Psychological adaptation to ICDs and the influence of anxiety sensitivity

Forty-nine patients scheduled for implantable cardioverter defibrillator (ICD) implantation completed self-report psychological questionnaires prior to surgery and at 2, 4 and 6 months after surgery. The most common psychological problem identified was anxiety, with clinically significant cases based on the Depression Anxiety and Stress Scale (DASS) ranging between 26% and 34%. Clinically significant depression ranged between 8% and 20%. Anxiety sensitivity was associated with high levels of anxiety, depression and stress at baseline, but not at follow-up assessments. It is possible that within this population anxiety sensitivity is associated with distress during high-threat situations, but the relationship diminishes once the threat has passed. In addition, the reassurance provided by the ICD may reduce negative perceptions of symptoms, promoting psychological adaptation.     

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.     

Measuring the executive regulation of emotion with self-rating scales in a nonclinical population

Prefrontal systems play an important role in the regulation of emotion as evidenced by clinical neuroimaging studies. Both subjective and objective neuropsychological tests provide functional evidence of executive dysfunction in emotional deregulation. The present authors evaluated these relationships here in a nonclinical community sample using the Frontal Systems Behavior Scale, Profile of Mood States (POMS), and Depression Anxiety Stress Scales (DASS). Positive correlations uniformly emerged between prefrontal system dysfunction and negative emotional states (anger, depression, anxiety, stress, confusion, and fatigue), whereas positive emotion (vigor) showed a modest inverse correlation with prefrontal system dysfunction, even after control for demographic influences. These relationships may result from cognitive strategies for managing emotion mediated by reciprocal connections between prefrontal systems and the limbic system. The findings corroborated those of other methodologies, supporting the Frontal Systems Behavior Scale (FrSBe) as a valid tool to measure prefrontal function in nonclinical populations.     

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.     

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.     

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.     

'Minor GAD': characteristics of subsyndromal GAD in older adults

Subsyndromal emotional symptoms are common in older adults and are associated with increased disability, health care utilization, and risk for developing psychiatric disorders. The purpose of this study was to examine subsyndromal generalized anxiety disorder (GAD) in older adults. Participants included 30 older adults with diagnosable GAD, 19 with subsyndromal anxiety symptoms [minor GAD; (MGAD)], and 21 normal control volunteers (NC). Participants were assessed using the Anxiety Disorders Interview Schedule for DSM-IV and completed self-report measures of anxiety, worry, depression, and life satisfaction. Excessive worry on more days than not, difficulty controlling worry, and clinically significant distress or impairment were the diagnostic criteria endorsed by MGAD participants least often. Therefore, these criteria may be useful in distinguishing between GAD and subsyndromal GAD. Self-reported anxiety and worry also systematically differed across groups in the expected directions, with a discriminant analysis yielding good classification of the GAD and NC groups based on these measures. Categorization of MGAD participants generally was poor, with most misclassified as GAD patients. Clinical implications of these findings are discussed.     

Preliminary tests of a cognitive model of generalized anxiety disorder.

Although worry is the central feature of Generalised Anxiety Disorder (GAD), little is known about the factors that contribute to pathological or problematic worry. In a recent cognitive model of GAD, Wells, A. (1995) proposed that negative appraisal of worrying itself (meta-worry or type 2 worry) should be distinguished from other types of worrying (type 1 worry). A central feature of this model is the idea that individuals with GAD hold rigid positive beliefs about the usefulness of worrying as a coping strategy. However, these individuals also hold negative beliefs and appraise worrying as uncontrollable and dangerous. This combination of cognitions and associated responses leads to an increased frequency and generality of worrying, and thus to the pathological worry characteristic of GAD. This paper reports a preliminary test of the hypothesis that meta-worry contributes to problematic and pathological worrying, and this relationship is independent of the frequency of other types of worry. In testing for associations between worry dimensions we controlled for overlaps with Trait anxiety, and the controllability of worrying. Results of a series of regression analyses support the hypothesis that pathological worry is associated with meta-worry and this association is independent of Trait-anxiety and type 1 worry. The clinical implications of these data are briefly discussed.     

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.     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。     

Stress associated changes in Pavlovian-instrumental transfer in humans

Predictive learning is known to influence instrumental responding for reward. Cues associated with an instrumental outcome can influence performance in two ways: (a) by selectively promoting actions associated with the outcome predicted by the cue (specific transfer), and (b) by increasing motivation and the vigour of instrumental responding (general transfer). To examine these two distinct processes in humans we developed a novel behavioural task in which participants were able to liberate junk-food snacks from a virtual vending machine. Additionally, the relationship between stress and cue-driven reward seeking was examined using participant scores on the Depression Anxiety and Stress Scale (DASS). Reward-paired cues were found to separately bias action selection and influence the rate of responding for rewards. Furthermore, the effects of reward-paired cues on the rate of responding for reward was influenced by increased stress and anxiety. Increased levels of stress and anxiety were associated particularly with changes in cue-driven response vigour; whereas high levels of stress and anxiety were associated with elevated responding above baseline in the presence of a cue associated with a non-rewarding outcome, participants with low levels of anxiety and stress showed appropriate suppression of responding during this cue. These differences in performance between high and low anxiety and stress participants provides initial evidence that, as has been demonstrated in rodents, stress affects the influence of cue-driven response vigour in humans.     

