Psychometric Analyses of the Italian 8-Item, 9-Item, and 12-Item Versions of the Depression, Stress and Anxiety Scale.

BackgroundTeachers in high-stress roles face increasing psychological distress such as anxiety and depression, underscoring the need for validated assessment instruments. Given the current absence of a comprehensive, designated, and time-efficient scale capable of evaluating depression, anxiety, and stress among the teacher population, the Depression, Anxiety, and Stress Scale-21 (DASS-21) presents itself as a promising alternative. Despite the widespread application of the DASS-21 for assessing psychological distress across various populations, its validity among teachers, along with questions about its factor structure and its potential property of time equivalence, remain unverified. This study endeavors to address these considerations by investigating the psychometric properties of the DASS-21 specifically within the population of Chinese primary and middle school teachers.MethodsCross-sectional (n = 9,030) and longitudinal surveys (n = 1,642) were conducted using a non-probability sampling method. In addition to the DASS-21, the Chinese version of Chinese Teachers’ Job Burnout Questionnaire (CTJBO) was utilized to evaluate the criterion validity of this scale. Three different approaches, namely confirmatory factor analysis, Rasch analysis, and network analysis, were employed to evaluate internal reliability, construct validity, as well as time invariance of the DASS-21.ResultsThe DASS-21 demonstrated a high degree of internal consistency (Cronbach’s α > 0.85) as well as excellent convergent validity, despite poor discriminant validity as determined by average variance extracted. Confirmatory factor analysis and network analysis further supported convergent validity. The three-factor structure outperformed one- and two-factor alternatives, establishing time invariance. Rasch analysis at the item level identified six inappropriate items within the anxiety and stress subscales, which were subsequently removed. Network analysis presented a better revised network. Regression analysis with emotional exhaustion as the criterion provided logical and accurate results.ConclusionThe DASS-21 was found to be a reliable and valid tool for measuring the mental health of teachers over time. To assess the instrument’s psychometric properties, a combination of confirmatory factor analysis, Rasch analysis, and network analysis was utilized, which proved effective and is recommended for evaluating contentious instruments. Based on the results of the study, researchers and healthcare professionals are recommended to use the DASS-21 for assessing teachers’ psychological distress. However, certain items identified in the study may need to be removed to enhance the instrument’s appropriateness for this specific population.

Anxiety sensitivity (AS) refers to fear of anxiety-related sensory arousal and has been revealed to be associated with increased psychological distress and mental problems. Although Anxiety Sensitivity Index-3 (ASI-3) has been confirmed to be effective in evaluating this construct, whether it is consistently applicable in college students is still elusive. The present study aimed to examine the psychometric properties and measurement invariance of Chinese version of ASI-3 (C-ASI-3) among college students experiencing campus lockdown due to novel coronavirus disease 2019 (COVID-19) pandemic. A total of 1532 Chinese college students (397, 25.9% males) aged between 16 and 25 were included in this study. Confirmatory factor analysis (CFA) was used to verify the factor structure of C-ASI-3. Multi-group CFA was conducted for analysis of measurement invariance with regard to gender. McDonald's omega values were computed for examination of scale reliability. For criterion, convergent, and divergent validity, average variance extracted (AVE) values for C-ASI-3 subscales, difference between square root of AVE for each factor and inter-factor correlation, as well as pearson correlation and partial correlation between the C-ASI-3 and other three scales, including the Depression, Anxiety, and Stress Scale-21 (DASS-21), the State-Trait Anxiety Inventory (STAI), and the Fear of COVID-19 scale (FCV-19S) were evaluated. The C-ASI-3 presented a three-factor scale structure with fit indices being as follows: χ2/df = 11.590, CFI = 0.938, RMSEA = 0.083, SRMR = 0.042. Strict measurement invariance was reached across gender. Regarding convergent validity, the C-ASI-3 had a high correlation with the DASS-21 (r = 0.597, p < 0.01) and the STAI (r = 0.504, p < 0.01). All AVE values for C-ASI-3 subscales were above 0.5. In terms of divergent validity, the C-ASI-3 had medium correlation with the FCV-19S (r = 0.360, p < 0.01). Square of root of AVE for each factor was higher that inter-factor correlation. McDonald's omega values of the three dimensions ranged from 0.898 ~ 0.958. The C-ASI-3 has acceptable psychometric properties among college students. College students with different gender have consistent understanding on the scale construct.

