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Psychometric properties of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) among Malaysians during COVID-19: a methodological study

Author

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  • Arulmani Thiyagarajan

    (Leibniz Institute for Prevention Research and Epidemiology—BIPS)

  • Tyler G. James

    (University of Michigan)

  • Roy Rillera Marzo

    (Management and Science University
    Asia Metropolitan University
    Monash University)

Abstract

Depression, anxiety, and stress continue to be among the largest burdens of disease, globally. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) is a shortened version of DASS-41 developed to measure these mental health conditions. The DASS-41 has strong evidence of validity and reliability in multiple contexts. However, the DASS-21, and the resulting item properties, has been explored less in terms of modern test theories. One such theory is Item Response Theory (IRT), and we use IRT models to explore latent item and person traits of each DASS-21 sub-scale among people living in Malaysia. Specifically, we aimed to assess Classical Test Theory and IRT properties including dimensionality, internal consistency (reliability), and item-level properties. We conducted a web-based cross-sectional study and sent link-based questionnaires to people aged 18 and above in a private university and requested to roll out the link. Overall and individual sub-scales’ Cronbach’s alpha of the DASS-21 indicates an excellent internal consistency. The average inter-item correlation and corrected inter-item correlations for each of the sub-scales indicated acceptable discrimination. On average, DASS-21 total scores and sub-scale scores were significantly higher among female participants than males. The Graded Response Model had better empirical fit to sub-scale response data. Raw summated and latent (IRT estimated) scores of the Depression, Anxiety, and Stress sub-scales, and overall DASS-21 were strongly correlated. Thus, this study provides evidence of validity supporting the use of the DASS-21 as a mental health screening tool among Malaysians. Specifically, standard error of measurement was minimized to provide robust evidence of potential utility in identifying participants who are and are not experiencing these mental health issues. Additional research is warranted to ensure that test content culturally appropriate and accurately measuring cultural norms of depression, anxiety, and stress.

Suggested Citation

  • Arulmani Thiyagarajan & Tyler G. James & Roy Rillera Marzo, 2022. "Psychometric properties of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) among Malaysians during COVID-19: a methodological study," Palgrave Communications, Palgrave Macmillan, vol. 9(1), pages 1-8, December.
    • Handle: RePEc:pal:palcom:v:9:y:2022:i:1:d:10.1057_s41599-022-01229-x
    DOI: 10.1057/s41599-022-01229-x
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    1. Li Ping Wong & Haridah Alias & Afiqah Alyaa Md Fuzi & Intan Sofia Omar & Azmawaty Mohamad Nor & Maw Pin Tan & Diana Lea Baranovich & Che Zarrina Saari & Sareena Hanim Hamzah & Ku Wing Cheong & Chiew H, 2021. "Escalating progression of mental health disorders during the COVID-19 pandemic: Evidence from a nationwide survey," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-14, March.
    2. Rizopoulos, Dimitris, 2006. "ltm: An R Package for Latent Variable Modeling and Item Response Analysis," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 17(i05).
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