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Cited by 122Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingMental Health Research Topics

The depression anxiety stress scale 8-items expresses robust psychometric properties as an ideal shorter version of the depression anxiety stress scale 21 among healthy respondents from three continents

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Ali, Amira Mohammed, Hori, Hiroaki, Kim, Yoshiharu, Kunugi, Hiroshi·2022·Frontiers in Psychology
DOI 10.3389/fpsyg.2022.799769PMC PMC9044488
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Abstract

To examine the cultural limitations and implications in the applicability of the Depression Anxiety Stress Scale 8-items (DASS-8)—a shortened version of the DASS-21 recently introduced in an Arab sample—this study evaluated its psychometric properties, including measurement invariance, among healthy subjects from the United States, Australia, and Ghana. Confirmatory factor analysis revealed good fit of the DASS-8 relative to a 12-item version (DASS-12). Both the DASS-8 and the DASS-12 were invariant at all levels across genders, employment status, and students vs. non-students. The DASS-8/DASS-12 also expressed invariance at the configural and metric levels across all countries, albeit scalar invariance was not maintained due to misspecification of the factor loadings in the Ghanian sample. Mann–Whitney U test revealed significantly lower levels of mental symptomatology on the DASS measures among Ghanian students than in English-speaking respondents (both students and non-students). The DASS-8 expressed excellent internal consistency (coefficient alpha = 0.89), good convergent validity—noted by high values of item-total correlations (r = 0.87 to 0.88), good predictive validity—indicated by significantly strong correlation with the DASS-21 and its subscales (r = 0.95 to 0.80), and adequate discriminant validity—indicated by heterotrait–monotrait ratio of correlations <0.85. The DASS-8 correlated with the Internet Gaming Disorder-9, the Adult attention-deficit/hyperactivity disorder Self-Report Scale, and the Individualism and Collectivism Scale/Culture Orientation Scale at the same level as the DASS-21 and the DASS-12, denoting its adequate criterion validity. The DASS-8 can be used as a brief alternative to the DASS-21 to screen for mental symptomatology in English-speaking and African cultures. However, the same scores on the DASS-8 and the DASS-12 may not always indicate the same level of symptom severity in subjects from different countries. Further inter-cultural evaluations of the DASS-8 are needed.

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  • The DASS-8 Arabic version demonstrated satisfactory internal consistency in this study, with a Cronbach's alpha of 0.908.

    “We used the validated Arabic version of this scale [46], demonstrating a satisfactory internal consistency in our study, with a Cronbach’s alpha of 0.908.”

    From Coping strategies among family caregivers of community-dwelling older adults in Lebanon amid the economic crisis (2026) · cites this paper as [46]

    The Abstract and Results report strong psychometric properties for the DASS-8, including coefficient alpha = 0.89, in participants from the United States, Australia, and Ghana. The paper says the scale was previously introduced in an Arab sample, but it does not establish validation of the Arabic-language version used by the citing authors. The reported alpha of 0.908 is explicitly from the citing authors’ own study, not a result attributed to this source. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 49

