Evaluating the psychometric properties of the Chinese Depression Anxiety Stress Scale for Youth (DASS-Y) and DASS-21

Psychological Balances in the Digital World: Dynamic Relationships Among Social Media Addiction, Depression, Anxiety, Academic Self-Efficacy, General Belongingness, and Life Satisfaction

In the present era, the rapidly growing social media trends of the digital age have the potential to affect the psychological well-being of individuals. In this context, understanding how Social Media Addiction (SMA) interacts with various factors is important to understanding its potential impact on individuals' psychosocial health. In particular, the prevalence of SMA and its strong relationship with important variables such as anxiety, depression, stress, academic self-efficacy, general belongingness, and life satisfaction have received considerable attention from researchers and the society. This research aims to address the relationship between SMA and these variables in a holistic manner. The research further explored the relationship between life satisfaction and depression, anxiety, academic self-efficacy, and general belongingness. The research is based on a study conducted with 616 students (388 female and 228 male; 17-32 age range) at a state university in the Southeast of Turkey. Personal information form, Smartphone Addiction Scale, Depression Anxiety Stress Scale, Academic Self-Efficacy Scale, General Belongingness Scale, and Life Satisfaction Scale were used as data collection tools. Using a structural equation modeling approach, the research not only examined the significant relationships but also examined the mediating and moderating effects in more detail. According to the research results, SMA significantly affects academic self-efficacy, general belongingness, depression, stress and anxiety. Academic self-efficacy and general belongingness both impact life satisfaction. However, SMA does not have a significant effect on life satisfaction. Moreover, it is revealed general belongingness play effective roles in the relationship between SMA and life satisfaction. As a result of the research, it was revealed that gender plays a moderating role in the relationship between SMA and life satisfaction. It has been observed that gender has a moderating role in the relationships between academic self-efficacy, general belongingness, depression, anxiety and stress and life satisfaction. Conversely, there is no moderating influence of gender on the impact of SMA on academic self-efficacy, general belongingness, depression, anxiety, or stress. Consequently, the relationships between SMA and other variables play an important role in understanding their effects on individuals' mental health.

Indirect effects of health-related quality of life on suicidal ideation through psychological distress among cancer patients

The interrelationships of suicidal ideation, psychological distress, and impaired health-related quality of life (HRQoL) in cancer patients are complex and multifaceted. Limited empirical evidence exists on the indirect effects of impaired HRQoL on suicidal ideation through psychological distress among cancer patients. To fill this research gap, 250 cancer patients were recruited through a cross-sectional hospital-based research design. Structural equation model (SEM) results indicated that impaired HRQoL is a predictor of psychological distress (β = 0.153; p < 0.05), and psychological distress positively predicts suicidal ideation (β = 0.647; p < 0.000). The study found no direct effects of impaired HRQoL on suicidal ideation (β = -0.05; p = 0.223). Indirect effects of HRQoL on suicidal ideation was confirmed, showing a full-mediation effect β = 0.099 (SE = 0.048, CI = [0.030, 0.189], p < 0.05) (i.e. the pathway impaired HRQoL predict suicidal ideation is through psychological distress). Cognitive-behavioral therapy and other emotional support programs should be considered for cancer patients to mitigate psychological vulnerabilities linking impaired HRQoL to suicidal ideation.

The role of physical activity in mitigating stress-induced internet addiction among Chinese college students

BACKGROUND

This study addresses the nexus of stress, physical exercise, and internet addiction in college students, aiming to unravel their complex interactions. With prior research hinting at correlations, this study seeks deeper insights into the optimal exercise duration and the mediating role of physical activity in the stress-internet addiction relationship.

METHODS

We examined 2892 Chinese college students, assessing psychosocial traits via established scales: the Chinese Internet Addiction Scale (CIAS-R), International Physical Activity Questionnaire (IPAQ), and DASS-21 for stress. We adopted a questionnaire survey method to collect data, and through convenience sampling, participants were selected. Analysis involved Structural Equation Model (SEM) and restricted cubic splines (RCS).

RESULTS

Among participants, 22.0 % self-reported internet addiction symptoms. Notably, a non-linear correlation between moderate (MPA) and vigorous physical activity (VPA) and internet addiction was evident (P < 0.001), while light physical activity (LPA) showed no significant association (P = 0.182). MPA initially reduced internet addiction as activity hours increased, but its efficacy lessened after 0.8 h/day. Conversely, VPA's impact fluctuated, declining from 0 to 0.18 h/day, then stabilizing. SEM analysis highlighted VPA and MPA's partial mediation in the stress-internet addiction relationship. Specifically, the path coefficient from stress to MPA was -0.037 (P < 0.05), and the path coefficient from MPA to internet addiction was -0.056 (P < 0.01). Additionally, the path coefficient from stress to VPA was -0.067 (P < 0.001), and the path coefficient from VPA to internet addiction was -0.102 (P < 0.001).

