Psychometric evaluation of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) among Afghans

Abstract

Background Depression, anxiety, and stress are psychological mood states that have close relationships. Moreover, they are influenced by situational factors such as living in conflict zones (e.g., Afghanistan). The World Health Organization's assessment suggests that a significant proportion, specifically one-tenth, of the population residing in areas of conflict endure varying degrees of mental health disorders, ranging from moderate to severe. The most used psychometric instrument to assess these mood states is the 21-item Depression, Anxiety, Stress Scale (DASS-21). However, the scale has not been validated in Dari, the most spoken language in Afghanistan. Methods A cross-sectional investigation was undertaken between June and September of 2023 across various locales within Afghanistan, aiming to assess the psychometric attributes of the Dari iteration of the DASS-21 instrument. The sample comprised 1318 participants (69% females) with mean age of 32 years. Results Cronbach’s alpha of the total scale was 0.94. Findings indicated a robust and consistent level of test-retest reliability across all three dimensions. All subscales and the overall DASS-21 scale exhibited favorable fit indices supporting the proposed factor structure. Conclusions The Dari version of DASS-21 is a reliable and valid instrument to assess the magnitude of depression, anxiety, and stress among the Afghan adult population. The availability of the Dari adaptation of the DASS-21 will facilitate Afghan clinicians and researchers in the screening of prevalent mental health disorders within the Afghan populace.