The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World

Abstract

Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman’s correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic

“…Limitations of this study include it being a single-centre study carried out in one department which may limit the study’s generalizability to other healthcare settings, and that socioeconomic factors, which may be confounders, had not been collected. The self-report nature of depression and anxiety under the DASS-21 scale, rather than a clinician-facilitated assessment, could also introduce bias to the results [ 43 , 44 ].…”

The Six-Item Version of the Internet Addiction Test: Its Development, Psychometric Properties, and Measurement Invariance among Women with Eating Disorders and Healthy School and University Students

“…In addition, the model exhibited between group variance involving item loadings, item residuals, and the variance explained by factors underlying the scale ( Table 4 , Supplementary material ). Cumulative knowledge highlights the importance of combining statistical and content approaches in composite scale reduction to ensure that the shortened version retains the validity and other psychometric properties of the original scale [ 79 , 81 ]. Accordingly, we have extensively revised the IAT by stepwise including a single item (the most relevant with the highest loadings) to represent each of the six components on Griffiths’ addiction components model, ending with a six-item version that evaluates conflict, mood modification, salience, tolerance, withdrawal, and relapse components of IA ( Appendix 2 ).…”

“…Apart from its superior fit and invariance, the six-item IAT enjoys additional excellent psychometric properties. Because multiple replicate items contribute to scale reliability, eliminating items is usually associated with a decrease in scale reliability unless it involves heterogeneous items [ 79 , 91 ]. Despite the extensive reduction in its number of items, the internal consistency of the six-item IAT was excellent and good in the ED and university student samples ( Table 5 and Table 9 ).…”

“…Model-data fit was considered good and acceptable, in order, if values of the Comparative Fit Index (CFI) and the Tucker–Lewis Index (TLI) were equal to or above 0.95 and 0.90, respectively, along with values of the root mean square error of approximation (RMSEA) and standardized root-mean-square residual (SRMR) less than 0.06 and 0.08 [ 31 , 44 ]. This combination facilitates a sound judgement because some indices such as RMSEA and SRMR may be sensitive to misspecification of the factor loadings or misspecification of the co-variances, respectively [ 31 , 79 ]. Based on modification indices, all crude models of the IAT were modified by allowing some residuals to correlate.…”

Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain

“…Depression is highly comorbid with EDs (7), and it occurs as a symptom of distress associated with discomfort about body shape and/or food consumption (2,5,8). Depressive symptoms in women with EDs also result from malnutrition/starvation as indicated by body weight, BMI, fat free mass index (FFMI), and serum level of beta-hydroxybutyric acid (2,9,10). Adipokines produced by fat tissue in obese individuals such as leptin stimulate the production of proinflammatory cytokines and free radicals resulting in a chronic general state of systemic inflammation and metabolic dysregulation (11,12).…”