Scale of Alopecia Areata Distress (SAAD‐41): Initial Validation Part 2—Scoring, Preliminary Reference Values and Validity

Background The Scale of Alopecia Areata Distress (SAAD‐41) was designed to comprehensively assess Alopecia Areata (AA) psychosocial patient‐reported outcomes. No previous such measure existed. Objectives To assess SAAD‐41 scoring; preliminary reference values; and convergent, criterion and known‐group validity. Methods A cross‐sectional, non‐interventional survey (June–November 2021) recruited participants from the National Alopecia Areata Foundation and University of Minnesota‐Twin Cities hair disease clinics. Participants were adults diagnosed with AA within the United States. Excluded were non‐English readers and those with diminished comprehension. 695 consented, of which 358 fully completed the SAAD‐41. Participation rates for known and potential eligibility were 68% and 55%, respectively. To assess scoring, Pearson's correlations among SAAD‐41's Subdomain‐Scores and SAAD‐41‐Total (i.e., 41‐item sum) were used. Preliminary reference values were determined by score‐distribution descriptives and validity by statistical relationships among SAAD‐41‐Total, Dermatology Life Quality Index (DLQI), Brief Resilient Coping Scale (BRCS), and Acceptance of Chronic Health Conditions Scale (ACHCS). Hypotheses were formulated a priori. Results Subdomain‐scores strongly correlated with the SAAD‐41‐Total (lowest r: 0.76; 95% CI [0.71,0.8], p < 0.001; strongest r: 0.93, 95% CI [0.92, 0.95], p < 0.001) and moderately with each other (lowest r: 0.52; 95% CI [0.44, 0.59], p < 0.001; strongest r: 0.79, 95% CI [0.75, 0.83], p < 0.001). All score distributions were positively skewed, with 20%–40% of participants endorsing meaningful distress. The SAAD‐41‐Total correlated with the DLQI (0.68, 95% CI [0.62, 0.73], p < 0.001), BRCS (−0.22, 95% CI [−0.32, −0.11], p < 0.001), and ACHCS (−0.75, 95% CI [−0.8, −0.7], p < 0.001). It differed across DLQI interpretive bands (F 3,348 = 87.18, p < 0.001) and participant subgroups (age, gender, self‐reported AA severity and duration). Results predominantly supported hypotheses. Conclusions Findings further validate the SAAD‐41 as a comprehensive measure of AA psychosocial outcomes. They support subdomain scoring, provisionally support total‐score scoring, and provide preliminary reference values for each. Additional SAAD‐41 psychometric research is needed.