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Cited by 165Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingPsychotherapy Techniques and Applications

Assessing clinical significance of treatment outcomes using the DASS-21.

Ronk, Fiona R., Korman, James R., Hooke, Geoffrey R., Page, Andrew C.·2013·Psychological Assessment
DOI 10.1037/a0033100
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Abstract

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

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  • The proportion of individuals experiencing symptom deterioration during face-to-face psychological interventions is estimated to range between 3-14%, comparable to deterioration rates for online interventions.

    “Although deterioration rates are infrequently reported in the literature, the proportion of individuals experiencing symptom deterioration during face-to-face psychological interventions is estimated to range between 3-14% (Ebert et al., 2016; Cujipers et al., 2018; Ronk et al., 2013), which is comparable to deterioration rates for online interventions (Ebert et al., 2016).”

    From A randomised trial comparing a brief online delivery of mindfulness-plus-values versus values only for symptoms of depression: Does baseline severity matter? (2020) · cites this paper as Ronk et al., 2013

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Authors
Ronk, F. R., Korman, J. R., Hooke, G. R., & Page, A. C.
Affiliations
  • The University of Western Australia (AU)
  • Summit Medical Group (United States) (US)
ORCID
Venue
Psychological Assessment
Publisher
American Psychological Association (APA)
Published
2013-12
Volume
25
Issue
4
Pages
1103-1110
ISSN
  • 1040-3590 (ISSN-L)
  • 1939-134X
DOI
10.1037/a0033100
OpenAlex
W2029173731
Cited by
165
References
22
Citations by year
2026: 17 · 2025: 27 · 2024: 15 · 2023: 16 · 2022: 16 · 2021: 13 · 2020: 12 · 2019: 9 · 2018: 9 · 2017: 13 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 2
FWCI
8.11
Type
journal article
Language
en
Open access
closed
Locations
  • Psychological Assessment (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
clinical significance, DASS-21, DASS, reliable change index, treatment outcome assessment, depression, anxiety, stress, quality of life
MeSH terms
Adjustment Disorders, Adolescent, Adult, Aged, Ambulatory Care, Anxiety Disorders, Behavior Therapy, Mental Disorders, Cross-Cultural Comparison, Depressive Disorder, Female, Hospitalization, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Personality Disorders, Personality Inventory, Psychometrics, Psychotherapy, Group, Psychotic Disorders, Quality of Life, Reference Values, United States, Western Australia, Reproducibility of Results, Cognitive Behavioral Therapy, Mood Disorders, Substance-Related Disorders, Young Adult

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