ObjectivesTo assess the internal consistency, latent structure and convergent validity of the Depression, Anxiety and Stress Scale-21 (DASS-21) among adolescents in Vietnam.MethodAn anonymous, self-completed questionnaire was conducted among 1,745 high school students in Hanoi, Vietnam between October, 2013 and January, 2014. Confirmatory factor analyses were performed to assess the latent structure of the DASS-21. Factorial invariance between girls and boys was examined. Cronbach alphas and correlation coefficients between DASS-21 factor scores and the domain scores of the Duke Health Profile Adolescent Vietnamese validated version (ADHP-V) were calculated to assess DASS-21 internal consistency and convergent validity.ResultsA total of 1,606/ 1,745 (92.6%) students returned the questionnaire. Of those, 1,387 students provided complete DASS-21 data. The scale demonstrated adequate internal consistency (Cronbach α: 0.761 to 0.906). A four-factor model showed the best fit to the data. Items loaded significantly on a common general distress factor, the depression, and the anxiety factors, but few on the stress factor (p<0.05). DASS-21 convergent validity was confirmed with moderate correlation coefficients (-0.47 to -0.66) between its factor scores and the ADHP-V mental health related domains.ConclusionsThe DASS-21 is reliable and suitable for use to assess symptoms of common mental health problems, especially depression and anxiety among Vietnamese adolescents. However, its ability in detecting stress among these adolescents may be limited. Further research is warrant to explore these results.

Purpose: The aim of this study is to examine the relationship between emotional appetite and life satisfaction of depression, anxiety, and stress of university students Material and Methods: This cross-sectional, descriptive study was based on volunteerism and was conducted on a total of 1006 undergraduate students, 243 male and 763 female, studying at Üsküdar University in the 2020-2021 academic year. Students were online surveyed through questions about the sociodemographic characteristics and nutritional status of the students and the Emotional Appetite Questionnaire (EMAQ), Life Satisfaction Scale (SWLS) and Depression, Anxiety and Stress Scale (DASS). Data were analyzed with IBM SPSS and version 26. Results: 75.8% of the students participating in the study were female and 24.2% were male. The mean age of the students is 19.20±1.12 years, and the mean body mass index (BMI) is 22.04±3.85 kg/m2. “Advanced” and “very advanced” depression prevalence was 91.3%, anxiety prevalence was 61.5% and stress prevalence was 61.8%. The average score of the participants on the Life Satisfaction Scale (SWLS) was 19.16±7.60, and their life satisfaction was moderate. Eating habits of students show similarity in positive or negative emotions and situations according to their emotional appetite. As life satisfaction score increases, a decrease was found in the scores of “Depression”, “Anxiety” and “Stress” and “DASS Total” (p&lt;0.05). As the life satisfaction score increased, there was an increase in the "EMAQ Positive " score (p&gt;0.05) and "EMAQ Negative" score (p&lt;0.05). As the “Depression” score increased, the “EMAQ Positive” score increased (p&gt;0.05) and the “EMAQ Negative” score decreased (p&lt;0.05). As the “DASS Total” score increased, there was a decrease in the “EMAQ Positive” score (p&gt;0.05) and the “EMAQ Negative” score (p&lt;0.05). As the "EMAQ Positive" score increased, the "EMAQ Negative" score increased (p&lt;0.05). Conclusion: The change in the emotional moods of university students affects their life satisfaction and emotional appetite. In negative moods, life satisfaction and emotional appetite decrease.

BackgroundPrimary schoolteachers play a pivotal role in the education of children, highlighting the importance of addressing their psychological well-being and mental health. While the Depression, Anxiety, and Stress Scale-21 (DASS-21) is a globally recognized instrument for evaluating mental health, its systematic validation among primary schoolteachers, particularly in a cross-national context, remains understudied. The present cross-cultural study evaluated the psychometric properties of DASS-21 among primary schoolteachers in Spain and China to compare the DASS-21 between teachers across Western and Eastern cultures.MethodsThe study sample comprised 1,350 Spanish and 2,580 Chinese primary schoolteachers. The DASS-21, alongside the Emotional Exhaustion Scale for Teachers, was used to evaluate its psychometric properties. The construct and concurrent validity of the DASS-21 were examined using Rasch analysis, Confirmatory Factor Analysis (CFA), and Structural Equation Modeling (SEM). Additionally, measurement invariance was tested across two national teacher cohorts.ResultsRasch analysis confirmed the validity of most DASS-21 items among both the Spanish and Chinese teachers, with only the same item from the Anxiety subscale showing inadequate fit in both countries. CFA across both countries initially favored a bifactor model, which was subsequently excluded due to problematic factor loadings. Instead, a single-factor model provided the best fit for Chinese teachers, while a correlated three-factor model was optimal for Spanish teachers. SEM demonstrated the DASS-21’s concurrent validity with emotional exhaustion, with consistent findings across both samples. After excluding Differential Item Functioning (DIF) items, strict measurement invariance between Spanish and Chinese teachers was achieved, as verified by multi-group CFA.ConclusionThe DASS-21 exhibits commendable psychometric properties, rendering it a suitable instrument for evaluating the mental illness of primary schoolteachers in both Spain and China.

