Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women
Open accessAbstract
BACKGROUND: Depression and anxiety are recognised increasingly as serious public health problems among women in low- and lower-middle income countries. The aim of this study was to validate the 21-item Depression Anxiety and Stress Scale (DASS21) for use in screening for these common mental disorders among rural women with young children in the North of Vietnam. METHODS: The DASS-21 was translated from English to Vietnamese, culturally verified, back-translated and administered to women who also completed, separately, a psychiatrist-administered Structured Clinical Interview for DSM IV Axis 1 diagnoses of depressive and anxiety disorders. The sample was a community-based representative cohort of adult women with young children living in Ha Nam Province in northern Viet Nam. Cronbach's alpha, Exploratory Factor Analyses (EFA) and Receiver Operating Characteristic (ROC) analyses were performed to identify the psychometric properties of the Depression, Anxiety, and Stress subscales and the overall scale. RESULTS: Complete data were available for 221 women. The internal consistency (Cronbach's alpha) of each sub-scale and the overall scale were high, ranging from 0.70 for the Stress subscale to 0.88 for the overall scale, but EFA indicated that the 21 items all loaded on one factor. Scores on each of the three sub-scales, and the combinations of two or three of them were able to detect the common mental disorders of depression and anxiety in women with a sensitivity of 79.1% and a specificity of 77.0% at the optimal cut off of >33. However, they did not distinguish between those experiencing only depression or only anxiety. CONCLUSIONS: The total score of the 21 items of the DASS21-Vietnamese validation appears to be comprehensible and sensitive to detecting common mental disorders in women with young children in primary health care in rural northern Vietnam and therefore might also be useful to screen for these conditions in other resource-constrained settings.
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DASS-21 was validated among Vietnamese population with good reliability.
“The scale was validated among Vietnamese population with a good reliability (Tran, Tran, & Fisher, 2013).”
From Reassessing the most popularly suggested measurement models and measurement invariance of the Maslach Burnout Inventory – human service survey among Vietnamese healthcare professionals (2022) · cites this paper as Tran, Tran, & Fisher, 2013
The Results (Internal reliability) report high internal consistency for the Vietnamese DASS-21 overall score (Cronbach’s alpha = 0.88), and the Conclusions describe the scale as psychometrically sound. But the Discussion limits generalisability to rural northern Vietnamese women with young children, not the Vietnamese population as a whole. (LLM, conf=0.88)
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Cites
Lovibond, P. F., & Lovibond, S. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00075-u · Cited by 14,523 · see citing works
Henry, J. D., & Crawford, J. R. (2005) · British Journal of Clinical Psychology · doi:10.1348/014466505x29657 · Cited by 5,801 · see citing works
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998) · Psychological Assessment · doi:10.1037/1040-3590.10.2.176 · Cited by 4,874 · see citing works
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
Clark, L. A., & Watson, D. (1991) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.100.3.316 · Cited by 4,601 · see citing works
Flagged first, then by citations
Research works printed but not linked: 13
- Goldberg D Huxley P Common Mental Disorders: A Biosocial Model 1992 London: Tavistock / Routledge
- Fisher J Mello MC Patel V Rahman A Tran T Holton S Holmes W Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review Bull World Health Organ 2012 90 2 139 149G 10.2471/BLT.11.091850 PMC3302553 22423165 · DOI · Paper page
- Ng F Trauer T Dodd S Callaly T Campbell S Berk M The validity of the 21‐item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure Acta Neuropsychiatrica 2007 19 5 304 310 10.1111/j.1601-5215.2007.00217.x 26952943 · DOI
- Brown TA Chorpita BF Korotitsch W Barlow DH Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples Behav Res Ther 1997 35 1 79 89 10.1016/S0005-7967(96)00068-X 9009048 · DOI · Paper page
- Chan RC Xu T Huang J Wang Y Zhao Q Shum DH O’Gorman J Potangaroa R Extending the utility of the Depression Anxiety Stress scale by examining its psychometric properties in Chinese settings Psychiatry Res 2012 in press 22921506
- Musa R Fadzil MA ZZ Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS) ASEAN Journal of Psychiatry 2007 82 2 82 89
- Severino GA Haynes WDG Development of an Italian version of the Depression Anxiety Stress Scales Psychol Health Med 2010 15 5 607 621 10.1080/13548506.2010.498889 20835970 · DOI
- Tran TD Tran T La B Lee D Rosenthal D Fisher J Screening for perinatal common mental disorders in women in the north of Vietnam: a comparison of three psychometric instruments J Affect Disord 2011 133 1–2 281 293 21529963
- Fisher J Tran T La BT Kriitmaa K Rosenthal D Tuan T Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use Bull World Health Organ 2010 88 10 737 745 10.2471/BLT.09.067066 20931058 PMC2947037 · DOI
- Maruyama G Basics of structural equation modeling 1997 Thousand Oaks, Calif: Sage Publications
- Kline P An easy guide to factor analysis 2002 London: Routledge
- Warner J Clinicians’ guide to evaluating diagnostic and screening tests in psychiatry Adv Psychiatr Treat 2004 10 446 454 10.1192/apt.10.6.446 · DOI
- Tran TD Tran T Fisher J Validation of three psychometric instruments for screening for perinatal common mental disorders in men in the north of Vietnam J Affect Disord 2012 136 104 109 10.1016/j.jad.2011.08.012 21907417 · DOI
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Wang, K., Shi, H.-S., Geng, F.-L., Zou, L.-Q., Tan, S.-P., Wang, Y., Neumann, D. L., Shum, D. H. K., & Chan, R. C. K. (2016) · Psychological Assessment · doi:10.1037/pas0000207 · Cited by 635 · see citing works
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Foster, K., Shochet, I., Wurfl, A., Roche, M., Maybery, D., Shakespeare‐Finch, J., & Furness, T. (2018) · International Journal of Mental Health Nursing · doi:10.1111/inm.12447 · Cited by 68 · see citing works
Grasso, D. J., Drury, S., Briggs-Gowan, M., Johnson, A., Ford, J., Lapidus, G., Scranton, V., Abreu, C., & Covault, J. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104604 · Cited by 65 · see citing works
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- Authors
- Tran, T. D., Tran, T., & Fisher, J.
- Affiliations
- Jean Hailes (AU)
- Corresponding author
- Tran, Thach Duc
- Venue
- BMC Psychiatry
- Published
- 2013-01-12
- Volume
- 13
- Issue
- 1
- Pages
- 24-24
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3566910
- OpenAlex
- W2139314688
- Cited by
- 476
- References
- 4
- Citations by year
- 2026: 45 · 2025: 35 · 2024: 60 · 2023: 59 · 2022: 63 · 2021: 74 · 2020: 49 · 2019: 32 · 2018: 18 · 2017: 18 · 2016: 10 · 2015: 9 · 2014: 3 · 2013: 1
- FWCI
- 9.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Myer Foundation
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- DASS-21, depression screening, anxiety screening, common mental disorders, rural women, women with young children, Vietnamese translation, psychometric validation, primary care, northern Vietnam, low- and middle-income countries
- MeSH terms
- Adult, Anxiety Disorders, Depression, Factor Analysis, Statistical, Female, Humans, Mass Screening, Psychiatric Status Rating Scales, Rural Population, Sensitivity and Specificity, Vietnam, Reproducibility of Results, Young Adult
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