  1. Ali A. M. Alkhamees A. A. Hori H. Kim Y. Kunugi H. (2021a). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post-COVID-19 world. Int. J. Environ. Res. Public Health 18: 10142. doi: 10.3390/ijerph181910142, PMID: 34639443 PMC8507889 · DOI
  2. Ali A. M. Green J. (2019). Factor structure of the depression anxiety stress Scale-21 (DASS-21): Unidimensionality of the Arabic version among Egyptian drug users. Subst. Abuse Treat. Prev. Policy 14: 40. doi: 10.1186/s13011-019-0226-1, PMID: 31533766 PMC6751677 · DOI
  3. Ali A. M. Hendawy A. O. Ahmad O. Sabbah H. A. Smail L. Kunugi H. (2021b). The Arabic version of the Cohen perceived stress scale: factorial validity and measurement invariance. Brain Sci. 11: 419. doi: 10.3390/brainsci11040419, PMID: 33810322 PMC8066085 · DOI
  4. Ali A. M. Hendawy A. O. Almarwani A. M. Alzahrani N. Ibrahim N. Alkhamees A. A.. (2021c). The six-item version of the internet addiction test: its development, psychometric properties, and measurement invariance among women with eating disorders and healthy school and university students. Int. J. Environ. Res. Public Health 18: 12341. doi: 10.3390/ijerph182312341, PMID: 34886068 PMC8657305 · DOI
  5. Ali A. M. Hori H. Kim Y. Kunugi H. (2021d). Predictors of nutritional status, depression, internet addiction, Facebook addiction, and tobacco smoking among women with eating disorders in Spain. Front. Psychiatry. 12: 2001. doi: 10.3389/fpsyt.2021.735109, PMID: 34899416 PMC8663168 · DOI
  6. Ali A. M. Kunugi H. Abdelmageed H. A. Mandour A. S. Ahmed M. E. Ahmad S.. (2021e). Vitamin K in COVID-19—potential anti-COVID-19 effects of vitamin K antagonists (VKA) and fermented milk fortified with bee honey as a natural source of vitamin K and probiotics. Fermentation 7: 202. doi: 10.3390/fermentation7040202 · DOI
  7. Andreetta J. Teh M. J. Burleigh T. L. Gomez R. Stavropoulos V. (2020). Associations between comorbid stress and internet gaming disorder symptoms: are there cultural and gender variations? Asia Pac. Psychiatry 12: e12387. doi: 10.1111/appy.12387, PMID: 32286004 · DOI
  8. Anlesinya A. Adepoju O. A. Richter U. H. (2019). Cultural orientation, perceived support and participation of female students in formal entrepreneurship in the sub-Saharan economy of Ghana. Int. J. Gend. Entrep. 11, 299– 322. doi: 10.1108/IJGE-01-2019-0018 · DOI
  9. Brevik E. J. Lundervold A. J. Haavik J. Posserud M. B. (2020). Validity and accuracy of the adult attention-deficit/hyperactivity disorder (ADHD) self-report scale (ASRS) and the Wender Utah rating scale (WURS) symptom checklists in discriminating between adults with and without ADHD. Brain Behav. 10: e01605. doi: 10.1002/brb3.1605, PMID: 32285644 PMC7303368 · DOI · Paper page
  10. Burleigh TL. (2019). IGD_Culture. Data Archiving and Networked Services (DANS) V1. doi:10.17026/dans-xgs-hpdn · DOI
  11. Caetano A. C. Oliveira D. Gomes Z. Mesquita E. Rolanda C. (2017). Psychometry and Pescatori projective test in coloproctological patients. Ann. Gastroenterol. 30, 433– 437. doi: 10.20524/aog.2017.0145, PMID: 28655980 PMC5479996 · DOI
  12. Cooke J. E. Eirich R. Racine N. Madigan S. (2020). Prevalence of posttraumatic and general psychological stress during COVID-19: a rapid review and meta-analysis. Psychiatry Res. 292: 113347. doi: 10.1016/j.psychres.2020.113347, PMID: 32763477 PMC7392847 · DOI · Paper page
  13. Corcoran M. McNulty M. (2018). Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective well-being. Child Abuse Negl. 76, 297– 309. doi: 10.1016/j.chiabu.2017.11.012, PMID: 29175733 · DOI
