Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

Abstract

The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory ( M = 19.7 years of age) and confirmatory factor analytic methods ( M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.

Teacher Support and Mental Well-Being in Chinese Adolescents: The Mediating Role of Negative Emotions and Resilience

“…In the current study, we used the short-form version of the Depression Anxiety Stress Scale (DASS-21, Lovibond and Lovibond, 1995) to measure the negative emotions, including depression, anxiety, and stress. The DASS-21 is an excellent tool which was conceptualized as a correlated three-factor model, and the total score of DASS-21 represents a full spectrum of negative emotional states (Lovibond and Lovibond, 1995;Chin et al, 2019; as cited in Prabhu, 2016). The buffering model of social support postulates that social support can maintain good health by decreasing the negative influence of stress on the body and mind (Gong, 1994).…”

The depression anxiety and stress Scales-21: Bifactor statistical indices in support of the total and depression scores

“…However, Tully, Zajac, and Venning (2009) and Szabό (2010) opted for a bifactor solution with two specific factors in adolescent samples. More recently, Chin et al (2018) reported the results of both exploratory and confirmatory bifactor models on non-clinical samples supporting a bifactor solution in which only the revised Depression subscale had sufficient validity.…”

“…Additionally, some obtained less conclusive evidence for existence of the Stress factor in their factor analytic studies (e.g., Szabό, 2010). Finally, the specificity of both the Stress and Anxiety factors (Chin, Buchanan, Ebesutani, & Young, 2018) and all three DASS-21 specific factors have been questioned recently (Osman et al, 2012).…”

“…The authors rarely reported additional indicators such as existence and the number of substantive factor loadings per specific factor or how much reliable variance remains within the scales once the reliability due to the G factor has been accounted for. However, the studies which considered these additional criteria, on non-clinical samples did not provide evidence for sufficient specificity of all three DASS-21 subscales (Osman et al, 2012), or the Anxiety and Stress scales (Chin et al, 2018). No bifactor modelling study on clinical samples, with detailed reliability and dimensionality indices, has been reported, leaving the opportunity that some inconsistent findings might have arisen from insufficient reporting practices.…”

P.0213 Self-perceived mental health and isolation as screening tools in mental health symptoms during covid-19 pandemic

“…There are different scales used for measured these symptoms. The Depression, Anxiety and Stress Scale-21 (DASS-21) is one of them, with strong psychometric properties [ 2 , 3 ] and it is validated in Spanish [4] . Due to the increase on mental health problems it is mandatory to look for new parameters that can be used on population as screening tool.…”