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.     

Negative Recurrent Thinking as a Moderator of the Relationship Between Perceived Stress and Depressive Symptoms

Both perceived stress and negative recurrent thinking (rumination and worry) have been associated with depressive symptoms. However, no research to date has investigated the association between perceived stress and negative recurrent thinking. In the present study we aimed to explore whether perceived stress and negative recurrent thinking are associated and whether negative recurrent thinking moderates the relationship between perceived stress and depressive symptoms. A convenience sample of 273 undergraduate students completed the Perceived Stress Scale, the Ruminative Responses Scale-10, the Penn State Worry Questionnaire and the Hospital Anxiety and Depression Scale 2 weeks prior to sitting mid-year examinations. Correlation analyses showed that perceived stress, rumination and worry were positively and significantly associated with depressive symptoms and that perceived stress was positively and significantly associated with rumination and worry. A moderation analysis confirmed that negative recurrent thinking moderated the relationship between perceived stress and depressive symptoms. The implications of these findings are discussed.     

Verbal ability, social stress, and anxiety in children with autistic disorder

The aims of this study were to evaluate the physiological stress and anxiety responses in children with autism following completion of a standardized, social-evaluative stressor (Trier Social Stress Test-Child version), document the relationship between verbal ability, stress, and anxiety, and determine the association between stress and anxiety in children with autism and typical development. Results demonstrated the Trier Social Stress Test-Child version to be a benign stressor for children with autism. Lower verbal ability in children with autism did not predict salivary cortisol or anxiety responses. There was a lack of association between stress and anxiety for both groups, highlighting the importance of considering these terms as separate constructs. Clinical implications and the limited utility of the Trier Social Stress Test-Child version in evaluating psychosocial stress in autism 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.     

The Implicit Relational Assessment Procedure as a Measure of Implicit Depression and the Role of Psychological Flexibility

A broad implicit measure of depressive emotional reactions was created by mapping the content of the depression scale from the Depression Anxiety and Stress Scale (DASS) on to the Implicit Relational Assessment Procedure (IRAP). Participants were asked to relate pairings of antecedents and emotional reactions that followed the formula “When X happens . . . I feel Y.” Groups of participants representing the low and high extremes of normative levels of depressive symptoms completed an IRAP before and after a sad mood–induction procedure. At baseline both groups produced a positive emotional response bias on the IRAP. After the sad mood induction, the “normal” group showed no change, whereas the “mild/moderate” depression group showed a significant decrease in the positivity of their emotional responses. A similar pattern of differential change was found when groups were created using scores on the AAQ-II. The findings are related to the broader literature on cognitive reactivity and implications for future research are considered.     

Treating chronic worry: Psychological and physiological effects of a training programme based on mindfulness

The present study examines psychological and physiological indices of emotional regulation in non-clinical high worriers after a mindfulness-based training programme aimed at reducing worry. Thirty-six female university students with high Penn State Worry Questionnaire scores were split into two equal intervention groups: (a) mindfulness, and (b) progressive muscle relaxation plus self-instruction to postpone worrying to a specific time of the day. Assessment included clinical questionnaires, daily self-report of number/duration of worry episodes and indices of emotional meta-cognition. A set of somatic and autonomic measures was recorded (a) during resting, mindfulness/relaxation and worrying periods, and (b) during cued and non-cued affective modulation of defence reactions (cardiac defence and eye-blink startle). Both groups showed equal post-treatment improvement in the clinical and daily self-report measures. However, mindfulness participants reported better emotional meta-cognition (emotional comprehension) and showed improved indices of somatic and autonomic regulation (reduced breathing pattern and increased vagal reactivity during evocation of cardiac defense). These findings suggest that mindfulness reduces chronic worry by promoting emotional and physiological regulatory mechanisms contrary to those maintaining chronic worry.     

An examination of worry in relation to anxious responding to voluntary hyperventilation among adolescents

This study examined the association between worry and fearful responding to a 3-min voluntary hyperventilation procedure. Participants were 160 adolescents (71 females) between the ages of 12 and 17 years (M=14.92 years). After accounting for the significant effects of state anxiety and anxiety sensitivity, results indicated that pre-challenge levels of worry indexed by the Penn State Worry Questionnaire-Child Version predicted post-challenge anxiety and intensity of panic symptoms. Results are discussed in terms of the role of worry in relation to panic-relevant emotional vulnerability among youth.     

Reliability and preliminary evidence of validity of a Farsi version of the depression anxiety stress scales

The internal consistency, test-retest reliability, and construct validity of the Farsi version of the Depression Anxiety Stress Scales were examined, with a sample of 306 undergraduate students (123 men, 183 women) ranging from 18 to 51 years of age (M age = 25.4, SD = 6.1). Participants completed the Satisfaction with Life Scale, Rosenberg Self-esteem Scale, and the Depression Anxiety Stress Scales. The findings confirmed the preliminary reliabilities and preliminary construct validity of the Farsi translation of the Depression Anxiety Stress Scales.