  14. DeLuca J. S. Hwang J. Stepinski L. Yanos P. T. (2020). Understanding explanatory mechanisms for racial and ethnic differences in mental health stigma: the role of vertical individualism and right-wing authoritarianism. J. Ment. Health 31, 39– 49. doi: 10.1080/09638237.2020.1836556, PMID: 33112173 · DOI
  15. Dyrbye L. N. Thomas M. R. Shanafelt T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad. Med. 81, 354– 373. doi: 10.1097/00001888-200604000-00009, PMID: 16565188 · DOI · Paper page
  16. Germani A. Delvecchio E. Li J.-B. Mazzeschi C. (2020). The horizontal and vertical individualism and collectivism scale: early evidence on validation in an Italian sample. J. Child Fam. Stud. 29, 904– 911. doi: 10.1007/s10826-019-01571-w · DOI
  17. Gignac G. E. (2014). Fluid intelligence shares closer to 60% of its variance with working memory capacity and is a better indicator of general intelligence. Intelligence 47, 122– 133. doi: 10.1016/j.intell.2014.09.004 · DOI
  18. Guerrini Usubini A. Cattivelli R. Varallo G. Castelnuovo G. Molinari E. Giusti E. M.. (2021). The relationship between psychological distress during the second wave lockdown of COVID-19 and emotional eating in Italian young adults: The mediating role of emotional Dysregulation. J. Person. Med.: 569, 11. doi: 10.3390/jpm11060569 PMC8235082 34204480 · DOI
  19. Henseler J. Ringle C. M. Sarstedt M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. J. Acad. Mark. Sci. 43, 115– 135. doi: 10.1007/s11747-014-0403-8 · DOI · Paper page
  20. Jun D. Johnston V. Kim J. M. O'Leary S. (2018). Cross-cultural adaptation and validation of the Depression, Anxiety and Stress Scale-21 (DASS-21) in the Korean working population. Work 59, 93– 102. doi: 10.3233/wor-172661, PMID: 29439379 · DOI
  21. Le M. T. H. Tran T. D. Holton S. Nguyen H. T. Wolfe R. Fisher J. (2017). Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents. PLoS One 12: e0180557. doi: 10.1371/journal.pone.0180557, PMID: 28723909 PMC5516980 · DOI
  22. Lee E. H. Moon S. H. Cho M. S. Park E. S. Kim S. Y. Han J. S.. (2019). The 21-item and 12-item versions of the depression anxiety stress scales: psychometric evaluation in a Korean population. Asian. Nurs. Res. 13, 30– 37. doi: 10.1016/j.anr.2018.11.006, PMID: 30503903 · DOI
  23. Lohse T. Rohrmann S. Richard A. Bopp M. Faeh D. (2017). Type A personality and mortality: competitiveness but not speed is associated with increased risk. Atherosclerosis 262, 19– 24. doi: 10.1016/j.atherosclerosis.2017.04.016 28478195 · DOI
  24. Masuyama A. Kubo T. Sugawara D. Chishima Y. (2021). Interest consistency can buffer the effect of COVID-19 fear on psychological distress. Int. J. Ment. Heal. Addict., 1– 12. doi: 10.1007/s11469-021-00564-5, PMID: 34220383 PMC8238385 · DOI
  25. Megreya A. M. Latzman R. D. Al-Emadi A. A. Al-Attiyah A. A. (2018). An integrative model of emotion regulation and associations with positive and negative affectivity across four Arabic speaking countries and the USA. Motiv. Emot. 42, 566– 575. doi: 10.1007/s11031-018-9682-6 · DOI
  26. Melita D. Willis G. B. Rodríguez-Bailón R. (2021). Economic inequality increases status anxiety Through perceived contextual competitiveness. Front. Psychol. 12: 637365. doi: 10.3389/fpsyg.2021.637365, PMID: 34108908 PMC8182636 · DOI
