Development and Preliminary Psychometric Evaluation of the Preoperative Aesthetic Psychiatric Screening Scale (PASS-10)

Background and Objectives: Psychological vulnerability, body image dissatisfaction, anxiety, and depressive symptoms may substantially influence expectations, decision-making, and postoperative satisfaction among individuals seeking cosmetic surgery. Psychological screening is increasingly recommended during the preoperative assessment, brief and clinically applicable instruments specifically designed for cosmetic surgery candidates remain limited. This pilot study aimed to develop and perform a preliminary psychometric evaluation of the Preoperative Aesthetic Psychiatric Screening Scale (PASS-10). Materials and Methods: A cross-sectional pilot study was conducted among 142 adults considering cosmetic surgery procedures in Romania. Participants completed an anonymous online questionnaire including sociodemographic items, the newly developed PASS-10 questionnaire, and the Patient Health Questionnaire-4 (PHQ-4). Internal consistency was evaluated using Cronbach’s alpha, McDonald’s omega, and corrected item-total correlations. Exploratory factor analysis using principal axis factoring with Promax oblique rotation was performed to examine the factorial structure. Convergent validity was assessed using Spearman’s rank correlation coefficient between PASS-10 and PHQ-4 total scores. Floor and ceiling effects and exploratory group differences according to sex were also examined. Results: The PASS-10 demonstrated good internal consistency (Cronbach’s α = 0.854). Corrected item-total correlations ranged from 0.323 to 0.677. The Kaiser-Meyer-Olkin measure was 0.844, and Bartlett’s test of sphericity was statistically significant (χ2 = 506.733, p < 0.001), supporting the suitability of the data for factor analysis. Exploratory factor analysis using Promax rotation suggested a preliminary correlated two-factor solution explaining 55.97% of the total variance. The proposed two-factor structure remains exploratory and requires further validation in a larger, independent sample. No floor or ceiling effects were observed. PASS-10 total scores showed a moderate positive correlation with PHQ-4 scores (Spearman’s ρ = 0.562, p < 0.001), providing preliminary evidence of an association with general anxiety and depressive symptoms. Male participants demonstrated significantly higher PASS-10 scores than female participants (p = 0.003). Conclusions: The PASS-10 demonstrated promising preliminary psychometric properties, including good internal consistency and an exploratory two-factor structure. The association with PHQ-4 scores provides initial evidence of a relationship with general psychological distress. Further validation in larger, independent samples is required to confirm the factorial structure and establish the reliability and validity of the questionnaire.