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.
Highlights
Depressive and anxiety disorders are widespread in the general population, especially during the current COVID-19 pandemic [1,2]
exploratory factor analysis (EFA) revealed that the Depression Anxiety Stress Scales-21 (DASS-21) in the quarantine sample covers four factors with eigen values >1, which explained 48.3%, 7.0%, 5.8%, and 4.9% of the variance
This study examined the psychometric properties of a standard Arabic version of the Depression Anxiety Stress Scale (DASS)-21 as well as five shortened versions of the DASS-21 in a quarantined sample because of COVID-19, a clinical sample, and in the general public through various robust testing techniques
Summary
Depressive and anxiety disorders are widespread in the general population, especially during the current COVID-19 pandemic [1,2]. The pandemic is associated with developing unhealthy dietary patterns and decreased levels of physical activity due to increased time spent at home [4,5,6] These factors are associated with the development of a systematic inflammatory reaction that may affect brain regions involved in emotional regulation, resulting in the development of affective dysfunctions [7,8]. SARSCoV-2, the causative virus of COVID-19, causes neurodegeneration via direct invasion of brain cells and the cytokine storm, resulting in accelerated rates of the development of depression and anxiety in COVID-19 survivors [9] In addition to their high occurrence in a wide-range of patient populations [10,11,12,13], depressive and anxiety disorders are highly co-morbid with one another [14,15,16]. Their comorbidity is associated with common risk factors (e.g., childhood trauma and age of onset), and it coincides with the worst functional, somatic, and psychiatric outcomes [14]
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