Testing the validity and reliability of the Depression Anxiety Stress Scale (DASS)-21 instrument for individuals with psychodermatology

Qothrun Nada*    -  Master's Program in Clinical Psychology Profession, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
Ike Herdiana    -  Department of Clinical Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
Fitri Andriani  -  Department of Educational and Developmental Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia

(*) Corresponding Author

Individual psychological health can be seen from the health of the skin. Some skin diseases such as psoriasis and atopic dermatitis can be exacerbated by psychological problems. Based on this, a collaboration between specialist doctors and psychologists is needed to screen for psychological disorders in sufferers. One psychological screening instrument is the Depression Anxiety Stress Scale (DASS)-21; this study aims to test its validity and reliability. Non-probability convenience sampling was employed, and 292 participants aged 18-54 were willing to take part in the study. An internal structure validity test was conducted using confirmatory factor analysis, while concurrent validity was assessed by correlating DASS-21 with PHQ-9, GAD-7 and PSS scores. The reliability test was analyzed using composite reliability. The results of the CFA analysis showed that the data matched Lovibond's theory and that all DASS-21 items were valid (RMSEA =.076, CFI=.961, TLI = .955, SRMR = .065). The results of the concurrent analysis showed that the three scales had a positive correlation with the dimensions of DASS-21, while the reliability results showed a satisfactory value (.850 – .923). The results of the study indicate that DASS-21 is a valid and reliable instrument and can be used to measure depression, anxiety and stress in individuals with psoriasis and atopic dermatitis.

Keywords: DASS-21; psychodermatology; reliability; validity

  1. AERA, APA, & NCME. (2014). Standards for educational and psychological testing: National Council on Measurement in Education. American Educational Research Association.
  2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. https://doi.org/10.1037/1040-3590.10.2.176
  3. Bakara, D. M., Ibrahim, K., & Sriati, A. (2015). Efek Spiritual Emotional Freedom Technique terhadap cemas dan depresi, sindrom koroner akut. Jurnal Keperawatan Padjadjaran, 1(1), 1–8. https://doi.org/10.24198/jkp.v1i1.51
  4. Bostoen, J., Bracke, S., De Keyser, S., & Lambert, J. (2012). An educational programme for patients with psoriasis and atopic dermatitis: A prospective randomized controlled trial. British Journal of Dermatology, 167(5), 1025–1031. https://doi.org/10.1111/j.1365-2133.2012.11113.x
  5. Bottesi, G., Ghisi, M., Altoè, G., Conforti, E., Melli, G., & Sica, C. (2015). The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Comprehensive Psychiatry, 60, 170–181. https://doi.org/10.1016/j.comppsych.2015.04.005
  6. Brown, T. A. (2015). Confirmatory factor analysis for applied research. Guilford Press.
  7. Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. https://doi.org/10.1037/0021-843X.100.3.316
  8. Clarke, E. N., Thompson, A. R., & Norman, P. (2020). Depression in people with skin conditions: The effects of disgust and self‐compassion. British Journal of Health Psychology, 25(3), 540–557. https://doi.org/10.1111/bjhp.12421
  9. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404
  10. Coolican, H. (2018). Research methods and statistics in psychology. Routledge. https://doi.org/10.4324/9781315201009
  11. Egeberg, A., Griffiths, C. E. M., Williams, H. C., Andersen, Y. M. F., & Thyssen, J. P. (2020). Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adults. British Journal of Dermatology, 183(1), 128–138. https://doi.org/10.1111/bjd.18622
  12. Germain, N., Augustin, M., François, C., Legau, K., Bogoeva, N., Desroches, M., Toumi, M., & Sommer, R. (2021). Stigma in visible skin diseases – a literature review and development of a conceptual model. Journal of the European Academy of Dermatology and Venereology, 35(7), 1493–1504. https://doi.org/10.1111/jdv.17110
  13. Golpour, M., Hosseini, S. H., Khademloo, M., Ghasemi, M., Ebadi, A., Koohkan, F., & Shahmohammadi, S. (2012). Depression and anxiety disorders among patients with Psoriasis: A hospital-based case-control study. Dermatology Research and Practice, 2012, 1–5. https://doi.org/10.1155/2012/381905
  14. González-Rivera, J. A., Pagán-Torres, O. M., & Pérez-Torres, E. M. (2020). Depression, Anxiety and Stress Scales (DASS-21): Construct validity problem in hispanics. European Journal of Investigation in Health, Psychology and Education, 10(1), 375–389. https://doi.org/10.3390/ejihpe10010028
  15. Hair Jr, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2009). Multivariate data analysis (7th ed.). Prentice Hall International.