  27. Mumang A. A. Syamsuddin S. Maria I. L. Yusuf I. (2021). Gender differences in depression in the general population of Indonesia: confounding effects. Depress. Res. Treat. 2021, 3162445– 3162448. doi: 10.1155/2021/3162445, PMID: 34258060 PMC8253638 · DOI
  28. Nordfjærn T. Jørgensen S. Rundmo T. (2012). Cultural and socio-demographic predictors of car accident involvement in Norway, Ghana, Tanzania and Uganda. Saf. Sci. 50, 1862– 1872. doi: 10.1016/j.ssci.2012.05.003 · DOI
  29. O’Farrell D. L. Baynes K.-L. M. Pontes H. D. Griffiths M. Stavropoulos V. (2020). Depression and disordered gaming: does culture matter? Int. J. Ment. Heal. Addict., 1– 9. doi: 10.1007/s11469-020-00231-1 · DOI
  30. Oei T. P. S. Sawang S. Goh Y. W. Mukhtar F. (2013). Using the depression anxiety stress scale 21 (DASS-21) Across cultures. Int. J. Psychol. 48, 1018– 1029. doi: 10.1080/00207594.2012.755535, PMID: 23425257 · DOI · Paper page
  31. Office of the Surgeon General (US), Center for Mental Health Services (US) National Institute of Mental Health (US) (2001). “ Culture Counts: The Influence of Culture and Society on Mental Health,” in Mental Health: Culture R, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville (MD): Substance Abuse and Mental Health Services Administration (US) (United States: Department of Health and Human Services, U. S. Public Health Service). 20669516
  32. Olsson U. H. Foss T. Troye S. V. Howell R. D. (2000). The performance of ML, GLS, and WLS estimation in structural equation modeling Under conditions of misspecification and nonnormality. Struct. Equ. Model. Multidiscip. J. 7, 557– 595. doi: 10.1207/S15328007SEM0704_3 · DOI
  33. Osman A. Wong J. L. Bagge C. L. Freedenthal S. Gutierrez P. M. Lozano G. (2012). The depression anxiety stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J. Clin. Psychol. 68, 1322– 1338. doi: 10.1002/jclp.21908, PMID: 22930477 · DOI
  34. Pontes H. M. Griffiths M. D. (2015). Measuring DSM-5 internet gaming disorder: development and validation of a short psychometric scale. Comput. Hum. Behav. 45, 137– 143. doi: 10.1016/j.chb.2014.12.006 · DOI · Paper page
  35. Pontes H. M. Stavropoulos V. Griffiths M. D. (2017). Measurement invariance of the internet gaming disorder scale-short-form (IGDS9-SF) between the United States of America, India and the United Kingdom. Psychiatry Res. 257, 472– 478. doi: 10.1016/j.psychres.2017.08.013, PMID: 28837939 · DOI
  36. Scholten S. Velten J. Bieda A. Zhang X. C. Margraf J. (2017). Testing measurement invariance of the depression, anxiety, and stress scales (DASS-21) across four countries. Psychol. Assess. 29, 1376– 1390. doi: 10.1037/pas0000440, PMID: 28125249 · DOI · Paper page
  37. Seymour K. E. Chronis-Tuscano A. Iwamoto D. K. Kurdziel G. MacPherson L. (2014). Emotion regulation mediates the association Between ADHD and depressive symptoms in a community sample of youth. J. Abnorm. Child Psychol. 42, 611– 621. doi: 10.1007/s10802-013-9799-8, PMID: 24221724 PMC4207628 · DOI
  38. Shekriladze I. Javakhishvili N. Chkhaidze N. (2021). Culture related factors may shape coping During pandemics. Front. Psychol. 12: 634078. doi: 10.3389/fpsyg.2021.634078, PMID: 34093315 PMC8170015 · DOI
  39. Shrout P. E. Yager T. J. (1989). Reliability and validity of screening scales: effect of reducing scale length. J. Clin. Epidemiol. 42, 69– 78. doi: 10.1016/0895-4356(89)90027-9, PMID: 2913189 · DOI
  40. Silva H. A. Passos M. H. Oliveira V. M. Palmeira A. C. Pitangui A. C. Araújo R. C. (2016). Short version of the Depression Anxiety Stress Scale-21: is it valid for Brazilian adolescents? Einstein 14, 486– 493. doi: 10.1590/s1679-45082016ao3732, PMID: 28076595 PMC5221374 · DOI