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver’s licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty (DD), emotion dysregulation, and negative affect in emerging drivers with and without autistic traits (AT), and investigated how emotion dysregulation and negative affect relate to perceived DD. We expected (1) greater perceived DD, emotion dysregulation, and negative affect in participants with AT and (2) a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults (15 AT) self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale (DERS) and the Depression, Anxiety, and Stress Scale (DASS). Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed.

Introduction There is a constant need for theoretically sound and valid self-report instruments for measuring psychological distress. Previous studies have shown that the Depression, Anxiety and Stress Scale-21 (DASS-21) is theoretically sound, but there have been some inconsistent results regarding its factor structure. Aims The aim of the present study was to investigate and elucidate the factor structure and convergent validity of the DASS-21. Methods A total of 624 participants recruited from student, primary care and psychotherapy populations. The factor structure of the DASS-21 was assessed by confirmatory factor analyses and the convergent validity by investigating its unique correlations with other psychiatric instruments. Results A bifactor structure with depression, anxiety, stress and a general factor provided the best fit indices for the DASS-21. The convergent validity was adequate for the Depression and Anxiety subscales but more ambiguous for the Stress subscale. Discussion The present study overall supports the validity and factor structure of the DASS-21. Implications for practice The DASS-21 can be used to measure symptoms of depression and anxiety as well as overall distress. It can be useful for mental health nurses, and other first-line psychiatric professionals, in need of a short, feasible and valid instrument in everyday care.

Background: Coronavirus disease 2019 (COVID-19) has spread to over 150 countries worldwide. Since the first case of COVID-19 was confirmed in Saudi Arabia, cases have continued to escalate exponentially. The COVID-19 outbreak has had a negative effect on mental health and well-being. The study aimed to investigate the effects of the strict national regulations associated with the COVID-19 pandemic on mental health.Methods: This was a cross-sectional study of a convenience sample of Saudi residents. Saudi residents aged 18 years or older were invited to complete an online questionnaire after one month of a nationwide 24-h curfew between May 6, 2020 and May 13, 2020. We measured psychological distress using the Depression, Anxiety, and Stress Scale-21 (DASS-21). We ran binary logistic regression analyses to detect variables that significantly predicted DASS-21 scores.Results: A sample of 2252 participants was recruited from the general population of Saudi Arabia. The DASS-21 score means and standard deviations for depression and anxiety for the whole sample (10.73 ± 10.29 and 6.98 ± 8.30, respectively) were in the range of mild depression and anxiety. In contrast, the mean DASS-21 stress score was within the normal range (11.97 ± 10.80). The mean stress score for healthcare workers was within the normal range (13.70 ± 10.68) but was significantly higher than the mean score for the public (11.56 ± 10.89; P = 0.0006). Several variables (e.g., age, gender, and history of contact with confirmed COVID-19 cases) were significantly associated with higher DASS-21 scores.Conclusions: The COVID-19 pandemic has created a psychological burden. Therefore, there is an urgent need to implement emergency public health interventions that ameliorate the risk perception of COVID-19 through the dissemination of adequate and targeted health information that could be a successful measure to mitigate the psychological impact of the Covid-19 pandemic.

Emotional reactivity, intensity, and perseveration: Independent dimensions of trait affect and associations with depression, anxiety, and stress symptoms

High comorbidity rates among emotional disorders have led researchers to examine transdiagnostic factors that may contribute to shared psychopathology. Bifactor models provide a unique method for examining transdiagnostic variables by modelling the common and unique factors within measures. Previous findings suggest that the bifactor model of the Depression Anxiety and Stress Scale (DASS) may provide a method for examining transdiagnostic factors within emotional disorders. This study aimed to replicate the bifactor model of the DASS, a multidimensional measure of psychological distress, within a US adult sample and provide initial estimates of the reliability of the general and domain-specific factors. Furthermore, this study hypothesized that Worry, a theorized transdiagnostic variable, would show stronger relations to general emotional distress than domain-specific subscales. Confirmatory factor analysis was used to evaluate the bifactor model structure of the DASS in 456 US adult participants (279 females and 177 males, mean age 35.9 years) recruited online. The DASS bifactor model fitted well (CFI = 0.98; RMSEA = 0.05). The General Emotional Distress factor accounted for most of the reliable variance in item scores. Domain-specific subscales accounted for modest portions of reliable variance in items after accounting for the general scale. Finally, structural equation modelling indicated that Worry was strongly predicted by the General Emotional Distress factor. The DASS bifactor model is generalizable to a US community sample and General Emotional Distress, but not domain-specific factors, strongly predict the transdiagnostic variable Worry.

