Assessing clinical significance of treatment outcomes using the DASS-21.

Abstract

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

Effectiveness of routine psychotherapy: Method matters

“…A general distress measure, the Distress Index (DI), is also used in practice which is an aggregate score based on 20 items across all but the Eating Concerns and Alcohol Use subscales, and as such provides a measure of general distress and negative affect across symptom groups (Nordberg et al, 2016). In practice two cut points are used for each subscale, theoretically dividing each into three regions (consistent with other measures common in practice, e.g., Ronk, Korman, Hooke, & Page, 2013). As developed by McAleavey et al (2012), the lower cut point is based on Jacobson and Truax's (1991) criterion "c" cut point, which is the distributional midpoint between a nonclinical and a clinical group.…”

Defining early positive response to psychotherapy: An empirical comparison between clinically significant change criteria and growth mixture modeling.

“…We chose the clinically significant change criteria for the evaluation of treatment outcome (see Tables 2 and 3) because they are widely used methods in clinical research and practice (cf. Ronk, Korman, Hooke, & Page, 2013). It should be noted that the predictive power of a method is regularly relatively high if it is used to define a state at two time points and the latter state is predicted from the first state.…”

Emotion regulation in adolescents and young adults with autism spectrum disorders

“…Again this adolescent stated that she would still recommend the programme to others. This difference in findings between the DASS Depression scale and the BDI is puzzling as both are widely used measures of depression with acceptable psychometric properties (Crawford & Henry, 2003;Ronk, Korman, Hooke, & Page, 2013;Richter, Werner, Heerlein, Kraus, & Sauer;. They are also typically correlated with each other (Lovibond & Lovibond, 1995b), which was replicated in the current study (r = .84, p < .001 at baseline, r = .71, p < .001 post-intervention).…”