The Depression Anxiety and Stress Scales: Reference data from a large psychiatric outpatient sample

The published norms for the Depression Anxiety and Stress Scale (DASS) give results for clinical populations that largely fall in the severe to very severe categories. As a result, within this population, the ability to compare the comparative contributions of the underlying emotional components is reduced. The present study presents results from a large general psychiatric outpatient population and provides percentile norms with confidence intervals for both the original DASS and the shorter 21‐item form. It is noted that both forms have high validity but that the correlations between scales are higher than those reported in non‐clinical populations. There was little variation between sexes but some variation of results with age with both younger and older cohorts having lower scores except for the Stress scale where there were higher scores in the older group. There is some evidence of a ceiling effect in the Depression and Stress scales. It was noted that nearly a quarter of patient scores fell within the originally defined normal range suggesting that the DASS would not be a particularly sensitive instrument in its previously reported use as a screening instrument for psychiatric illness.     

The Emotional Experience Associated with Worrying in Adolescents

Among adults, both normal and pathological worrying has been found to be associated with a unique emotional syndrome involving irritability, restlessness, low frustration tolerance and difficulty relaxing. This emotional state is empirically distinguishable from anxiety and depression, and is reliably assessed by the Stress scale of the Depression Anxiety Stress Scales (DASS). The association between worry and ‘stress’ may have important implications for a better theoretical understanding of worrying in adults. Among youth, however, the emotional experience associated with worrying has not yet been clearly described. The present study aimed to explore whether a distinct, adult-like ‘stress’ syndrome can be assessed in adolescents via self-report, and whether, as in adults, stress has a specific association with worrying. A simplified version of the DASS was created to maximize its comprehension by adolescents. A group of 340 12–18-year-olds completed the simplified DASS and a self-report measure of worry. Factor analyses revealed a three-factor structure underlying the simplified DASS, similar to the original adult version. Further analyses showed that worry had a unique association with Stress, over and above its association with Depression and Anxiety. Adolescents who worry more excessively and uncontrollably also reported higher levels of irritability, restlessness and difficulty relaxing, while the autonomic arousal symptoms of anxiety had consistently low associations with worrying, especially in older adolescents. Results indicate that the proposed cognitive avoidance function of worrying may be present by adolescence.     

Cognitive and affective components of empathy and their relationship with personality dimensions in a Chinese sample

Empathy is an essential component of social interactions and may be related to personality characteristics. However, this issue has not been extensively examined in a Chinese sample. Students at six universities in China (N = 257) completed the Interpersonal Reactivity Index (IRI), the Eysenck Personality Questionnaire‐Revised (EPQ‐R), and the Depression, Anxiety and Stress Scale (DASS‐21). Using multiple regression analyses, and after accounting for demographic variables (sex and age), it was found that the affective empathy component Personal Distress positively predicted EPQ‐R Neuroticism scores (β = .49), negatively predicted Extraversion (β = –.21) and Lie scale scores (β = –.22), and positively predicted DASS‐21 Depression (β = .26), Anxiety (β = .34) and Stress scores (β = .39). Empathic Concern positively predicted Lie Scale scores (β = .21), and negatively predicted Psychoticism scores (β = –.24). Individuals with high scores in Empathic Concern were also found to score more highly on Fantasy, Personal Distress, Neuroticism, Stress and Anxiety. Thus, more empathic individuals are likely to experience elevations in negative affectivity when they perceive the emotional suffering of others.     

