Structural Validity and Reliability of the Depression Anxiety Stress Scale in Peruvian University Students
Keywords:
factor analysis, anxiety, validation study, depression, mental health, psychometrics.Abstract
Introduction: The Depression, Anxiety, Stress Scale (DASS-21) is a validated instrument in various populations; however, it needs to be continuously verified to ensure its correct use.
Objective: Explore the structural validity and reliability of the Depression, Anxiety, Stress Scale (DASS-21), through different estimation methods in Peruvian university students.
Method: An instrumental study was carried out. 406 health science students from a public university in Peru participated. Item variability, construct validity with exploratory factor analysis, the number of factors with Horn parallel analysis and confirmatory factor analysis were examined, including different estimation methods. Reliability and discriminative, correlational, predictive validity were analyzed.
Results: A bifactorial structure of 21 items grouped into a general factor and three specific factors was corroborated. The model revealed optimal fit indices independently of the estimation method. The items discriminated satisfactorily, as well as the global scale according to age and religion. Correlation and predictive validity were adequate. The ordinal alpha was optimal for the global scale (0.969), and subscales depression (0.964), anxiety (0.890) and stress (0.980); Cronbach's Alpha, McDonald's Omega and Gutmann's coefficients supported these findings.
Conclusions: The DASS-21 scale is a valid and reliable instrument to be used with Peruvian health science students. It is recommended to be used in research and clinical practice.
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References
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23. Sideridis G, Jaffari F. An R function to correct fit indices and omnibus tests in confirmatory factor analysis. Measurement and Evaluation in Counseling and Development. 2022; 55(1):48-70. Disponible en: https://doi.org/10.1080/07481756.2021.1906159
24. McNeish D, Wolf M. Dynamic fit index cutoffs for confirmatory factor analysis models. Psychological Methods. 2023; 28(1):61-88. Disponible en: https://doi.org/10.1037/met0000425
25. Romo C, Tobon S, Juarez-Hernandez L. Diseño y validación de un instrumento para evaluar la práctica docente centrada en la metacognición en el aula. Cuad. Investig. Educ. Montevideo. 2020; 11(2):55-76. Disponible en: https://doi.org/10.18861/cied.2020.11.2.2981.
26. Valencia P. Las Escalas de Depresión, Ansiedad y Estrés (DASS-21): ¿miden algo más que un factor general?. Avances En Psicología. 2019;27(2): 177–190. Disponible en: https://doi.org/10.33539/avpsicol.2019.v27n2.1796
2. Al-Khlaiwi T, Habib SS, Akram A, Al-Khliwi H, Habib SM. Comparison of depression, anxiety, and stress between public and private university medical students. J Family Med Prim Care. 2023;12(6):1092-1098. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10451576/
3. Valladares-Garrido D, Quiroga-Castañeda PP, Berrios-Villegas I, Zila-Velasque JP, Anchay-Zuloeta C, Chumán-Sánchez M, et al. Depression, anxiety, and stress in medical students in Peru: a cross-sectional study. Front Psychiatry. 2023;14:1268872. DOI: 10.3389/fpsyt.2023.1268872
4. Becerra-Canales B, Campos-Martínez H. Estado anímico y salud mental de estudiantes de una universidad peruana en pandemia por la COVID-19. Educación Médica Superior. 2021; 35. Disponible en: https://ems.sld.cu/index.php/ems/article/view/2500
5. Asociación Americana de Psiquiatría. Manual diagnóstico y estadístico de los trastornos mentales (5.ª Ed.). Arlington: Médica Panamericana. 2014.
6. Belloch A, Sandín B, Ramos F. (2009). Manual de psicopatología. Vol II, 3a.ed. España: McGraw-Hill; 2020.
7. Lovibond P, Lovibond S. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995; 33(3): 335-43. DOI: 10.1016/0005-7967(94)00075-U
8. Tee M, Wang C, Tee C, Pan R, Reyes P, Wan X, et al. Impacto de la pandemia de COVID-19 en la salud física y mental en países asiáticos de ingresos medios bajos y altos: una comparación entre Filipinas y China. Frontiers in Psychiatry. 2021; 9(11): 568929. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33633595/
9. Becerra Canales BD, Condori Becerra AS, Del Rio Mendoza JR. Validez y confiabilidad de la Escala de Valoración del Estado de Ánimo, en el contexto de la pandemia por COVID-19. Rev. cuba. enferm. 2021; 37(1). Disponible en: https://revenfermeria.sld.cu/index.php/enf/article/view/4460
10. Chavez-Espinoza JH, Castillo-Romero PC, Ruiz-Reyes RE, Reyes-Mejía MG, Hernández-López M Ángel. Adaptación y validación peruana del Cuestionario de Salud General (GHQ-12) en trabajadores de salud. Iatreia. 2022; 36(3). Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/350754
11. Antony M, Bieling P, Cox B, Enns M, Swinson R. 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. 1998; 10(2): 176-81.