  16. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239. https://doi.org/10.1348/014466505X29657
  17. Hidayati, R. W., Susilowati, L., & Utami, K. D. (2021). Pengaruh Terapi Hypnofivesic terhadap depresi, cemas, dan stres mahasiswa dalam menjalani proses belajar mengajar daring selama pandemi COVID-19. Jurnal Kesehatan Mesencephalon, 7(1), 63–68. https://doi.org/10.36053/mesencephalon.v7i1.253
  18. Jankowiak, B., Kowalewska, B., Krajewska-Kułak, E., & Khvorik, D. F. (2020). Stigmatization and quality of life in patients with Psoriasis. Dermatology and Therapy, 10(2), 285–296. https://doi.org/10.1007/s13555-020-00363-1
  19. Kemenkes RI. (2019). Situasi kesehatan jiwa di Indonesia. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. https://pusdatin.kemkes.go.id/article/view/20031100001/situasi-kesehatan-jiwa-di-indonesia.html
  20. Kia-Keating, M., No, U., Moore, S., Furlong, M. J., Liu, S., & You, S. (2018). Structural validity of the Depression, Anxiety, and Stress Scales-21 adapted for U.S. undergraduates. Emerging Adulthood, 6(6), 434–440. https://doi.org/10.1177/2167696817745407
  21. Kim, S.-H., Hur, J., Jang, J.-Y., Park, H.-S., Hong, C. H., Son, S. J., & Chang, K. J. (2015). Psychological distress in young adult males with atopic dermatitis. Medicine, 94(23), e949. https://doi.org/10.1097/MD.0000000000000949
  22. Kinanth, M. R., Listiyandini, R. A., Amaliah, U. S., & Ramadhanty, R. (2020). Adaptasi DASS 21 versi Indonesia pada populasi mahasiswa di Jakarta. Seminar Nasional Psikologi dan Call for Paper UMB Yogyakarta 2020.
  23. Koo, J., & Lebwohl, A. (2001). Psycho dermatology: The mind and skin connection. American Family Physician, 64(11), 1873–1878. http://www.ncbi.nlm.nih.gov/pubmed/11764865
  24. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  25. Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004
  26. Kwon, C. W., Fried, R. G., Nousari, Y., Ritchlin, C., & Tausk, F. (2018). Psoriasis: Psychosomatic, somatopsychic, or both? Clinics in Dermatology, 36(6), 698–703. https://doi.org/10.1016/j.clindermatol.2018.08.009
  27. Leibovici, V., Canetti, L., Yahalomi, S., Cooper-Kazaz, R., Bonne, O., Ingber, A., & Bachar, E. (2010). Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study. Journal of the European Academy of Dermatology and Venereology, 24(8), 897–903. https://doi.org/10.1111/j.1468-3083.2009.03542.x
  28. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation.
  29. Malfasari, E., & Erlin, F. (2017). Terapi Thought Stopping (TS) untuk ansietas mahasiswa praktik kLinik di rumah sakit. Jurnal Endurance, 2(3), 444–450. https://doi.org/10.22216/jen.v2i3.2460
  30. McCoach, D. B., Gable, R. K., & Madura, J. P. (2013). Instrument development in the affective domain. Springer New York. https://doi.org/10.1007/978-1-4614-7135-6
  31. Mento, C., Rizzo, A., Muscatello, M. R. A., Zoccali, R. A., & Bruno, A. (2020). Negative emotions in skin disorders: A systematic review. International Journal of Psychological Research, 13(1), 71–86. https://doi.org/10.21500/20112084.4078
