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Objectives. To test the construct validity of the short-form version of the Depression anxiety and stress scale (DASS-21), and in particular, to assess whether stress as indexed by this measure is synonymous with negative affectivity (NA) or whether it represents a related, but distinct, construct. To provide normative data for the general adult population.

Design. Cross-sectional, correlational and confirmatory factor analysis (CFA).

Methods. The DASS-21 was administered to a non-clinical sample, broadly representative of the general adult UK population (N=1,794). Competing models of the latent structure of the DASS-21 were evaluated using CFA.

Results. The model with optimal fit (RCFI = 0.94) had a quadripartite structure, and consisted of a general factor of psychological distress plus orthogonal specific factors of depression, anxiety, and stress. This model was a significantly better fit than a competing model that tested the possibility that the Stress scale simply measures NA.

Conclusions. The DASS-21 subscales can validly be used to measure the dimensions of depression, anxiety, and stress. However, each of these subscales also taps a more general dimension of psychological distress or NA. The utility of the measure is enhanced by the provision of normative data based on a large sample.

/pdf/the-short-form-version-of-the-depression-anxiety-stress-5bk9pi8dqa.pdf

The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample

https://science.sciencemag.org/content/sci/5/110/206.full.pdf

The american psychological association.

Anxiety is as common as depression; however, it has received less attention and is often undetected and undertreated. The authors administered a 7-item anxiety scale to 965 primary care patients, w...

Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection

We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d = 1.65) and low on conscientiousness (mean d = -1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d = -1.47) and social phobia (d = -1.31). Disinhibition was linked to only a few conditions, including SUD (d = 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.

Linking "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis.

The Depression–Anxiety–Stress Scales (DASS; P. F. Lovibond & S. H. Lovibond, 1995) have shown considerable promise in their ability to differentially assess depression and anxiety symptoms. Most of the work to date has relied on normal or predominantly anxious clinical samples. To extend this research to a predominantly depressed sample, a psychiatric sample from a mood disorders program (N = 439) was used to investigate the factor structure of the DASS. Confirmatory factor analyses indicated that a 3-factor model for the 21-item DASS was supported. A 3-factor model with crossloading items for the 42-item version showed no practical improvement. Further confirmatory analyses evaluated the ability of item subsets from the DASS to represent the constructs specified in the tripartite model (L. A. Clark & D. Watson, 1991). Strong support was obtained for the DASS to represent the construct of anhedonia and physiological hyperarousal, and their relative importance is consistent with predictions of the tripartite model in understanding the relationship between anxiety and depression.

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

http://employment.education.uiowa.edu/jgreenfe/research/Walker_IBD.pdf

The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders.

Confirmatory factor analysis was used to evaluate 2 multidimensional measures of perfectionism (R. O. Frost, P. Marten, C. Lahart, & R. Rosenblate, 1990; P. L. Hewitt & G. L. Flett, 1991). On a first-order level, support was found for Hewitt and Flett's (1991) original 3-factor conceptualization of perfectionism, although only for an empirically derived 15-item subset. Support was also obtained for 5 of the 6 dimensions proposed by R. O. Frost et al. (1990), but the model only displayed good fit when a refined scale containing 22 of the original 35 items was used. A second-order analysis found evidence for 2 higher-order factors of adaptive and maladaptive perfectionism. Perfectionism dimensions correlated in expected directions with personality domains, symptom distress, and academic achievement. The brief measures of perfectionism also retained the construct-related validity displayed by the full-item versions.

The multidimensional structure of perfectionism in clinically distressed and college student samples.

Objective: Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems. Methods: Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier. Results: The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands. Conclusions: Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands. (Psychiatric Services 58:357–364, 2007)

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2007.58.3.357

Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands

Background: Evidence has been emerging that anxiety disorders are associated with several physical health conditions. We used the first community survey, which assessed physical conditions based on physician assessment and included standardized diagnostic assessment of mental disorders by trained health professionals, to examine the relationship between anxiety disorders and physical conditions. Methods: The German Health Survey (N =4 181; response rate, 87.6%; ages 18-65 years) used the Composite International Diagnostic Interview to assessDiagnosticandStatisticalManualofMentalDisorders,FourthEdition mood, substance use, and anxiety disorders (panic disorder, social phobia, specific phobia, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder) and a standardized medical interview supplemented by laboratory data to assess a broad range of physical conditions. The Medical Outcomes Study 36-Item ShortForm Health Survey (SF-36) was used to measure healthrelated quality of life. Number of days of role impairment was used to measure past 30-day disability. Results: After adjusting for sociodemographic factors and other common mental disorders, the presence of an anxiety disorder was significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions (adjusted odds ratios between 1.39 and 2.12;P.05). Compared with physical disorders alone, the presence of comorbid anxiety disorder with 1 or more physical disorders was associated with poorer physical component scores on the SF-36 (adjusted mean scores for physical condition alone and physical condition with anxiety disorder, 48.50 and 45.86, respectively; P.001) and past 30-day disability due to physical problems (adjusted odds ratio, 1.69; 95% confidence interval, 1.20-2.37). Conclusion: Anxiety disorders are independently associated with several physical conditions in the community, and this comorbidity is significantly associated with poor quality of life and disability. Arch Intern Med. 2006;166:2109-2116

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/411123/ioi60107.pdf

Ian Clara

Papers

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders.

The multidimensional structure of perfectionism in clinically distressed and college student samples.

Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands

Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions