Testing the validity and reliability of the Depression Anxiety Stress Scale (DASS)-21 instrument for individuals with psychodermatology
Main Article Content
Abstract
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.
Downloads
Article Details
The copyright of the accepted article shall be assigned to the publisher of the journal. The intended copyright includes the right to publish the article in various forms (including reprints). The journal maintains the publishing rights to published articles.
In line with the license, authors and any users (readers and other researchers) are allowed to share and adapt the material only for non-commercial purposes. In addition, the material must be given appropriate credit, provided with a link to the license, and indicated if changes were made. If authors remix, transform, or build upon the material, authors must distribute their contributions under the same license as the original.
References
AERA, APA, & NCME. (2014). Standards for educational and psychological testing: National Council on Measurement in Education. American Educational Research Association.
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
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
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
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
Brown, T. A. (2015). Confirmatory factor analysis for applied research. Guilford Press.
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
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
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
Coolican, H. (2018). Research methods and statistics in psychology. Routledge. https://doi.org/10.4324/9781315201009
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
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
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
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
Hair Jr, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2009). Multivariate data analysis (7th ed.). Prentice Hall International.
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
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
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
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
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
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
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.
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
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
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
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
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
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation.
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
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
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
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.
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
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
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
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
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
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
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
Paola, G. (2020). The importance of using valid and reliable measures in psychology and psychiatry. Psychology and Psychiatry, 9(4), 24–25.
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
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
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
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
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
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
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
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
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
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
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
Stevens, J. P. (2009). Applied multivariate statistics for the social sciences (5th ed.). Routledge.
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
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
Urbina, S. (2014). Essentials of psychological testing. John Wiley & Sons.
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
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
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
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
Wardhana, I. M. (2012). Stres psikologis pada pasien psoriasis: Suatu kajian psikoneuroimunologi. Media Dermato-Venereologica Indonesiana, 39(1), 10–14.
Widhiarso, W., & Ravand, H. (2014). Estimating reliability coefficient for multidimensional measures: A pedagogical illustration. Review of Psychology, 21(2), 111–121.
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
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
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