.

Results: Based on descriptive fit indices, a one-factor model showed good fit with the data using CFA (Comparative Fit Index [CFI] = 0.91, Standardized Root Mean Residual [SRMR] = 0.04, Root Mean Square Error of Approximation [RMSEA] = 0.12). The multiple-group CFA evaluated configural invariance (i.e., baseline model fitting a one-factor solution for limited and diffuse subtypes), metric invariance (i.e., factor loadings constrained to equivalence across subtypes), and factor variance invariance (i.e., factor loadings and variances constrained to equivalence across subtypes) based on descriptive fit indices (CFI, SRMR, and RMSEA), change in CFI, and the Satorra-Bentler X² difference test. Results from the multiple-group CFA provided support for the factor variance invariance model, suggesting a one-factor structure with equivalent response patterns and variances across limited and diffuse subtypes. Internal consistency was good for both limited (α  = 0.96) and diffuse (α  = 0.97) groups. Convergent validity was demonstrated via moderate to strong correlations with measures of depression (r = 0.52, p < .01), body image dissatisfaction (r = 0.68, p < .01), and social anxiety (2 measures; r = 0.58 to 0.67, p < .01) in the total sample.

 Conclusion: Overall, results indicate that the one-factor SAAS can be used to assess fear of appearance evaluation among patients with SSc. In addition, scores on the SAAS can be meaningfully compared across limited and diffuse subtypes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psychometric-properties-of-the-social-appearance-anxiety-scale-in-patients-with-limited-and-diffuse-systemic-sclerosis-analysis-from-the-scleroderma-patient-centered-intervention-network-cohort/