Psychometric Evaluation and Normative Data for the Depression,Anxiety,and Stress Scales-21 (DASS-21) in a Nonclinical Sample of U.S. Adults

Abstract

Health care professionals are coming under increased pressure to empirically monitor patient outcomes across settings as a means of improving clinical practice. Within the psychiatric and primary care communities, many have begun utilizing brief psychometric measures of psychological functioning to accomplish these goals. The purpose of this study was to evaluate the psychometric properties and clinical utility of the Depression, Anxiety, and Stress Scales—21-item version (DASS-21), and contribute normative data to facilitate interpretation using a sample of U.S. adults (N = 503). Item-scale convergence was generally supported, although assumptions of item-scale divergence were not met. Only 86%, 50%, and 43% of Depression, Anxiety, and Stress items, respectively, correlated significantly greater with their hypothesized scales than other scales. Internal consistency reliability was acceptable for all scales and comparable to existing research (αs = .91, .80, and .84 for Depression, Anxiety, and Stress, respectively). Scale-level correlations were greater than what has been reported elsewhere (range of rs = .68 to .73), and principal components analysis supported the extraction of only one component accounting for 47% of the item-level variance. However, confirmatory factor analysis (CFA) favored a three-factor structure when compared to a one-factor model. The implications for the health care professions are discussed.

Keywords

depression anxiety stress DASS-21 psychometric

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders-TR (4th ed.). Washington, DC: Author.

Antony

M. M.

Bieling

P. J.

Cox

B. J.

Enns

M. W.

Swinson

R. P.

(1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.

Blais

M. A.

Frank

R. G.

Nierenberg

A. A.

Rauch

S. L.

(2009). Measuring outcomes makes good sense. Psychiatric Services, 60, 112.

Brown

Cudeck

(1993). Alternative ways of assessing model fit. In Long

K. A.

(Ed.), Testing structural equation modeling. Thousand Oaks, CA: Sage.

Brown

T. A.

Chorpita

B. F.

Korotitsch

Barlow

D. H.

(1997). Psychometric properties of the depression anxiety stress scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79–89.

Campbell

D. T.

Fiske

D. W.

(1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56, 81–105.

Cattell

R. B.

(1966). Handbook of multivariate experimental psychology. Chicago, IL: Rand McNally.

Clara

I. P.

Cox

B. J.

Enns

M. W.

(2001). Confirmatory factor analysis of the depression-anxiety-stress scales in depressed and anxious patients. Journal of Psychopathology and Behavioral Assessment, 23, 61–67.

Crawford

J. R.

Henry

J. D.

(2003). The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111–131.

10.

Cronbach

L. J.

(1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.

11.

Daza

Novy

D. M.

Stanley

M. A.

Averill

(2002). The depression anxiety stress scale-21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology and Behavioral Assessment, 24, 195–205.

12.

Fliege

Becker

Walter

O. B.

Bjorner

J. B.

Klapp

B. F.

Rose

(2005). Development of a computer adaptive test for depression (D-CAT). Quality of Life Research, 14, 2277–2291.

13.

Henry

J. D.

Crawford

J. R.

(2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.

14.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

15.

Liptzin

(2009). Quality improvement, pay for performance, and “outcomes measurement”: What makes sense? Psychiatric Services, 60, 108–111.

16.

Lovibond

P. F.

(1998). Long-term stability of depression, anxiety, and stress syndromes. Journal of Abnormal Psychology, 3, 520–526.

17.

Lovibond

S. H.

Lovibond

P. F.

(1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behavioural Research and Therapy, 33, 335–343.

18.

MacCallum

R. C.

Browne

M. W.

Sugawara

H. M.

(1996). Power analysis and determination of sample size for covariance structural modeling. Psychological Methods, 1, 130–149.

19.

Muthen

B. O.

Muthen

(1998). Mplus user’s guide. Los Angeles, CA: Author.

20.

Nunnally

J. C.

Bernstein

I. H.

(1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill.

21.

Posternak

M. A.

Zimmerman

Soloman

(2002). Integrating outcomes research into clinical practice. Psychiatric Services, 53, 335–336.

22.

Rivers

(2006). Sample matching: Representative sampling from internet panels. Palo Alto, CA: Polimetrix.

23.

Rosenberg

(1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

24.

Sanderson

W. C.

Di Nardo

P. A.

Rapee

R. M.

Barlow

D. H.

(1990). Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. Journal of Abnormal Psychology, 99, 308–312.

25.

Sinclair

S. J.

Blais

M. A.

Gansler

D. A.

Sandberg

Bistis

LoCicero

(2010). Psychometric properties of the Rosenberg self esteem scale: Overall and across demographic groups living within the United States. Evaluation & the Health Professions, 33, 56–80.

26.

Tucker

Lewis

(1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrica, 38, 1–10.

27.

Ware

J. E.

Harris

W. J.

Gandek

B. L.

Rogers

B. W.

Reese

P. R.

(1997). MAP-R Multitrait/multi-item analysis program – revised. Boston, MA: The Health Assessment Lab.