The psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) Bangla version

Psychometric properties of the Depression Anxiety Stress Scales (DASS-21) in women with breast cancer

Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald's omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients.

Construct validity and reliability of Amharic version of DASS-21 scale among Ethiopian Defense University College of Health Science students

BACKGROUND

DASS-21 is the common and widely used tool for assessing depression, anxiety and stress. However, its validity and Reliability in Ethiopian Amharic language is not assessed.

OBJECTIVE

To translate the DASS-21 and assess its validity and reliability among Ethiopian Defense University college of health science students in Bishoftu, Ethiopia.

METHOD

An institutional based cross-sectional study was conducted using a self-administered questionnaire. A total of 435 students from different departments in accordance with their proportional size were participated in this study. As to the sampling technique, the study units were selected from each department and year of study using simple random sampling proportional to size. Confirmatory factor analyses were employed to assess the factor structure and construct validity of Amharic version of the DASS-21. Cronbach alpha coefficient and corrected item total correlation was calculated to assess the internal consistency of Amharic version of DASS-21.

RESULT

Among 435 undergraduate students who participated in the study, 246(56.6%) were the age of 18-25 year and majority 347(79.8%) were males. Regarding their year of study; 200 (46.0%) were first year students. Confirmatory factor analysis indicates a good model fit of the three correlated factors (Comparative fit index (CFI) = 0.92 with root mean square error of approximation (RMSEA) = 0.059[0.052-0.066] and standardize root mean residual SRMR = 0.045). The internal consistency of overall DASS-21 and each sub scale were in acceptable range (0.91, 0.82, 0.77 and 0.77) respectively.

CONCLUSION

Amharic version of DASS-21 was found to be a valid and reliable instrument to measure the mental problem especially, Depression, Anxiety and Stress among university students.

Examining the interplay between physical activity, problematic internet use and the negative emotional state of depression, anxiety and stress: insights from a moderated mediation path model in university students

BACKGROUND

The aim of this study was to investigate the relationship between Problematic Internet Use (PIU), emotional states of stress, anxiety and depression, and the practice of physical activity among Tunisian students.

METHODS

Cross-sectional data were collected from 976 university students aged 20.76 ± 1.63 years (46.8% female). They filled out an online survey comprised of a socio-demographic questionnaire, the depression, anxiety and stress scale- 21 items (DASS-21), the international physical activity questionnaire (IPAQ) and the compulsive internet use scale (CIUS). Students were divided, based on their economic levels, into three groups: low (n = 256, 26.23%), medium (n = 523, 53.59%) and high (n = 197, 20.18%).

RESULTS

Mediation analysis: Indirect effects of IPAQ and gender on DASS-21 were highlighted: β= -0.18 (p < 0.01) and β= -0.04, P < 0.01) respectively. In addition, a significant and negative effect of IPAQ on CIUS was demonstrated (β = -0.45, P < 0.01). In addition, the effect of CIUS on DASS-21 was significant (β = 0.39, P < 0.01). Also, the effect of gender on CIUS was significant (β=-0.10, P < 0.01) However, its effect on DASS-21 was not significant (β = 0.05, p = 0.078). The total effect of IPAQ on DASS21 was significant (β= -0.52, p < 0.01) but the effect of Gender on DASS-21 was not significant (β = 0.01, p = 0.817). Moderation analysis: the results showed a significant moderation effect of the interaction between IPAQ and Gender on CIUS (β = 0.07, p < 0.01). However, it was not significant between Gender and CIUS on DASS-21 (β = 0.09, p = 0.390) and between IPAQ and Gender on DASS21 (β = 0.01, p = 0.736) Also, the interaction between IPAQ and CIUS did not have a significant moderation effect on DASS-21 (β = 0.15, p = 0.115).

CONCLUSIONS

Findings suggest that relationships between PIU and negative emotional state of depression, anxiety and stress are mediated via physical exercise. These results underscore the importance of the physical activity factor in the studies analyzing longitudinal effects of PIU on mental health outcomes.

Menstrual Practice Needs Scale short form (MPNS-SF) and rapid (MPNS-R): development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

OBJECTIVES

Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36).

DESIGN

Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency and validity in multiple cross-sectional surveys.

SETTING AND PARTICIPANTS

Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49).

RESULTS

The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: root mean square error of approximation (RMSEA)=0.064, 90% CI 0.043 to 0.084, Comparative Fit Index (CFI)=0.94, Tucker-Lewis Index (TLI)=0.92. Cohort baseline: RMSEA=0.050, 90% CI 0.039 to 0.062, CFI=0.96, TLI=0.95. Uganda: RMSEA=0.039, 90% CI 0.028 to 0.050, CFI=0.95, TLI=0.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092, 90% CI 0.000 to 0.158, CFI=0.93, TLI=0.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable.

CONCLUSIONS

The MPNS-SF offers a reliable and valid measure of adolescent girls' menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to short surveys and including menstrual health within broader research topics.

