Assessing emotional status following acquired brain injury: The clinical potential of the depression, anxiety and stress scales
Abstract
PRIMARY OBJECTIVE: To investigate the clinical potential of the Depression, Anxiety and Stress Scales (DASS 42) and its shorter version (DASS 21) for assessing emotional status following acquired brain injury. METHODS AND PROCEDURES: Participants included 23 individuals with traumatic brain injury (TBI), 25 individuals with brain tumour and 29 non-clinical controls. Investigations of internal consistency, test-re-test reliability, theory-consistent differences, sensitivity to change and concurrent validity were conducted. MAIN OUTCOMES AND RESULTS: Internal consistency of the DASS was generally acceptable (r > 0.70), with the exception of the anxiety scale for the TBI sample. Test-re-test reliability (1-3 weeks) was sound for the depression scale (r > 0.75) and significant but comparatively lower for other scales (r = 0.60-0.73, p < 0.01). Theory-consistent differences were only evident between the brain tumour sample and non-clinical control sample on the anxiety scale (p < 0.01). Sensitivity to change of the DASS in the context of hospital discharge was demonstrated for depression and stress (p < 0.01), but not for anxiety (p > 0.05). Concurrent validity with the Hospital Anxiety and Depression Scale was significant for all scales of the DASS (p < 0.05). CONCLUSIONS: While the results generally support the clinical application of the DASS following ABI, further research examining the factor structure of existing and modified versions of the DASS is recommended.
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The DASS-21 has good psychometric properties (Cronbach's alpha=0.73-0.81) and is a valid measure of depression, anxiety and stress symptoms in people with ABI.
“The DASS-21 has good psychometric properties (Cronbach’s alpha=0.73–0.8163) and is a valid measure of depression, anxiety and stress symptoms in people with ABI.64”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [64]
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“The DASS has well-established psychometric properties (Lovibond & Lovibond, 1995) and has been validated for a TBI population (Ownsworth et al., 2008).”
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Horton, L., Duffy, T., & Martin, C. R. (2015) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2015.1050997 · Cited by 8 · see citing works
Faulkner, J., Prouty, D., Devlin, L., Appleton, D., Roche, M., Below, K., Moffat, J., Snell, D., Williams, M. N., Barker-Collo, S., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-089727 · Cited by 7 · see citing works
Faulkner, J. W., Snell, D. L., Theadom, A., de Terte, I., & Low, R. S. T. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2227401 · Cited by 6 · see citing works
“The DASS-21 has good psychometric properties (Cronbach’s alpha = 0.73–0.81; Lovibond & Lovibond, 1995) and is a valid measure of depression, anxiety and stress symptoms in people with ABI (Ownsworth et al., 2008).”
MethodInfluentialCocks, E., Bulsara, C., O’Callaghan, A., Netto, J., & Boaden, R. (2014) · Brain Injury · doi:10.3109/02699052.2014.880799 · Cited by 6 · see citing works
An integration of third wave cognitive behavioural interventions following stroke: a case study
Shields, C., & Ownsworth, T. (2013) · Griffith Research Online · Cited by 6 · see citing works
Self-citationAn Empirical Examination of the Relationship Between Emotion Regulation and Emotional Labor
Joffe, A. D., Kangas, M., & Peters, L. (2024) · The Journal of Psychology · doi:10.1080/00223980.2024.2383937 · Cited by 5 · see citing works
“The DASS-21 has shown good-to-excellent internal consistency (Crawford et al., 2011; Henry & Crawford, 2005) and adequate test-retest reliability (Ownsworth et al., 2008).”
Zaman, S., Arouj, K., & Irfan, S. (2020) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2020.105981 · Cited by 5 · see citing works
Psychological flexibility in mild traumatic brain injury: an evaluation of measures
Faulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., Barker-Collo, S., & Skirrow, P. (2021) · Brain Injury · doi:10.1080/02699052.2021.1959062 · Cited by 4 · see citing works
Harris, G., Jones, S., Pinkham, M. B., Lion, K., & Ownsworth, T. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2191015 · Cited by 4 · see citing works
“For example, fatigue, sleep disturbance, concentration, and memory difficulties can be symptoms associated with depression, brain tumour, and treatment [14,15].”
BackgroundMethodInfluentialSelf-citationValued living after mild traumatic brain injury: Characteristics and relationship with outcomes
Faulkner, J. W., Whiting, D. L., Theadom, A., Snell, D. L., Roche, M., & Barker-Collo, S. L. (2024) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2024.2328876 · Cited by 3 · see citing works
“Recently, Miller et al. (2022) recommended an adapted version of the VLQ based on their findings that individuals with ABI demonstrated poor understanding of instructions, key terms, and concepts within this measure.”
InfluentialNicol, C., Pinkham, M. B., Foote, M. C., McBean, A., Conlon, E. G., & Ownsworth, T. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2401631 · Cited by 3 · see citing works
“The DASS-depression scale has been found to be a reliable and valid measure for persons with brain tumor, with excellent internal consistency ( α = 0.90), and adequate temporal stability ( r = 0.78, SD = 6.7) and evidence of convergent validity and sensitivity to change [50,51].”