Proneness to hallucinations and delusions in a non‐clinical sample: Exploring associations with metacognition and negative affect

Commonly, individuals prone to hallucinations and delusions hold dysfunctional metacognitive beliefs and report higher levels of negative affect, yet, these associations have not been clearly investigated in non‐clinical samples due to the failure to control for high intercorrelations between variables. The aim of the current study was to investigate how hallucination and delusion proneness are associated with dysfunctional metacognitions and negative affect. A cross‐sectional sample of 715 students free from psychiatric diagnoses (M_age = 28.1 years, SD = 10.9, range 18–65) completed the Launay‐Slade Hallucination Scale (LSHS‐R); Peters et al. Delusion Inventory (PDI‐21); Depression, Anxiety, and Stress Scale (DASS‐21); and the Metacognition Questionnaire (MCQ‐30). Findings that participants who were prone to both hallucinations and delusions reported elevated levels of negative affect support the need for targeted mental health treatment for individuals who experience psychological distress related to their hallucinatory and delusional experiences. While metacognition beliefs of need to control thoughts and cognitive self‐consciousness, along with the anxiety and stress DASS‐21 subscales appeared as significant cross‐sectional predictors of proneness to hallucinations and delusions, only metacognitions demonstrated any notable predictive value for delusion proneness. This finding questions the role of metacognitions in determining hallucination and delusion proneness in non‐clinical samples.     

Percentile Norms and Accompanying Interval Estimates from an Australian General Adult Population Sample for Self‐Report Mood Scales (BAI,BDI, CRSD,CES‐D,DASS, DASS‐21, STAI‐X,STAI‐Y,SRDS, and SRAS)

Despite their widespread use, many self‐report mood scales have very limited normative data. To rectify this, Crawford et al. have recently provided percentile norms for a series of self‐report scales. The present study aimed to extend the work of Crawford et al. by providing percentile norms for additional mood scales based on samples drawn from the general Australian adult population. Participants completed a series of self‐report mood scales. The resultant normative data were incorporated into a computer programme that provides point and interval estimates of the percentile ranks corresponding to raw scores for each of the scales. The programme can be used to obtain point and interval estimates of the percentile ranks of an individual's raw scores on the Beck Anxiety Inventory, the Beck Depression Inventory, the Carroll Rating Scale for Depression, the Centre for Epidemiological Studies Rating Scale for Depression, the Depression, Anxiety, and Stress Scales (DASS), the short‐form version of the DASS (DASS‐21), the Self‐rating Scale for Anxiety, the Self‐rating Scale for Depression, the State–Trait Anxiety Inventory (STAI), form X, and the STAI, form Y, based on normative sample sizes ranging from 497 to 769. The interval estimates can be obtained using either classical or Bayesian methods as preferred. The programme (which can be downloaded at http://www.abdn.ac.uk/~psy086/dept/MoodScore_Aus.htm ) provides a convenient and reliable means of obtaining the percentile ranks of individuals' raw scores on self‐report mood scales.     

Depression Anxiety Stress Scales: Factor structure and differential item functioning across women and men

This study examined the factor structure, and differential item functioning of the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995) across sex. The DASS was completed by 201 women and 165 men from the general community. Confirmatory factor analysis (CFA) indicated support for the original 3-factor oblique model (factors for depression, anxiety and stress). There was however more support for a bifactor model, with four orthogonal factors: a general factor on which all the depression, anxiety and stress items load, and specific independent factors for depression, anxiety and stress items. None of the DASS items showed DIF. The practical, theoretical, research and clinical implications of the findings are discussed.     