Factor structure and measurement invariance of the Depression anxiety stress scale (DASS-21) in Chinese left-behind and non-left-behind children: an exploratory structural equation modeling approach

BACKGROUND

Comprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children.

METHOD

The test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data.

RESULTS

Analysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald's omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good.

CONCLUSIONS

The DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children.

Assessment of the impact of social media addiction on psychosocial behaviour like depression, stress, and anxiety in working professionals

OBJECTIVE

Social media (SM), with its addictive nature and the accompanying psychosocial challenges such as stress, anxiety, and depression, is the primary factor exacerbating mental health problems and adversely impacting individuals' wellbeing. Our study's goal was to determine how SM affects employees' psychosocial behaviours and assess the various factors that contributed to the employee's excessive use of SM.

METHODS

A cross-sectional correlational analysis was conducted. Using a relevant questionnaire on employees, the study was assessed to establish the relationship or association between SM addiction and psychosocial disorders like depression, anxiety, and stress. 200 people with a minimum age of 24 were enrolled in the study. The questionnaire contained the social networking addiction scale (SNAS) and the depression, anxiety, and stress-21 (DASS-21) scales; the data were statistically assessed.

RESULTS

The association between SM addiction and psychosocial behaviours has been examined using statistical tools including descriptive statistics and the Chi-square analysis. SM addiction has a strong, statistically significant correlation with depression (p = 0.001), stress (p = 0.001), and anxiety (p = 0.001).

CONCLUSION

This study discovered a connection between SM use and depression, stress, and anxiety among working employees, raising questions regarding worries about overuse and addiction to SM. Various factors influencing excessive usage included revealed that employees also majorly over used SM for entertainment, boredom avoidance, constant knowledge sharing, and relationship-building.

Factor structure and psychometric properties of the Jordanian version of the depression anxiety stress scale (DASS-21)

AIM

Early diagnosis of health conditions such as depression, anxiety, and stress, which have been recognized as global health issues, is essential for providing psychological support to people who experience negative emotions. Therefore, it is important to identify a reliable method for diagnosing depression, anxiety, and stress. To this end, this study investigated the factor structure and evaluated the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) in Jordan.

METHODS

A university sample of 336 Jordanians completed the Arabic version of the DASS-21 and several psychopathology measures. Cross-sectional study and confirmatory factor analysis (CFA) were applied to achieve the study's aims.

RESULTS

CFA favored the bifactor model compared to the other four models. In contrast, the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) strongly correlated with the DASS-21, indicating that the DASS-21 has adequate convergent and divergent validity. Subsequently, the scale's discriminant validity was tested using the heterotrait-monotrait (HTMT) correlation ratio, which was found to be relatively insufficient. While DASS-21 showed strong reliability, Cronbach's α and McDonald's omega values ranged between 0.83 and 0.93.

CONCLUSION

The bifactor model best fits the Jordanian sample data. The DASS-21 has optimum psychometric properties; therefore, it can be used to assess the general distress experienced by the Jordanian community during research investigations and in non-clinical settings.

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

BACKGROUND

Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh.

METHODS AND ANALYSIS

AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

ETHICS AND DISSEMINATION

AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

Assessment and Psychometric Properties of the 21-Item Depression Anxiety Stress Scale (DASS-21) among Portuguese Higher Education Students during the COVID-19 Pandemic

The COVID-19 pandemic has caused substantial disruptions in the lives of higher education students, with detrimental repercussions for academic performance and overall mental health. Therefore, we aimed to evaluate the prevalence of depression, anxiety, and stress symptoms among Portuguese higher education students during the first wave of the coronavirus pandemic and investigate DASS-21's psychometric characteristics and whether it functions effectively during a pandemic. A convenience sampling procedure was used to recruit 1522 participants (75.1% women and 79.2% undergraduate students) for this cross-sectional research. Participants completed an e-survey created using DASS-21. The results revealed a considerable prevalence of symptoms of depression [≥10] (N = 434, 28.5%), anxiety [≥7] (N = 551, 36.2%), and stress [≥11] (N = 544, 35.7%). Confirmatory factor analysis (CFA) revealed the scale's three-factor structure, which matched the three DASS-21 subscales. Subsequently, the heterotrait-monotrait (HTMT) correlation ratio evaluated the scale's discriminant validity, which was relatively good. Cronbach's alpha measured the internal consistency of the DASS subscales, which was excellent (Cronbach's α > 0.90). DASS-21 was shown to be a reliable and appropriate measure for assessing students' mental health. Furthermore, DASS-21 is recommended for use by academics and healthcare professionals in measuring students' psychological distress. Further validation studies of this scale are needed with larger and more representative samples.

Psychometric evaluation of the depression, anxiety, and stress scale-21 (DASS-21) among Chinese primary and middle school teachers

BACKGROUND

Teachers in high-stress roles face increasing psychological distress such as anxiety and depression, underscoring the need for validated assessment instruments. Given the current absence of a comprehensive, designated, and time-efficient scale capable of evaluating depression, anxiety, and stress among the teacher population, the Depression, Anxiety, and Stress Scale-21 (DASS-21) presents itself as a promising alternative. Despite the widespread application of the DASS-21 for assessing psychological distress across various populations, its validity among teachers, along with questions about its factor structure and its potential property of time equivalence, remain unverified. This study endeavors to address these considerations by investigating the psychometric properties of the DASS-21 specifically within the population of Chinese primary and middle school teachers.