12. Bengwasan PD, Bernardo ABI, Maximo SI. Translation and Initial Validation of the Depression Anxiety and Stress Scale (DASS-21) in Ilokano. Psychol Stud (Mysore). 2022;67(4):594-604. DOI: 10.1007/s12646-022-00696-1
13. Susanti HD, Sonko I, Chung MH. Translation and validation of the Depression Anxiety Stress Scales for menopausal women in Indonesia. Climacteric. 2022;25(5):483-89. DOI: 10.1080/13697137.2022.2052839.
14. Camacho Á, Cordero E, Perkins T. Psychometric properties of the DASS-21 among Latina/o college students by the US-Mexico border. Journal of Immigrant and Minority Health. 2016; 18(5): 1017-23. DOI:10.1007/s10903-016-0415-1
15. Duffy C, Cunningham E, Moore S. Brief report: The factor structure of mood states in an early adolescent sample. Journal of Adolescence. 2005; 28(5): 677-80. DOI: 10.1016/j.adolescence.2005.08.013
16. Szabó M, Lovibond P. Anxiety, depression and tension/stress in children. Journal of Psychopathology and Behavioral Assessment. 2006; 28(3): 195-205. DOI: 10.1007/s10862-005-9008-3
17. Yap AU, Lee DZ. Use of the Depression Anxiety Stress Scale-21 in young people with temporomandibular disorders: Reliability and dimensionality. Cranio. 2023; 2:1-9. DOI: 10.1080/08869634.2022.2158259.
18. Salinas-Rodríguez A, Argumedo G, Hernández-Alcaraz C, Contreras-Manzano A, Jáuregui A. Depression, Anxiety, and Stress Scale: Factor validation during the first COVID-19 lockdown in Mexico. Revista Latinoamericana de Psicología. 2023; 55: 83-90 DOI: https://doi.org/10.14349/rlp.2023.v55.10
19. González-Rivera JA, Pagán-Torres OM, Pérez-Torres EM. Depression, Anxiety and Stress Scales (DASS-21): Construct Validity Problem in Hispanics. Eur J Investig Health Psychol Educ. 2020;10(1):375-89. DOI: 10.3390/ejihpe10010028.
20. Villegas-Maestre J, Pedraza-Rodríguez E, Corrales-Reyes I, Carranza-Esteban R, Mamani-Benito O. Validez y confiabilidad de una escala de depresión, ansiedad y estrés en estudiantes cubanos de odontología durante la COVID-19. Rev Cubana Estomatol. 2023; 60(3): e4428. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75072023000300001&lng=en.
21. Ebel R, Frisbie D. Essentials of Education Measurement. Englewood Cliffs, NJ: Prentice Hall. 1986.
22. Trejos-Herrera A, Bahamón M, Alarcón-Vásquez Y, Vinaccia S, González O, Quevedo-Barrios D, et al. Validación de las propiedades psicométricas de la Escala de Personalidad Tipo D en adultos colombianos. Acta Colombiana de Psicología. 2023; 26(2):128-40. Disponible en: https://doi.org/10.14718/ACP.2023.26.2.11
23. Sideridis G, Jaffari F. An R function to correct fit indices and omnibus tests in confirmatory factor analysis. Measurement and Evaluation in Counseling and Development. 2022; 55(1):48-70. Disponible en: https://doi.org/10.1080/07481756.2021.1906159
24. McNeish D, Wolf M. Dynamic fit index cutoffs for confirmatory factor analysis models. Psychological Methods. 2023; 28(1):61-88. Disponible en: https://doi.org/10.1037/met0000425
25. Romo C, Tobon S, Juarez-Hernandez L. Diseño y validación de un instrumento para evaluar la práctica docente centrada en la metacognición en el aula. Cuad. Investig. Educ. Montevideo. 2020; 11(2):55-76. Disponible en: https://doi.org/10.18861/cied.2020.11.2.2981.
26. Valencia P. Las Escalas de Depresión, Ansiedad y Estrés (DASS-21): ¿miden algo más que un factor general?. Avances En Psicología. 2019;27(2): 177–190. Disponible en: https://doi.org/10.33539/avpsicol.2019.v27n2.1796
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Published
2024-04-26
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1.
Becerra-Canales B, Hernández-Huaripaucar E, Córdova-Delgado M, Pastor-Ramírez N, Melgarejo-Ángeles WE, Balbuena-Conislla H, et al. Structural Validity and Reliability of the Depression Anxiety Stress Scale in Peruvian University Students. Rev. Hosp. Psiq. Habana [Internet]. 2024 Apr. 26 [cited 2025 Sep. 7];21(1). Available from: https://revhph.sld.cu/index.php/hph/article/view/498
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