Validation of a Chinese achievement goal orientation questionnaire

Background . The mixed findings of previous studies on the nature and effects of performance goals have led to a call for re‐examination of the dichotomous framework of achievement goal orientation theory. While the call for a revised achievement goal orientation theory has received considerable discussion in Western studies, it is not clear whether the revised theory can also be applied in other ethnic and cultural contexts. Aims . Our aim was to validate the Chinese version of Elliot and Church's (1007) Goal Orientation Questionnaire and to initially test the revised goal orientation theory in the context of Chinese students in Hong Kong. Sample . A total of 270 Chinese students (137 boys and 133 girls) from a primary and secondary school in Hong Kong participated in Study 1. Study 2 involved a total of 9,440 students (5,420 boys and 4,020 girls) from 10 primary and 18 secondary schools in Hong Kong. Method . Participants in Study 1 completed a Chinese Goal Orientation Questionnaire (CGOQ) measuring three types of goal orientation. Exploratory factor analysis, item–total correlation, and reliability analyses were undertaken to assess the psychometric quality of the CGOQ. In Study 2, confirmatory factor analysis was used to provide further validation for the revised questionnaire. The relationships among different goal orientations and that with students' perceived classroom environment and self‐efficacy were also explored using structural equation modelling. Results . Findings of exploratory factor analysis in Study 1 and confirmatory factor analysis in Study 2 supported the proposed factor structure of the CGOQ. All the subscales in the questionnaire also showed good internal consistency reliabilities. The construct validity of the CGOQ was supported by its significant relationship with criterion measures. While most of the relationships between the three types of goal orientation and the learning‐related variables measured in our study were consistent with the revised goal orientation theory, the positive relationships between performance‐avoidance goals, mastery goals, and perceived classroom environment were different from previous studies. Conclusion . Our findings generally supported the trichotomous framework of the revised goal orientation theory with Chinese students in Hong Kong. Consistent with the revised goal orientation theory, our findings indicated that both mastery and performance‐approach goals had positive impacts on students' learning. However, the positive relationships between performance‐avoidance goals, mastery goals, and perceived classroom environment were contradictory to the conceptualization of performance‐avoidance goals in the revised theory. Cultural and social factors affecting Hong Kong students' goal orientations are discussed.     

Depression Anxiety and Stress Scales (DASS-21): psychometric analysis across four racial groups

Growing cross-cultural awareness has led researchers to examine frequently used research instruments and assessment tools in racially diverse populations. The present study was conducted to assess the psychometric characteristics of the 21-item version of the Depression, Anxiety, and Stress Scales (DASS-21) among different racial groups. The DASS-21 was chosen because it appears to be a reliable and easy to administer measure, ideal for both clinical and research purposes. Results suggest that the internal consistency, and convergent and divergent validity of the DASS-21 are similar across racial groups. Multigroup CFA, however, indicated that item loadings were invariant, while scale covariances were not invariant. This suggests that, although the items may load similarly on the depression, anxiety and stress constructs, these constructs may be differentially inter-related across groups. Implications for application in clinical practice are discussed.     

The Psychometric Properties of an Internet-Administered Version of the Depression Anxiety and Stress Scales (DASS) in a Sample of Dutch Adults

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.     

Validation of the Depression Anxiety Stress Scale-21 (DASS-21) in a non-clinical sample of South African working adults

This study investigated the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) in a non-clinical sample of working people. Working South African persons (N = 269; females = 62%; mean age = 33, SD = 11.5) completed the DASS-21, as well as the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Results following Confirmatory Factor Analysis and correlational analysis yielded a three-factor structure (depression, anxiety, and stress) for the DASS-21. The evidence for discriminant and convergent validity was strong. Additionally, we found good reliabilities for the overall scale as well as the subscales. The DASS-21 appears a valid and reliable instrument for measuring depression, anxiety, and stress in the workplace. Future studies should investigate differential item functioning and equivalence of items among South African working populations.     

Psychometric properties and measurement invariance of Depression,Anxiety and Stress Scales (DASS-21) across cultures

Cross-culturally measurement invariant instruments are useful for the assessment of mental symptoms across cultures. The current study aimed to investigate the psychometric properties and measurement invariance of the Depression, Anxiety and Stress Scales (DASS-21) (DASS) across Pakistan and Germany. German participants were recruited through an online survey (N = 1323), while Pakistani participants were recruited through online survey or paper-and-pencil survey (N = 1841). The DASS-21 showed good reliability, construct and structure validity in both countries. The DASS-21 indicated partial weak (stress subscale) and partial strong measurement invariance (depression and anxiety subscales) between both countries. Latent mean comparison of depression and anxiety symptoms between Pakistani and German students indicated that Pakistani university students experience more symptoms of depression and anxiety. Results suggest that the DASS-21 could be used in Pakistan and Germany, but caution should be taken when making direct comparisons between the two countries.     

