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

Abstract

This study explored several, latent factor models of the Depression Anxiety and Stress Scales-21 (DASS-21) using both a sample of clinically depressed patients and a Facebook sample from Serbia. The DASS-21, the Beck Depression Inventory-II, and the State Trait Anxiety Inventory-Trait were administered to a sample of depressed individuals (N = 296; Mage = 52.21, SDage = 11.56). A Facebook sample (N = 376; Mage =29.12, SD = 8.96) completed the DASS-21 only. A bifactor model with one general distress (G) and two specific factors (Depression and Anxiety) were supported. The three factors had high omega coefficients, whereas omega hierarchical for Depression and Anxiety were low. Based on all evidence from our study, external validation, factor determinacy, and replicability, we concluded that the Serbian version of the DASS-21 assesses reliably general distress and anhedonia in both people with the clinical level of severity of distress and in general population. The Anxiety subscale can be safely used in clinical settings when one wishes to assess individuals presenting with a mixture of distress and anxious arousal. However, until further validation support is provided, we do not recommend use of this scale when the task is to estimate precisely anxious arousal only. The Stress subscale assesses general distress only. Low omega hierarchical coefficients of the Depression and Anxiety subscales could be addressed by re-selecting their items from the initial item pool, based on which the DASS-21 was created, using those with substantial loadings on both the G and their respective group factors.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross‐cultural network analysis

“…The Italian network was completely in line with the previous factor-analytic work revealing seven items per community (Bottesi et al, 2015). Within the Croatian and Serbian networks, one and two items, respectively, were positioned differently than what would be expected based on the previous factor-analytic studies carried out in these two cultures (Ivezic et al, 2012;Mihi c et al, 2021). In the Croatian sample, item Intolerant had the highest edge with Panic, which probably led to its inclusion within the anxiety/anxious arousal community.…”

“…In the Croatian sample, the only difference in comparison to the previous studies was that Intolerant was included in the anxious/autonomic arousal community. In the Serbian sample, two symptoms, namely, Scared and Worried about panic, from the anxious/autonomic arousal domain (Mihi c et al, 2021) were included in the stress/stress community.…”

“…The DASS‐21 has been translated into many languages (Lovibond, 2017), with a preponderance of validation studies conducted on non‐clinical samples (Chin et al, 2019; Osman et al, 2012; Szabó, 2010. ), and a few studies on clinical samples (Antony et al, 1998; Bottesi et al, 2015; Clara et al, 2001; Ivezic et al, 2012; Mihić et al, 2021). All validation studies were conducted from the common cause perspective, identifying different possible patterns of latent factors (Bottesi et al, 2015; Mihić et al, 2021).…”

“…), and a few studies on clinical samples (Antony et al, 1998; Bottesi et al, 2015; Clara et al, 2001; Ivezic et al, 2012; Mihić et al, 2021). All validation studies were conducted from the common cause perspective, identifying different possible patterns of latent factors (Bottesi et al, 2015; Mihić et al, 2021). The network approach could provide a different angle from which to consider item covariations whereby the depression, anxiety and stress symptoms hang together due to the dynamic interplay among them, not due to the presence of an underlying factor(s).…”

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

“…Recently, concerns have been raised regarding the three-factor structure of the DASS-21 [44,45]: data across multiple studies is more suggestive of a bifactor model comprising a general factor (reflecting "a mixture of negative emotions such as depression, anxiety, and [being] stress-reactive" (45, p. 166)) and a group factor (including all three subscales or just the two most independent: depression and anxiety). Due to these psychometric concerns, the present analysis utilised DASS-Total scores as a reflection of these psychopathological states, albeit a non-specific one as regards to differentiating between anxious and depressive symptoms.…”