  32. Musa, R., Fadzil, M. A., & Zain, Z. (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry, 8(2), 82–89.
  33. Muttaqin, D., & Ripa, S. (2021). Psychometric properties of the Indonesian version of the Depression Anxiety Stress Scale: Factor structure, reliability, gender, and age measurement invariance. Psikohumaniora: Jurnal Penelitian Psikologi, 6(1), 61–76. https://doi.org/10.21580/pjpp.v6i1.7815
  34. Ng, F., Trauer, T., Dodd, S., Callaly, T., Campbell, S., & Berk, M. (2007). The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatrica, 19(5), 304–310. https://doi.org/10.1111/j.1601-5215.2007.00217.x
  35. Nurjanah, D. E. (2018). Pengaruh terapi kognitif terhadap tingkat kecemasan pada pasien gagal ginjal kronik yang menjalani hemodialisa. Jurnal Media Kesehatan, 7(1), 19–25. https://doi.org/10.33088/jmk.v7i1.218
  36. Oei, T. P. S., Sawang, S., Goh, Y. W., & Mukhtar, F. (2013). Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures. International Journal of Psychology, 48(6), 1018–1029. https://doi.org/10.1080/00207594.2012.755535
  37. Onie, S., Kirana, A. C., Adisya, A., Mustika, N. P., Adesla, V., & Ibrahim, R. (2020). Assessing the predictive validity and reliability of the DASS-21. PsyArXiv Preprint. https://doi.org/10.31234/osf.io/eqcm9
  38. 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. Journal of Clinical Psychology, 68(12), 1322–1338. https://doi.org/10.1002/jclp.21908
  39. Page, A. C., Hooke, G. R., & Morrison, D. L. (2007). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in depressed clinical samples. British Journal of Clinical Psychology, 46(3), 283–297. https://doi.org/10.1348/014466506X158996
  40. Paola, G. (2020). The importance of using valid and reliable measures in psychology and psychiatry. Psychology and Psychiatry, 9(4), 24–25.
  41. Pezirkianidis, C., Karakasidou, E., Lakioti, A., Stalikas, A., & Galanakis, M. (2018). Psychometric properties of the Depression, Anxiety, Stress Scales-21 (DASS-21) in a Greek sample. Psychology, 09(15), 2933–2950. https://doi.org/10.4236/psych.2018.915170
  42. Picchianti Diamanti, A., Cattaruzza, M. S., Di Rosa, R., Del Porto, F., Salemi, S., Sorgi, M. L., Martin Martin, L. S., Rai, A., Iacono, D., Sesti, G., Alessandri, G., & Laganà, B. (2020). Psychological distress in patients with autoimmune arthritis during the COVID-19 induced lockdown in Italy. Microorganisms, 8(11), 1818. https://doi.org/10.3390/microorganisms8111818
  43. Primasari, I., & Hidayat, R. (2016). General Health Qquestionnaire-12 (GHQ-12) sebagai instrumen skrinning gangguan penyesuaian. Jurnal Psikologi, 43(2), 121–134. https://doi.org/10.22146/jpsi.9155
  44. Priyanti, D., Saputra, D., Haryanto, H. C., & Ghozali, G. (2014). Efektivitas intervensi psikoterapi Ilham terhadap tingkat stres yang dialami mahasiswa di Universitas Paramadina. Inquiry: Jurnal Ilmiah Psikologi, 12(01), 67–86. https://doi.org/10.51353/inquiry.v12i01.504
  45. Purnami, C. T., Suwondo, A., Sawitri, D. R., Sumarni, S., Hadisaputro, S., & Lazuardi, L. (2019). Psychometric measurement of perceived stress among midwives at primary health care Province of Central Java Indonesia. Indian Journal of Public Health Research & Development, 10(3), 804–809. https://doi.org/10.5958/0976-5506.2019.00600.4
  46. Randall, D., Thomas, M., Whiting, D., & McGrath, A. (2017). Depression Anxiety Stress Scales (DASS-21): Factor structure in traumatic brain injury rehabilitation. Journal of Head Trauma Rehabilitation, 32(2), 134–144. https://doi.org/10.1097/HTR.0000000000000250
  47. Roberts, J. E., Smith, A. M., Wilkerson, A. H., Chandra, A., Patel, V., Quadri, S. S. A., Mann, J. R., Brodell, R. T., & Nahar, V. K. (2020). “Psychodermatology” knowledge, attitudes, and practice among health care professionals. Archives of Dermatological Research, 312(8), 545–558. https://doi.org/10.1007/s00403-020-02050-9
  48. Schut, C., Weik, U., Tews, N., Gieler, U., Deinzer, R., & Kupfer, J. (2013). Psychophysiological effects of stress management in patients with atopic dermatitis: A randomized controlled trial. Acta Dermato Venereologica, 93(1), 57–61. https://doi.org/10.2340/00015555-1415
  49. Senra, M. S., & Wollenberg, A. (2014). Psychodermatological aspects of atopic dermatitis. British Journal of Dermatology, 170, 38–43. https://doi.org/10.1111/bjd.13084
  50. Soliman, M. (2021). Depressive, anxiety, stress, and insomnia symptoms in patients with psoriasis: A cross-sectional study. Advances in Dermatology and Allergology, 38(3), 510–519. https://doi.org/10.5114/ada.2020.98726