  41. Sweetland A. C. Belkin G. S. Verdeli H. (2014). Measuring depression and anxiety in sub-saharan Africa. Depress. Anxiety 31, 223– 232. doi: 10.1002/da.22142, PMID: 23780834 PMC4109689 · DOI
  42. Teo Y. C. Hj Yusuf A. Alice Lim W. P. Ghazali N. B. Abd Rahman H. Lin N.. (2019). Validation of DASS-21 among nursing and midwifery students in Brunei. J. Public Health 27, 387– 391. doi: 10.1007/s10389-018-0947-z · DOI
  43. ter Meulen W. G. Draisma S. van Hemert A. M. Schoevers R. A. Kupka R. W. Beekman A. T. F.. (2021). Depressive and anxiety disorders in concert–A synthesis of findings on comorbidity in the NESDA study. J. Affect. Disord. 284, 85– 97. doi: 10.1016/j.jad.2021.02.004, PMID: 33588240 · DOI
  44. Tonsing K. N. (2014). Psychometric properties and validation of Nepali version of the depression anxiety stress scales (DASS-21). Asian J. Psychiatr. 8, 63– 66. doi: 10.1016/j.ajp.2013.11.001, PMID: 24655630 · DOI
  45. Triandis H. C. Gelfand M. J. (1998). Converging measurement of horizontal and vertical individualism and collectivism. J. Pers. Soc. Psychol. 74, 118– 128. doi: 10.1037/0022-3514.74.1.118 · DOI
  46. Vahedian-Azimi A. Moayed M. S. Rahimibashar F. Shojaei S. Ashtari S. Pourhoseingholi M. A. (2020). Comparison of the severity of psychological distress among four groups of an Iranian population regarding COVID-19 pandemic. BMC Psychiatry 20: 402. doi: 10.1186/s12888-020-02804-9, PMID: 32770975 PMC7414274 · DOI
  47. Yıldırım A. Boysan M. Kefeli M. C. (2018). Psychometric properties of the Turkish version of the depression anxiety stress Scale-21 (DASS-21). British J. Guid. Counsel. 46, 582– 595. doi: 10.1080/03069885.2018.1442558 · DOI
  48. Zanon C. Brenner R. E. Baptista M. N. Vogel D. L. Rubin M. Al-Darmaki F. R.. (2020). Examining the dimensionality, reliability, and invariance of the depression, anxiety, and stress Scale-21 (DASS-21) Across eight countries. Assessment 28, 1531– 1544. doi: 10.1177/1073191119887449, PMID: 31916468 · DOI
  49. Zhang J. Lu H. Zeng H. Zhang S. Du Q. Jiang T.. (2020). The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav. Immun. 87, 49– 50. doi: 10.1016/j.bbi.2020.04.031, PMID: 32304883 PMC7156946 · DOI · Paper page

Cited by

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Authors
Ali, A. M., Hori, H., Kim, Y., & Kunugi, H.
Affiliations
National Center of Neurology and Psychiatry (JP)
Corresponding author
Ali, Amira Mohammed
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2022-03-24
Volume
13
Pages
799769-799769
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2022.799769
PMC
PMC9044488
OpenAlex
W4220845463
Cited by
122
References
10
Citations by year
2026: 20 · 2025: 33 · 2024: 35 · 2023: 22 · 2022: 12
FWCI
23.47
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Institutional Repositories DataBase (IRDB) (submittedVersion)
Funders
Japan Society for the Promotion of Science (20K07937)
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 › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
DASS-21, depression, anxiety, stress, psychometric properties, measurement invariance, cross-cultural validity, short-form questionnaire, internet gaming disorder, attention deficit hyperactivity disorder, individualism-collectivism, Ghanaian students, healthy adults

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