CONCLUSION

This study unveils the intricate interplay between physical activity, stress, and internet addiction among college students. With 22.0 % reporting addiction symptoms, urgent interventions tailored to promoting healthy physical activity levels are imperative to mitigate internet addiction risks.

LIMITATIONS

The cross-sectional nature of our design precludes the establishment of causal relationships between psychological stress and internet addiction.

The long-term effects of perceived instructional leadership on teachers' psychological well-being during COVID-19

The COVID-19 outbreak led to widespread school closures and the shift to remote teaching, potentially resulting in lasting negative impacts on teachers' psychological well-being due to increased workloads and a perceived lack of administrative support. Despite the significance of these challenges, few studies have delved into the long-term effects of perceived instructional leadership on teachers' psychological health. To bridge this research gap, we utilized longitudinal data from 927 primary and secondary school teachers surveyed in two phases: Time 1 in mid-November 2021 and Time 2 in early January 2022. Using hierarchical linear modeling (HLM), our findings revealed that perceptions of instructional leadership, especially the "perceived school neglect of teaching autonomy" at Time 1 were positively correlated with burnout levels at Time 2. Additionally, burnout at Time 2 was positively associated with psychological distress and acted as a mediator between the "perceived school neglect of teaching autonomy" and psychological distress. In light of these findings, we recommend that schools prioritize teachers' teaching autonomy and take proactive measures to mitigate burnout and psychological distress, aiming for the sustainable well-being of both teachers and students in the post-pandemic era.

The Depression Anxiety Stress Scales for Youth (DASS-Y): evidence of validity and cross-national and gender measurement invariance

The Depression Anxiety Stress Scales for Youth (DASS-Y) is a recently developed measure of unpleasant emotional experiences for children and adolescents; however, the evidence for its validity is still limited. The present study evaluated the evidence for the structural, convergent, and incremental validity of the DASS-Y on a sample of Serbian adolescents aged 15-19 years (N = 421; 48% female, mean age = 16.86). Measurement invariance across gender and two countries (Serbia and Australia) was also tested. The findings supported the bifactor exploratory structural equation modeling (bifactor-ESEM) representation of the DASS-Y, which includes the General factor of negative affect/emotional distress, and three specific factors of Depression, Anxiety, and Stress. The DASS-Y factors showed evidence of incremental validity in predicting global externalizing symptoms and demonstrated convergent validity in relation to measures of global internalizing and externalizing symptoms as well as subjective well-being. The bifactor-ESEM model of the DASS-Y was found to be invariant across gender and two countries. The present study findings highlight the importance of distinguishing between general and specific components of unpleasant emotional states.

Food insecurity is related to eating disorder psychopathology beyond psychological distress in rural Chinese adolescents

OBJECTIVE

This study aimed to examine the relationship between food insecurity (FI) and eating disorder psychopathology in a large sample of rural Chinese adolescents.

METHODS

Analyses included 1654 adolescents (55.4% girls; Mage = 16.54 years, SD = 1.45) from a rural high school in southwestern China. FI, eating disorder psychopathology, and psychological distress (i.e., symptoms of depression, anxiety, and stress) were assessed. Data were analyzed by sex. Pearson correlation analysis was performed to investigate the zero-order association between FI and eating disorder psychopathology. Hierarchical linear regressions were used to explore whether FI could explain meaningful variance in eating disorder psychopathology beyond psychological distress and demographic covariates (e.g., socioeconomic status).

RESULTS

FI was significantly associated with higher eating disorder psychopathology for boys (r = 0.44, p < 0.001) and girls (r = 0.43, p < 0.001), with medium-to-large effect sizes. FI accounted for significant unique variance in eating disorder psychopathology beyond psychological distress and demographic covariates for boys (ΔR2 = 0.14, p < 0.001) and girls (ΔR2 = 0.10, p < 0.001).

DISCUSSION

Using a large sample of rural Chinese adolescents, this study extends the connection between FI and eating disorder pathology in adolescents beyond the Western context. Future investigations on the mechanisms underlying FI and eating disorder psychopathology are warranted for developing prevention strategies for eating disorders among rural Chinese adolescents.