The life events scale for students: Validation for use with British samples

The life events scale for students is a checklist measure of life events intended for use with undergraduate populations. The report describes the validation of the scale for use with British undergraduates. Ratings for the events on the scale were obtained from a sample of 191 undergraduates. A second analysis using a sample of 40 undergraduates showed that scores on the scale were predictive of elevated levels of psychopathology. Furthermore, this relationship was largely independent of negative affectivity or repression-sensitization. The Life Events Scale for Students provides a suitable measure for use in stress research using undergraduate populations.     

Profiles of psychological well‐being in a sample of Australian university students

The present study identified psychological well‐being profiles in a sample of Australian university students (N = 207, Mean age = 30.16 years; SD = 11.90). Respondents completed two measures: Ryff's (1989) Psychological Well‐Being (PWB) scale and Lovibond and Lovibond's (2002) Depression, Anxiety and Stress Scales‐21 (DASS‐21) assessing their levels of PWB and depression. Latent profile analysis was applied to six indices of positive functioning derived from PWB scale: self‐acceptance, purpose in life, environmental mastery, positive relations with others, personal growth and autonomy. An optimal 5‐profile solution, reflecting significant incremental shifts from very low to very high PWB, was interpreted. As predicted, profile membership distinguished participants on depression. Importantly, profiles indicating moderate to very high PWB, particularly with the presence of above average autonomy, reported significantly lower levels of depression. Our results suggest prevention of, and treatment efficacy for, mental health problems may be improved by incorporating strategies that address positive functioning attributes, particularly associated with a sense of autonomy.     

Collectivism and coping: Current theories,evidence, and measurements of collective coping

A burgeoning body of cultural coping research has begun to identify the prevalence and the functional importance of collective coping behaviors among culturally diverse populations in North America and internationally. These emerging findings are highly significant as they evidence culture's impacts on the stress‐coping process via collectivistic values and orientation. They provide a critical counterpoint to the prevailing Western, individualistic stress and coping paradigm. However, current research and understanding about collective coping appear to be piecemeal and not well integrated. To address this issue, this review attempts to comprehensively survey, summarize, and evaluate existing research related to collective coping and its implications for coping research with culturally diverse populations from multiple domains. Specifically, this paper reviews relevant research and knowledge on collective coping in terms of: (a) operational definitions; (b) theories; (c) empirical evidence based on studies of specific cultural groups and broad cultural values/dimensions; (d) measurements; and (e) implications for future cultural coping research. Overall, collective coping behaviors are conceived as a product of the communal/relational norms and values of a cultural group across studies. They also encompass a wide array of stress responses ranging from value‐driven to interpersonally based to culturally conditioned emotional/cognitive to religion‐ and spirituality‐grounded coping strategies. In addition, this review highlights: (a) the relevance and the potential of cultural coping theories to guide future collective coping research; (b) growing evidence for the prominence of collective coping behaviors particularly among Asian nationals, Asian Americans/Canadians and African Americans/Canadians; (c) preference for collective coping behaviors as a function of collectivism and interdependent cultural value and orientation; and (d) six cultural coping scales. This study brings to light the present theoretical and methodological contributions as well as limitations of this body of literature and the implications it holds for future coping research.     

E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

The aim of this study was to assess the effects of a 7‐week standardized cognitive behavioural treatment of work‐related stress conducted via e‐mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow‐up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS‐42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI‐GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention‐to‐treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p?0.025). In the treatment group, the effects were large to moderate (0.9 (stress)?d?0.5 (anxiety)). The between‐group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow‐up, the effects were more pronounced, but this result requires replication in view of high attrition at follow‐up. The results warrant further research on Internet‐driven standardized cognitive behavioural therapy for work‐related stress. Such research should include the direct comparison of this treatment with face‐to‐face treatment, and should address the optimal level of therapist contact in Internet‐driven treatment.     