InfluentialSelf-citationExperiences of Acquired Brain Injury as Expressed Through Mask-Making: A Qualitative Analysis
Gregory, S. K., & Kemp, A. M. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-23-00381 · Cited by 2 · see citing works
(2016) · Research Online (University of Wollongong) · Cited by 2 · see citing works
Foo, M., Himawan, K. K., & Susanto, E. (2025) · Mental Health Review Journal · doi:10.1108/mhrj-01-2024-0003
Snell, D. L., Faulkner, J. W., & Siegert, R. J. (2025) · Brain Impairment · doi:10.1071/ib25025 · Cited by 1 · see citing works
Kuppelin, M., Bemmouna, D., Weiner, L., Goetsch, T., & Krasny‐Pacini, A. (2026) · Neurorehabilitation · doi:10.1177/10538135251407687 · Cited by 1 · see citing works
“Acquired brain injury (ABI) leads to a range of physical, cognitive, behavioral and emotional consequences impacting the daily lives of those who suffer from it (Arundine et al., 2012; Ownsworth et al., 2008).”
InfluentialNorwood, M. F., Bennett, J. W., Marsh, C. H., Jones, S., Gan, L., Hollins, I., Lakhani, A., McAnirlin, O., Browning, M. H. E. M., & Gustafsson, L. A. (2025) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2025.102634 · Cited by 1 · see citing works
Snell, D. L., Mikolić, A., Faulkner, J. W., Theadom, A., & Silverberg, N. D. (2025) · Brain Injury · doi:10.1080/02699052.2025.2565640 · Cited by 1 · see citing works
“The DASS-21 has good psychometric properties and is a valid measure of depression, anxiety, and stress symptoms in people with brain injury (20).”
BUFFERING CAPACITY OF SALIVA, SALIVARY FLOW RATES AND CORTISOL LEVELS IN PATIENTS WITH ACTIVE CARIES
Hira, P. G. (2013) · University of the Witwatersrand, Johannesburg Institutional Repository on DSpace (University of the Witwatersrand, Johannesburg) · Cited by 1 · see citing works
Augmented and virtual reality mirror therapy system for hand rehabilitation in stroke patients
Spahn, A. A., Martínez, C. E., & Albornoz, E. M. (2022) · IEEE International Symposium on Computational Intelligence and Informatics (CINTI) · doi:10.1109/cinti-macro57952.2022.10029460
“When these conditions continue or increase over time, they produce problems in interpersonal relationships and social adaptation, causing a vicious circle of isolation, depression and anxiety [2, 3].”
BackgroundPretty, D., Norwood, M. F., Ownsworth, T., Dungey, K., Jones, S. A., Gomes, Z., Clanchy, K., & Kendall, E. A. (2025) · JMIR Research Protocols · doi:10.2196/69452
“The test-retest reliability (taken between 1 week and 3 weeks apart) of the depression, anxiety, and stress subscales in a brain tumor sample was 0.77, 0.65, and 0.60, respectively [59].”
InfluentialSelf-citationSnell, D. L., Faulkner, J. W., Williman, J. A., Silverberg, N. D., Theadom, A., Surgenor, L. J., & Siegert, R. J. (2025) · Brain Impairment · doi:10.1071/ib24074
The Brain Integration Programme
Ahmadi, N. (2013) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-62396-291-320251016
Riley, G. A., Gajewska, U., Hagger, B. F., Raj, A. J., Yasmin, N., & Yeates, G. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-026-01854-2
“: M = 9 ( N = 1771) ABI carers [47]: M = 19 ( N = 366) People with ABI [48]: Questionnaires completed only by partner with ABI have occurred in the person with the brain injury, and, if they have occurred, how much distress they cause to the family member.”
Lee, M.-S., Yang, T.-F., Shoemark, H., & Magee, W. L. (2026) · Journal of Music Therapy · doi:10.1093/jmt/thag010
- Authors
- Ownsworth, T., Little, T., Turner, B., Hawkes, A., & Shum, D.
- Affiliations
- Griffith University (AU)
- The University of Queensland (AU)
- Cancer Council Queensland (AU)
- Corresponding author
- Ownsworth, Tamara
- Venue
- Brain Injury
- Publisher
- Informa UK Limited
- Published
- 2008-01
- Volume
- 22
- Issue
- 11
- Pages
- 858-869
- ISSN
- 0269-9052 (ISSN-L)
- 1362-301X
- OpenAlex
- W2040325952
- Cited by
- 78
- References
- 49
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 6 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 6 · 2014: 6 · 2013: 7 · 2012: 8
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Brain Injury (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- acquired brain injury, traumatic brain injury, brain tumors, depression, anxiety, stress, DASS-42, DASS-21, psychometric properties, sensitivity to change, concurrent validity, Hospital Anxiety and Depression Scale
- MeSH terms
- Adult, Aged, Anxiety Disorders, Brain Injuries, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Stress, Psychological, Reproducibility of Results
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