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

ABSTRACT 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.