Hamid Sharif-Nia ^1,2 Erika Sivarajan Froelicher ³ Esmaeil Hoseinzadeh ⁴ Sima Hejazi ⁵ Reza Fatehi ⁶ Poorya Nowrozi ^6* Bita Mohammadi ⁷

• ¹ Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
• ² Department of Nursing, Amol School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
• ³ Professor Emeritus, Department of Physiological Nursing, School of Nursing, and Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, United States
• ⁴ Department of Nursing, Faculty of Medical Sciences, Gorgan Branch, Islamic Azad University, Gorgan, Golestan, Iran
• ⁵ Bojnurd School of Nursing, North Khorasan University of Medical Sciences, bojnurd, Iran
• ⁶ MSc Student in Nursing, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
• ⁷ Master of Nursing, Hospital Nurse 17 Shahrivar Amol, Mazandaran University of Medical Sciences, sari, Iran

Introduction: So far, the psychometric properties of the Persian version of the Pain Anxiety Symptom Scale have not been assessed in Iran. Therefore, this study was conducted to determine the validity and reliability of the Persian version of the Pain Anxiety Symptom Scale among a group of Iranian patients in Amol.Methods: This methodological study was conducted in 2023 with a sample of 400 postoperative patients from Amol, Iran, selected through convenience sampling. The dataset was divided into two groups of 200 for exploratory and confirmatory factor analyses. Construct validity was assessed using maximum likelihood exploratory factor analysis with Promax rotation, supported by Horn's parallel analysis and network analysis to visualize item relationships.Confirmatory factor analysis, convergent and discriminant validity was performed on the second dataset. Reliability was evaluated through various statistical measures, including Cronbach's alpha, McDonald's omega, average inter-item correlation coefficient, composite reliability, and maximal reliability (MaxR).Results: Among the 400 participants, the mean age was 44.38 years (SD = 13.49), with 152 (46.1%) being women and 178 (53.9%) men. Most participants (n = 268, 81.2%) had an education level lower than a diploma, and 93 individuals (28.2%) reported a history of surgery. The results of exploratory factor analysis with Promax rotation developed two factors accounting for 66.29% of the variance comprising 15 items. Also, after necessary modifications during confirmatory factor analysis, the final model was approved. As for reliability, the Cronbach's alpha, composite reliability, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability.According to the results, the Persian version of the Pain Anxiety Symptom Scale has a valid structure and acceptable reliability. This scale can be used by health professionals in many ways.