METHODS

Cross-sectional (n = 9,030) and longitudinal surveys (n = 1,642) were conducted using a non-probability sampling method. In addition to the DASS-21, the Chinese version of Chinese Teachers' Job Burnout Questionnaire (CTJBO) was utilized to evaluate the criterion validity of this scale. Three different approaches, namely confirmatory factor analysis, Rasch analysis, and network analysis, were employed to evaluate internal reliability, construct validity, as well as time invariance of the DASS-21.

RESULTS

The DASS-21 demonstrated a high degree of internal consistency (Cronbach's α > 0.85) as well as excellent convergent validity, despite poor discriminant validity as determined by average variance extracted. Confirmatory factor analysis and network analysis further supported convergent validity. The three-factor structure outperformed one- and two-factor alternatives, establishing time invariance. Rasch analysis at the item level identified six inappropriate items within the anxiety and stress subscales, which were subsequently removed. Network analysis presented a better revised network. Regression analysis with emotional exhaustion as the criterion provided logical and accurate results.

CONCLUSION

The DASS-21 was found to be a reliable and valid tool for measuring the mental health of teachers over time. To assess the instrument's psychometric properties, a combination of confirmatory factor analysis, Rasch analysis, and network analysis was utilized, which proved effective and is recommended for evaluating contentious instruments. Based on the results of the study, researchers and healthcare professionals are recommended to use the DASS-21 for assessing teachers' psychological distress. However, certain items identified in the study may need to be removed to enhance the instrument's appropriateness for this specific population.

Validation of depression, anxiety, and stress scales (DASS-21) among Thai nursing students in an online learning environment during the COVID-19 outbreak: A multi-center study

The Depression, Anxiety and Stress Scale (DASS-21), an introductory scale used to identify common mental disorders (CMDs) among adults, was validated across cultures in Asian populations; nevertheless, its capacity for screening these disorders may be limited for some specified groups, including nursing students. This study attempted to investigate the psychometric scale's unique features of DASS-21 for Thai nursing students in an online learning environment during the COVID-19 outbreak. A cross-sectional study using the multistage sampling technique recruited 3,705 nursing students from 18 universities located in south and northeast Thailand. The data were gathered using an online web-based survey, and then all respondents were divided into 2 groups (group 1, n = 2,000, group 2, n = 1,705). After using the statistical methods to reduce items, exploratory factor analysis (EFA) using group 1 was performed to investigate the factor structure of the DASS-21. Finally, group 2 used confirmatory factor analysis to verify the modified structure proposed by the EFA and assess the construct validity of the DASS-21. A total of 3,705 Thai nursing students were enrolled. For the factorial construct validity, a three-factor model was initially suggested containing 18 items (DASS-18) spread across 3 components: anxiety (7 items), depression (7 items) and stress (4 items). The internal consistency reliability was acceptable with Cronbach's alpha in the range of 0.73-0.92for either the total or its subscales. For convergent validity, average variance extracted (AVE) showed that all the DASS-18 subscales achieved convergence effect with AVE in the range of 0.50-0.67. The psychometric features of the DASS-18 will support Thai psychologists and researchers to screen CMDs more easily among undergraduate nursing students in tertiary institutions who enrolled in an online learning environment during the COVID-19 outbreak.

Demographic characteristics and anxiety in the educational setting during the COVID-19 pandemic in Indonesia: A cross-sectional study

Background and Aims

This study aims to analyze the relationship between gender, age, occupation, residence, and anxiety in the education environment during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

This study used a descriptive-analytic cross-sectional design to determine anxiety using the DASS 42 questionnaire given to 181 respondents. The sampling technique used was purposive sampling, and the data analysis used was the Chi-square test and multivariate analysis.

Results

It was found that 66.7% of teenagers experienced anxiety, while 33.3% of adults experienced anxiety. In addition, the school-age community (86.2%) experienced higher anxiety compared with the working-age community (13.8%) who experienced anxiety. Women experienced more significant anxiety (66.7%) compared with men (33.3%). People living on the island of Java (74.7%) have a greater incidence of anxiety compared with people living outside Java (25.3%).

Conclusion

There is a significant relationship between the type of occupation and the incidence of anxiety with p < 0.05 (OR = 0.341). A significant correlation was found between age with the incidence of anxiety with p < 0.05 (OR = 0.489). The demographic factors altogether had significant relationships with the anxiety in the educational environment during the COVID-19 pandemic with a p value < 0.05 and R Square of 0.069. There is a strong relationship between the demographic factors and the incidence of anxiety in the community's educational environment during the COVID-19 pandemic with p < 0.05. It is suggested that women, school-age communities, or the un-employment community need to be supported to alleviate the impact of COVID-19 on anxiety through several programs.