  51. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
  52. Stevens, J. P. (2009). Applied multivariate statistics for the social sciences (5th ed.). Routledge.
  53. Thiyagarajan, A., James, T. G., & Marzo, R. R. (2022). Psychometric properties of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) among Malaysians during COVID-19: A methodological study. Humanities and Social Sciences Communications, 9, 220. https://doi.org/10.1057/s41599-022-01229-x
  54. Tran, T. D., Tran, T., & Fisher, J. (2013). 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. BMC Psychiatry, 13, 24. https://doi.org/10.1186/1471-244X-13-24
  55. Urbina, S. (2014). Essentials of psychological testing. John Wiley & Sons.
  56. Urtasun, M., Daray, F. M., Teti, G. L., Coppolillo, F., Herlax, G., Saba, G., Rubinstein, A., Araya, R., & Irazola, V. (2019). Validation and calibration of the Patient Health Questionnaire (PHQ-9) in Argentina. BMC Psychiatry, 19, 291. https://doi.org/10.1186/s12888-019-2262-9
  57. van Beugen, S., van Middendorp, H., Ferwerda, M., Smit, J. V., Zeeuwen-Franssen, M. E. J., Kroft, E. B. M., de Jong, E. M. G. J., Donders, A. R. T., van de Kerkhof, P. C. M., & Evers, A. W. M. (2017). Predictors of perceived stigmatization in patients with psoriasis. British Journal of Dermatology, 176(3), 687–694. https://doi.org/10.1111/bjd.14875
  58. Vinet, L., & Zhedanov, A. (2011). A ‘missing’ family of classical orthogonal polynomials. Journal of Physics A: Mathematical and Theoretical, 44(8), 085201. https://doi.org/10.1088/1751-8113/44/8/085201
  59. Wahyuliarmy, A. I. (2016). Efektifitas SEFT (Spiritual Emotional Freedom Technique) terhadap sindrom ketergantungan obat pada lansia. Psikoislamika: Jurnal Psikologi Dan Psikologi Islam, 13(1), 51–58. https://doi.org/10.18860/psi.v13i1.6409
  60. Wardhana, I. M. (2012). Stres psikologis pada pasien psoriasis: Suatu kajian psikoneuroimunologi. Media Dermato-Venereologica Indonesiana, 39(1), 10–14.
  61. Widhiarso, W., & Ravand, H. (2014). Estimating reliability coefficient for multidimensional measures: A pedagogical illustration. Review of Psychology, 21(2), 111–121.
  62. Wood, B. M., Nicholas, M. K., Blyth, F., Asghari, A., & Gibson, S. (2010). The utility of the short version of the Depression Anxiety Stress Scales (DASS-21) in elderly patients with persistent pain: Does age make a difference? Pain Medicine, 11(12), 1780–1790. https://doi.org/10.1111/j.1526-4637.2010.01005.x
  63. Yıldırım, A., Boysan, M., & Kefeli, M. C. (2018). Psychometric properties of the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21). British Journal of Guidance & Counselling, 46(5), 582–595. https://doi.org/10.1080/03069885.2018.1442558
  64. Zhong, Q.-Y., Gelaye, B., Zaslavsky, A. M., Fann, J. R., Rondon, M. B., Sánchez, S. E., & Williams, M. A. (2015). Diagnostic validity of the Generalized Anxiety Disorder - 7 (GAD-7) among pregnant women. Plos One, 10(4), e0125096. https://doi.org/10.1371/journal.pone.0125096

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