Background:The Depression, Anxiety, and Stress Scale (DASS) is a widely used measure of negative emotional states. While the DASS is increasingly used in mental health research in India, to date no study has examined the factor structure among Indian adults.Methods:A large community sample of English-speaking Indian adults completed the DASS 21-item version, and confirmatory factor analyses were conducted.Results:The results indicated a good fit for a three factor (depression, anxiety, and stress) and a one-factor model (general psychological distress). There was no substantial difference between the fit of the models, and the DASS subscales were very strongly correlated with one another (r ≥ .80).Conclusion:The findings from this sample suggest that the DASS-21 items appear to assess general psychological distress, with little evidence that the items assess three distinct subscales.

Psychometric work on the widely used Depression Anxiety and Stress Scales (DASS) has mostly used classical psychometrics and ignored common internet-administered versions. Therefore, the present study used not only classical, but also modern psychometrics based on item response theory (IRT) to evaluate an internet-administered version of the DASS (Dutch translation). Internet-administered DASS data were collected as part of a large internet-based study in the Dutch adult population (n = 7972). Initially, external correlates (i.e. demographics other measures) and some classical psychometrics (internal consistency, convergent/divergent validity) of the DASS scales were evaluated. Next, IRT was used to investigate the scales’ dimensionality, discrimination and item-functioning. Finally, the DASS depression scale was further investigated by linking it to the more clinically-oriented Quick Inventory of Depressive Symptomatology (QIDS) using item response theory (IRT). Initial classical psychometric analyses supported the scales’ internal consistency (alpha = 0.94–0.98) and convergent/divergent validity. IRT analyses showed that each of the DASS scales was only suitable to measure variations in a very narrow and rather mild severity range. Linking the DASS depression scale with the QIDS also showed that the DASS depression scale discriminated best in the mild-moderate severity range, but not at higher severity levels that were covered by the QIDS. In conclusion, the scales of the internet-administered DASS show good internal consistency and validity. However, users should be aware that the scales discriminate best at mild-moderate severity ranges in the general population.

