Factor structure of the depression anxiety stress Scale-21 (DASS-21): Unidimensionality of the Arabic version among Egyptian drug users

Joseph Green,Amira Mohammed Ali

doi:10.1186/s13011-019-0226-1

Abstract

BackgroundEmotional distress is common among illicit drug users, and it can negatively affect treatment outcomes and increase the risk of relapse. Nonetheless, instruments that properly measure emotional distress are lacking. Therefore, this study investigated the factor structure of the Arabic Depression Anxiety Stress Scale-21 (DASS-21) in that population.MethodsThe DASS-21 and the Self-stigma of Alcohol Dependence Scale (SSAD) were completed by 149 inpatient Egyptian drug users. The DASS-21 was examined using exploratory factor analysis, partial confirmatory factor analysis, and parallel analysis. For validation testing, correlations between stigma scores and DASS scores were computed.ResultsA one-factor solution provided the best fit to the DASS-21 data. Four items with low loadings were removed. The resulting DASS-17 was also unidimensional, and its reliability was high (0.88). On the validation tests, the DASS scores correlated with the stigma scores as hypothesized.ConclusionSubscales of the Arabic version of the DASS-21 do not differentiate between depression and anxiety. A modified 17-item version (the DASS-17) was suitable for measuring overall distress, and the results of convergent validation testing indicated that it was superior to the DASS-21.

Highlights

Emotional distress is common among illicit drug users, and it can negatively affect treatment outcomes and increase the risk of relapse
A 17-item version of the Depression Anxiety Stress Scale (DASS) performed better than the 21-item version, and this DASS-17 provided a unidimensional index of overall psychological distress
In at least one study, items were forced to load in a manner that served the original structure of Lovibond and Lovibond (1995): for the Malay Depression Anxiety Stress Scale-21 (DASS-21), Nur Azma et al (2014) developed four CFA models, all had low fit indices

Summary

Introduction

Emotional distress is common among illicit drug users, and it can negatively affect treatment outcomes and increase the risk of relapse. More than three quarters of drug users have symptoms of depression and anxiety (Moody, Franck, & Bicke, 2016); the severity of symptoms varies between those in long-term residential treatment and those in outpatient treatment [8]. Their psychological distress is associated with low abstinence self-efficacy, craving, treatment failure, relapse, and continued use [9, 10], but the frequency of drug use decreases when negative emotions decline during treatment [11]. Measuring emotional negativity in people with substance use disorders is essential to evaluate and improve treatment outcomes and possibly prevent relapse [12]

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Results

Discussion

Conclusion