Examining the cross‐cultural validity of the positive affect and negative affect schedule between an Asian (Singaporean) sample and a Western (American) sample

The positive affect and negative affect schedule (PANAS) is a popular measure of positive (PA) and negative affectivity (NA). Developed and validated in Western contexts, the 20‐item scale has been frequently administered on respondents from Asian countries with the assumption of cross‐cultural measurement invariance. We examine this assumption via a rigorous multigroup confirmatory factor analysis, which allows us to assess between‐group differences in both strength of scale item‐to‐latent factor relationship (metric invariance test) and mean of each scale item (scalar invariance test), on a large sample of 1,065 respondents recruited from Singapore (Asian sample) and the United States (Western sample). We found that two items assessing PA (“excited” and “proud”) and three items assessing NA (“guilty,” “hostile,” and “ashamed”) exhibited metric noninvariance whereas 11 of the remaining metric invariant items exhibited scalar noninvariance, suggesting that the PA and NA constructs differ from what the PANAS is expected to measure for Asian respondents. Our findings serve as a cautionary note to researchers who intend to administer the PANAS in future studies as well as to researchers interpreting the results of past studies involving respondents from Asian countries.     

Stress and coping among student teachers at a South African university: An exploratory study

This article reports findings from an exploratory qualitative study on the lived experience of stress among a convenience sample of 14 South African university student teachers (female = 8, black = 7; age range = 22 to 31). The students were participating in training in mindfulness meditation, and completed three interviews over a six-week period on stressors impacting on their personal and professional lives and on how they experienced them and responded. There were additional data from recordings of the mindfulness training sessions and a self-report scale, the Depression, Anxiety and Stress Scale (DASS). Thematic analysis revealed a wide range of stressors experienced by the students and provided insight into sources of resilience in dealing with them. In conclusion, the authors consider whether the extreme experiences of stress foreshadow the discontent among South African students that would fuel the serious unrest and disruption that has been negatively affecting South African universities since.     

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

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.     

The development of a scale for tuned‐in parenting

This article provides preliminary evaluation for a new and easy to use parental sensitivity scale, which is rated from a short videotaped play session with the parental figure. The five Tuned‐In Parent Rating Scales (TIP‐RS) have been developed for use with identified dyadic problems in infant–parent relationships and provide a window on the micro‐behaviours that may contribute to the dyadic disjunctions. A sample of 88 mothers who contacted a community early parenting unit was filmed in interaction with their infants and completed surveys including the Depression Anxiety and Stress Scale (DASS) and the Edinburgh Postnatal Depression Scale (EPDS). Six trained coders rated the videos. Confirmatory factor analysis supported the unidimensionality of the TIP‐RS. The TIP‐RS total score was negatively correlated with both the EPDS (r[N = 42] = ?.34, p = .024) and the DASS (r[N = 42] = ?.43, p = .029), providing evidence for its concurrent validity. Inter‐rater reliability across the six raters for each of the TIP‐RS sub‐scales and total score ranged from .68 to .83. The present results warrant continued investigation of the psychometric properties of the TIP‐RS as a tool for intervention with targeted parent–child relationships.     

Biracial and monoracial infant own‐race face perception: an eye tracking study

We know that early experience plays a crucial role in the development of face processing, but we know little about how infants learn to distinguish faces from different races, especially for non‐Caucasian populations. Moreover, it is unknown whether differential processing of different race faces observed in typically studied monoracial infants extends to biracial infants as well. Thus, we investigated 3‐month‐old Caucasian, Asian and biracial (Caucasian‐Asian) infants’ ability to distinguish Caucasian and Asian faces. Infants completed two within‐subject, infant‐controlled habituation sequences and test trials as an eye tracker recorded looking times and scanning patterns. Examination of individual differences revealed significant positive correlations between own‐race novelty preference and scanning frequency between eye and mouth regions of own‐race habituation stimuli for Caucasian and Asian infants, suggesting that facility in own‐race face discrimination stems from active inspection of internal facial features in these groups. Biracial infants, however, showed the opposite effect: An ‘own‐race’ novelty preference was associated with reduced scanning between eye and mouth regions of ‘own‐race’ habituation stimuli, suggesting that biracial infants use a distinct approach to processing frequently encountered faces. Future directions for investigating face processing development in biracial populations are discussed. A video abstract of this article can be viewed at http://youtu.be/a_dDXfFuEfY