PUBLIC SIGNIFICANCE

This is the first investigation that examined the link between FI and eating disorder psychopathology among rural Chinese adolescents. Our findings highlight the importance of incorporating FI as a potential risk factor to screen for the prevention and intervention of eating disorders among rural Chinese adolescents.

Determinants of health-promoting behaviors in pregnant women

OBJECTIVE

The aim of the study was to examine the relationship between social support, marital dissatisfaction, psychological factors, and health-promoting behaviors in pregnant women.

METHODS

This cross-sectional study was conducted on 1,265 pregnant women who visited the outpatient clinic of a maternity hospital between May and August 2023. The Health Promotion Lifestyle-II Questionnaire was used to measure the healthy lifestyle behaviors of pregnant women. The mental health status of pregnant women was measured using the Depression Anxiety and Stress Scale-21. The Marital Disaffection Scale was used to assess the level of disaffection toward a spouse. Perceived social support was measured by the Multidimensional Perceived Social Support Scale.

RESULTS

Pregnant women had a mean age of 26.46±5.09 years. Multivariate linear regression analysis revealed that there was a positive association between perceived social support and health-promoting behaviors. It was also found that marital disaffection was negatively associated with health-promoting behaviors (p<0.001).

CONCLUSION

The present study suggests that stress, anxiety, depression, and marital disaffection are negatively associated with health-promoting lifestyle behaviors, while social support is positively associated with the adoption of health practices in pregnant women. Understanding the complex interplay between psychosocial factors and healthy behaviors is crucial to improving healthy behaviors in pregnant women.

Psychometric evaluation of the Psychache Scale: A multigroup comparison between white and hispanic undergraduate student drinkers

With psychache being an integral aspect of suicidal and addictive behavior, there is a need for efficient assessment, including generalizability across various racial and ethnic identities. Multigroup Confirmatory Factor Analysis of the Psychache Scale was conducted in the context of 1537 undergraduate college student drinkers (White = 1,171, Hispanic = 366). The alternative bifactor model was a better solution compared to other competing models suggesting that the Psychache Scale is sufficiently unidimensional. There was sufficient support for measurement invariance, which implies that the scale is measuring the same construct across groups. The Hispanic group had a significantly higher latent mean overall psychache score compared to their counterparts. The association of psychache with various adjustment outcomes was also similar across groups. The measure demonstrated robust properties to capture psychological pain. Additional studies need to be done to examine factors influencing psychache, especially among the Hispanic population.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers' wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82-0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness-in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

The effect of social support and resource support on emotional exhaustion, insomnia, and suicidal ideation among allied health trainees and post-graduate year doctors in Taiwan

BACKGROUND

COVID-19-related stigmatization refers to COVID-19-related judgements by others that devalue the individual. Such stigmatization towards healthcare workers may cause psychological burden and negative consequences. Such stigmatization may have particularly overwhelmed allied health trainees (AHTs) and post-graduate year doctors (PGYDs) because they just started their medical career. Social support and resource support have been reported to benefit psychological health and reduce stigmatization. Therefore, the present study used a cross-sectional study design to investigate the association between perceived stigma, self-stigma, psychological distress, and negative outcomes (including emotional exhaustion, insomnia and suicidal ideation) among AHTs and PGYDs in Taiwan.

METHODS

An online survey distributed between July and December, 2022 received 522 responses. Variables were assessed using the 21-item Depression, Anxiety and Stress Scale, Insomnia Severity Index and a series of self-designed questions to assess social support, resource support, perceived stigma, self-stigma, emotional exhaustion, and suicidal ideation.

RESULTS

Structural equation modeling showed that perceived stigma was associated with self-stigma (standardized coefficient [β] = 0.428, p < 0.001), and self-stigma was associated with psychological distress (β = 0.197, p < 0.001), as well as being associated with emotional exhaustion, insomnia, and suicidal ideation (β = 0.349, 0.556 and 0.212, all p-values < 0.001). While social support and resource support were negatively associated with perceived stigma (β= - 0.175 and - 0.152, p < 0.01), additional associations were found between social support and emotional exhaustion (β= - 0.093, p < 0.001), as well as between resource support and insomnia (β= - 0.120, p < 0.001).

CONCLUSIONS

The results showed that COVID-19 related stigmatization was correlated to the detrimental consequences of emotional exhaustion, insomnia and suicidal ideation. Clear paths regarding the associations of social support and resource support with the three negative associations were found as the possible solutions. Strategies to reduce the stigmatization and these negative outcomes, or improve the psychological health will benefit AHTs and PGYDs in maintaining a healthy mental status.

The relationship between physical activity and Internet addiction among adolescents in western China: a chain mediating model of anxiety and inhibitory control

This study aims to investigate the mediating effect of anxiety and inhibitory control in the relationship between physical activity and Internet addiction (IA) among adolescents. A total of 951 adolescents from western China completed a self-report survey assessing physical activity, anxiety, inhibitory control, and IA. Descriptive analysis, correlation analysis, and mediation analysis were conducted using SPSS software and the Process plug-in. Controlling for age, gender, and only child status, the findings revealed a negative association between physical activity and anxiety, inhibitory control, and IA. Moreover, anxiety were positively correlated with inhibitory control and IA. Additionally, anxiety exhibited a positive association with inhibitory control. Notably, physical activity directly and negatively predicted IA in adolescents, while also indirectly predicting it through anxiety and inhibitory control. This study contributes to a deeper understanding of the mechanisms that underlie the complex effects of physical activity on IA among adolescents.

The "bubbles"-study: Validation of ultra-short scales for the assessment of depression, anxiety and stress symptoms

Depression, anxiety and stress symptoms cause substantial psychological and economic burdens around the globe. To mitigate the negative consequences, the negative symptoms should be identified at an early stage. Therefore, the implementation of very brief valid screening tools in mental health prevention programs and in therapeutic settings is advantageous. In two studies on representative German population samples, we developed and validated three ultra-short scales-the "bubbles"-that consist of only one item based on the Depression Anxiety Stress 21 subscales (DASS-21) for the assessment of depression, anxiety and stress symptoms. The results of Study 1 (N = 1,001) and Study 2 (N = 894) revealed that the bubbles are valid instruments that fit the DASS-21 subscales on the factor level. Moreover, the bubbles replicated the association pattern of the DASS-21 subscales with demographic variables, and with variables that belong to the negative and the positive dimension of mental health. Thus, due to their time- and cost-efficiency, the bubbles can be used as brief screening tools in research (e.g., large-scale studies, longitudinal studies, experience sampling paradigms) and in praxis. Their shortness can prevent fatigue, motivation decrease, and participants' drop-out.

Are anxiety, depression, and stress distinguishable in Italian adolescents? an examination through the Depression Anxiety Stress Scales-21

The adolescents' ability to discriminate between different negative emotional states is still under debate. The Depression Anxiety Stress Scales-21 (DASS-21) serves as a useful tool to unravel this issue, yet the literature on its structural validity in young people is ambiguous. Therefore, this study aimed to expand knowledge on the emotional experience of youth by investigating the factor structure and psychometric properties of the DASS-21 in Italian adolescents. Six hundred fifty-five students (60.6% girls) aged 14-18 (M = 16.3 ± 1.29) completed an online survey containing the DASS-21 and Positive and Negative Affect Schedule (PANAS). To evaluate the factor structure of the DASS-21, several alternative models were tested, also adopting an Exploratory Structural Equation Modeling (ESEM) procedure. Measurement invariance, reliability, validity, and latent means differences were addressed. The ESEM model with three correlated factors of Depression, Anxiety, and Stress yielded the best fit to the data, supporting a hierarchical structure of the DASS-21. In addition, this model was invariant across sex and age groups. The Anxiety scale predicted both positive and negative affect, while Depression predicted positive affect only. Finally, girls scored higher than boys on Anxiety and Depression, but no age differences emerged. Overall, our results indicate that anxiety, depression, and stress are distinguishable in Italian adolescents but, simultaneously, share an underlying condition of general distress, which may explain the comorbidity between internalizing problems. Such findings are discussed in terms of clinical and preventive implications for the adolescent population.

Psychometric Properties of the Patient Health Questionnaire-9 for Saudi Caregivers: A Cross-Sectional Study in Saudi Arabia

To evaluate the psychometric properties of the Arabic-language Patient Health Questionnaire-9 (PHQ-9) among Saudi caregivers of patients with chronic diseases. Using a cross-sectional design, 94 Saudi caregivers (37 male and 57 female) in the medical city participated in the study. A comparative assessment was conducted on 4 models proposed in the existing PHQ-9 literature to gauge their compatibility through confirmatory factor analyses. This study evaluates convergent validity through a correlation analysis, examining the relationship between the PHQ-9 and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the various models we examined, the single-factor structure of the PHQ-9 displayed the best fit with the data we gathered. Notably, the Cronbach alpha coefficient for the PHQ-9 registered at .81, indicating a high level of internal consistency. Factor loadings spanned a range from .39 to .76. The convergent validity of the PHQ-9 and DASS-21 was deemed satisfactory. It is established that the PHQ-9 serves as an effective tool for depression screening among Saudi caregivers in Saudi Arabia. Its strengths lie in its demonstrated validity, dependability, brevity, and convenience of administration, positioning it as a valuable resource for preventative measures and performance assessment within mental health settings.