BACKGROUND Psychological distress among ICU and ED nurses: the infulance of emotional intelligence By Daliah Ahmad Almuhdi Background and Objective: Nurses in Intensive Care Units (ICUs) and Emergency Department (ED) often contend with elevated psychological distress (stress, anxiety, and depression), impacting patient care and personal well-being. Despite the known negative association between Emotional Intelligence (EI) and these psychological disorders, limited research in Jordan has explored this relationship. This study aims to examine the relationship between Emotional Intelligence (EI) and psychological distress (stress, anxiety, and depression) among acute care nurses in Jordan. Method: The study utilized a cross-sectional descriptive and predictive design, targeting ICU and ED nurses (n=296) from University Hospital (JUH) and King Abdullah University Hospital (KAUH). Eligible participants included registered nurses with a minimum of one year of experience in ICU or ED settings. A self-administered questionnaire consisting of a sociodemographic data sheet, the Wong and Law Emotional Intelligence Scale (WLIES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were employed. Descriptive and inferential statistics were applied for data analysis. Linear regression analysis was used to examine the predictors of EI with social demographics were tested as predictor variables. Also SPSS’s PROCESS macro (Hayes, 2013) was used to determine if EI significantly moderates the relationship between stress and depression as well as between stress and anxiety. Results: Despite nurses exhibiting high EI levels (5.34 ±1.0), 65.9%, 10.1%, and 14.9% of participating nurses experienced extremely severe stress, anxiety, and depression, respectively. Negative but non-significant correlations were observed between EI and stress, anxiety, or depression. No moderation effects of EI were detected. Stress has a significant positive effect on anxiety (b=.547, p=.035, but not EI (b= -1.488, p=.187). The interaction between stress and EI was not significant as well (b = .047, p =.304), indicating that EI did not moderate the relationship between stress and anxiety. On regression analysis, higher education level (B.s degree) was a significant predictor, higher education level (Bs degree) was a significant predictor, and higher education level (Bs degree) was a significant predictor of EI, explaining 5.3% of the variance. Conclusion: The study highlights the mental health challenges faced by acute care nurses in Jordan, emphasizing the need for targeted interventions to reduce psychological distress (stress, anxiety, and depression) in these settings. This research provides valuable insights for healthcare providers and policymakers to improve the overall well-being of nurses. OBJECTIVE This study aims to examine the relationship between Emotional Intelligence (EI) and psychological distress (stress, anxiety, and depression) among acute care nurses in Jordan. METHODS The study utilized a cross-sectional descriptive and predictive design, targeting ICU and ED nurses (n=296) from University Hospital (JUH) and King Abdullah University Hospital (KAUH). Eligible participants included registered nurses with a minimum of one year of experience in ICU or ED settings. A self-administered questionnaire consisting of a sociodemographic data sheet, the Wong and Law Emotional Intelligence Scale (WLIES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were employed. Descriptive and inferential statistics were applied for data analysis. Linear regression analysis was used to examine the predictors of EI with social demographics were tested as predictor variables. Also SPSS’s PROCESS macro (Hayes, 2013) was used to determine if EI significantly moderates the relationship between stress and depression as well as between stress and anxiety. RESULTS Despite nurses exhibiting high EI levels (5.34 ±1.0), 65.9%, 10.1%, and 14.9% of participating nurses experienced extremely severe stress, anxiety, and depression, respectively. Negative but non-significant correlations were observed between EI and stress, anxiety, or depression. No moderation effects of EI were detected. Stress has a significant positive effect on anxiety (b=.547, p=.035, but not EI (b= -1.488, p=.187). The interaction between stress and EI was not significant as well (b = .047, p =.304), indicating that EI did not moderate the relationship between stress and anxiety. On regression analysis, higher education level (B.s degree) was a significant predictor, higher education level (Bs degree) was a significant predictor, and higher education level (Bs degree) was a significant predictor of EI, explaining 5.3% of the variance. CONCLUSIONS The study highlights the mental health challenges faced by acute care nurses in Jordan, emphasizing the need for targeted interventions to reduce psychological distress (stress, anxiety, and depression) in these settings. This research provides valuable insights for healthcare providers and policymakers to improve the overall well-being of nurses.

The Depression Anxiety and Stress Scales-21 (DASS-21) involves a simple structure first-order three-factor oblique model, with factors for depression, anxiety, and stress. Recently, concerns have been raised over the value of using confirmatory factor analysis (CFA) for studying the factor structure of scales in general. However, such concerns can be circumvented using exploratory structural equation modeling (ESEM). Consequently, the present study used CFA and ESEM with target rotation to examine the factor structure of the DASS-21 among an adult community. It compared first-order CFA, ESEM with target rotation, bi-factor CFA (BCFA), and bi-factor BESEM with target rotation models with group/specific factors for depression, anxiety, and stress. A total of 738 adults (males = 374, and females = 364; M = 25.29 years; SD = 7.61 years) completed the DASS-21. While all models examined showed good global fit values, one or more of the group/specific factors in the BCFA, ESEM with target rotation and BESEM with target rotation models were poorly defined. As the first-order CFA model was most parsimonious, with well-defined factors that were also supported in terms of their reliabilities and validities, this model was selected as the preferred DASS-21 model. The implications of the findings for use and revision of the DASS-21 are discussed.

The Depression Anxiety and Stress Scales-21 (DASS-21) involves a simple structure first-order three-factor oblique model, with factors for depression, anxiety, and stress. Recently, concerns have been raised over the value of using confirmatory factor analysis (CFA) for studying the factor structure of scales in general. However, such concerns can be circumvented using exploratory structural equation modeling (ESEM). Consequently, the present study used CFA and ESEM with target rotation to examine the factor structure of the DASS-21 among an adult community. It compared first-order CFA, ESEM with target rotation, bi-factor CFA (BCFA), and bi-factor BESEM with target rotation models with group/specific factors for depression, anxiety, and stress. A total of 738 adults (males = 374, and females = 364; M = 25.29 years; SD = 7.61 years) completed the DASS-21. While all models examined showed good global fit values, one or more of the group/specific factors in the BCFA, ESEM with target rotation and BESEM with target rotation models were poorly defined. As the first-order CFA model was most parsimonious, with well-defined factors that were also supported in terms of their reliabilities and validities, this model was selected as the preferred DASS-21 model. The implications of the findings for use and revision of the DASS-21 are discussed.