Weight stigma is associated with body mass index among college students in Taiwan: the mediated role of internalized weight stigma

BACKGROUND

Weight stigma is an issue often studied in Western countries; however, such information is scarce in Asian studies.

METHODS

This study aimed to examine the role of internalized weight stigma as a mediator in the relationship between perceived weight stigma and changes in body mass index (BMI). The data were collected through a longitudinal online survey with two phases (n = 974; Phase 1: August and September 2021; Phase 2: November and December 2021). The Perceived Weight Stigma Scale (PWSS), Weight Self-Stigma Questionnaire (WSSQ), and Depression, Anxiety, Stress Scale - 21 (DASS-21) were administered to assess perceived weight stigma, internalized weight stigma, and psychological distress. Hierarchical regressions were used to examine the proposed model, and Hayes' Process Macro was used to test a mediation model.

RESULTS

The changes in perceived weight stigma and internalized weight stigma were significantly and positively associated with changes in BMI. There were significant and positive associations between perceived weight stigma, internalized weight stigma and psychological distress over time. Change in internalized weight stigma was found to be a significant mediator in the association of change in perceived weight stigma with change in BMI for the entire sample (unstandardized coefficient = 0.04; 95% CI = 0.02, 0.06), female subgroup (unstandardized coefficient = 0.05; 95% CI = 0.02, 0.08), and male subgroup (unstandardized coefficient = 0.03; 95% CI = 0.01, 0.06). Change in perceived weight stigma also had significant effects on change in BMI for the entire sample and the female subgroup, but not for the male subgroup.

CONCLUSION

Because perceived weight stigma may significantly impact changes in BMI through internalized weight stigma, treatment strategies to ameliorate self-stigma may enhance the results of weight-reduction programs. Such treatment strategies should be considered for inclusion in weight-loss interventions.

Psychometric properties of the Persian Gaming Disorder Test and relationships with psychological distress and insomnia in adolescents

BACKGROUND

Gaming Disorder (GD) was recently included by the World Health Organization (WHO) as a psychiatric condition in the eleventh revision of the International Classification of Diseases (ICD-11) and is a concern worldwide, including in Iran. Thus, based on the ICD-11 criteria, a Persian version of the Gaming Disorder Test (GDT) was developed to facilitate assessment of GD.

METHODS

The present study used classical test theory and Rasch analysis to examine the psychometric properties of the Persian GDT. Iranian adolescents (n = 3837; 2171 [56.6%] males; mean [SD] age = 16.02 [1.4] years) completed the GDT and other instruments assessing disordered gaming, psychological distress, and insomnia.

RESULTS

Overall, the psychometric properties of the Persian GDT were satisfactory based on classical test theory (i.e., confirmatory factor analysis corroborated the unidimensional structure of GDT) and Rasch analysis (i.e., fit statistics suggested that all items were embedded in the concept of GD). Moreover, the Persian GDT was found to be sex-invariant, displaying no items with substantial differential item functioning across sexes. Additionally, it was found that GD mediated associations between time spent gaming and measures of psychological distress and insomnia.

CONCLUSION

The Persian GDT is a convenient and short instrument for assessing GD among Iranian adolescents. The mediating roles of GD in the associations between time spent gaming and psychological distress and between time spent gaming and insomnia suggest that targeting features of GD may reduce psychological distress and improve sleep for Iranian adolescents.

Psychological Effect of the COVID-19 Pandemic on Nursing Students: Palestinian Perspective

Introduction

COVID-19 has had an important effect on nursing students, with some having their clinical practice cancelled or suspended and others suffering from the virus.

Objective

The purpose of this study was to assess the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic.

Methods

The study was cross-sectional, carried out by a convenience sample of 320 participants of nursing students between May and June 2020. Data collection was performed by "Depression Anxiety Stress-21 Scale" (DASS-21).

Results

The results revealed that 78 (24.3%) of participants reported stress; 121 (37.8%) reported anxiety; and 72 (22.5%) reported depression. Also, grade and socioeconomic status had statistically significant effect on anxiety, stress, and depression. In addition, age had statistically significant effect on depression, place of residence had statistically significant effect on anxiety, and gender had statistically significant effect on stress.

Conclusion

The study confirmed an alarming number of nursing students who experienced anxiety, stress, and depression. This study serves as an evidence concerning nursing students' mental health issues as a consequence of the COVID-19 pandemic.