DASS (psychology)

Last updated

DASS, the Depression Anxiety Stress Scales, [1] is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom. [2] Each of these is rated on a four-point Likert scale of frequency or severity of the participants' experiences over the last week to emphasize states over traits. These scores ranged from 0, meaning that the client believed the item "did not apply to them at all", to 3, meaning that the client considered the item to "apply to them very much or most of the time". It is also stressed in the instructions that there are no right or wrong answers.

Contents

Scales

The sum of the relevant 14 items for each scale constitute the participants' scores for each of Depression, Anxiety, and Stress, [2] including items such as "I couldn't seem to experience any positive feeling at all", "I was aware of the dryness of my mouth" and "I found it hard to wind down" in the respective order of the scales. The order of the 42 items has been randomized so that items of the same scale are not clustered together. Each of the scales is then broken down into subscales comprising two to five items each.

The Depression scale has subscales assessing dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia.

The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect.

The Stress scale's subscales highlight levels of non-chronic arousal through difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive, and impatient. [1]

Purpose

The main purpose of the DASS is to isolate and identify aspects of emotional disturbance, for example, to assess the degree of severity of the core symptoms of depression, anxiety, or stress. The initial aims of the scale's constructions were to define the full range of core symptoms of depression and anxiety, meet rigorous standards of psychometric adequacy, and develop maximum discrimination between the depression anxiety scales. While the DASS can be administered and scored by individuals without psychology qualifications, it is recommended that the interpretation and decisions based on results are made by an experienced clinician in combination with other forms of assessment. [1]

Development

The Depression, Anxiety, and Stress Scales were developed by researchers at the University of New South Wales (Australia). [3]

The test was developed using a sample of responses from the comparison of 504 sets of results from a trial by students, taken from a larger sample of 950 first-year university student responses. [1] The test was then normed on a sample of 1044 men and 1870 women aged between 17 and 69 years, across participants of varying backgrounds, including university students, nurses in training, and blue and white collared employees of a major airline, bank, railway workshop, and naval dockyard. The scores were subsequently checked for validity against outpatient groups, including patients with anxiety and depressive disorders, myocardial infarction patients, patients with insomnia, as well as patients undergoing treatment for sexual, menopausal, and depressive disorders. While the test was not normed against samples younger than 17, due to the simplicity of language, there has been no compelling evidence against the use of the scales for comparison against children as young as 12. [1] The reliability scores of the scales in terms of Cronbach's alpha scores rate the Depression scale at 0.91, the Anxiety scale at 0.84, and the Stress scale at 0.90 in the normative sample. The means and standard deviations for each scale are 6.34 and 6.97 for depression, 4.7 and 4.91 for anxiety, and 10.11 and 7.91 for stress, respectively. The mean scores in the normative sample did vary slightly between genders as well as varying by age, though the threshold scores for classifications do not change by these variations. [1] The Depression and Stress scales meet the standard threshold requirement of 0.9 for research; however, the Anxiety scale still meets the 0.7 thresholds for clinical applications and is still close to the 0.9 required for research.

See also

Related Research Articles

Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought to reflect individual or group differences in the construct the test purports to measure. The science behind psychological testing is psychometrics.

The Minnesota Multiphasic Personality Inventory (MMPI) is a standardized psychometric test of adult personality and psychopathology. Psychologists and other mental health professionals use various versions of the MMPI to help develop treatment plans, assist with differential diagnosis, help answer legal questions, screen job candidates during the personnel selection process, or as part of a therapeutic assessment procedure.

The Beck Depression Inventory, created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.

Personality Assessment Inventory (PAI), developed by Leslie Morey, is a self-report 344-item personality test that assesses a respondent's personality and psychopathology. Each item is a statement about the respondent that the respondent rates with a 4-point scale. It is used in various contexts, including psychotherapy, crisis/evaluation, forensic, personnel selection, pain/medical, and child custody assessment. The test construction strategy for the PAI was primarily deductive and rational. It shows good convergent validity with other personality tests, such as the Minnesota Multiphasic Personality Inventory and the Revised NEO Personality Inventory.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion focused-coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator. Self-report inventories often ask direct questions about personal interests, values, symptoms, behaviors, and traits or personality types. Inventories are different from tests in that there is no objectively correct answer; responses are based on opinions and subjective perceptions. Most self-report inventories are brief and can be taken or administered within five to 15 minutes, although some, such as the Minnesota Multiphasic Personality Inventory (MMPI), can take several hours to fully complete. They are popular because they can be inexpensive to give and to score, and their scores can often show good reliability.

The Beck Anxiety Inventory (BAI), created by Aaron T. Beck and other colleagues, is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in adolescents and adults ages 17 and older. The questions used in this measure ask about common symptoms of anxiety that the subject has had during the past week. It is designed for individuals who are of 17 years of age or older and takes 5 to 10 minutes to complete. Several studies have found the Beck Anxiety Inventory to be an accurate measure of anxiety symptoms in children and adults.

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.

Affect measures are used in the study of human affect, and refer to measures obtained from self-report studies asking participants to quantify their current feelings or average feelings over a longer period of time. Even though some affect measures contain variations that allow assessment of basic predispositions to experience a certain emotion, tests for such stable traits are usually considered to be personality tests.

The Health Dynamics Inventory (HDI) is a 50 item self-report questionnaire developed to evaluate mental health functioning and change over time and treatment. The HDI was written to evaluate the three aspects of mental disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM): "clinically significant behavioral or psychological syndrome or pattern...associated with present distress...or disability". This also corresponds to the phase model described by Howard and colleagues Accordingly, the HDI assesses (1) the experience of emotional or behavioral symptoms that define mental illness, such as dysphoria, worry, angry outbursts, low self-esteem, or excessive drinking, (2) the level of emotional distress related to these symptoms, and (3) the impairment or problems fulfilling the major roles of one's life.

The State-Trait Anxiety Inventory (STAI) is a psychological inventory consisting of 40 self-report items on a 4-point Likert scale. The STAI measures two types of anxiety – state anxiety and trait anxiety. Higher scores are positively correlated with higher levels of anxiety. Its most current revision is Form Y and it is offered in more than 40 languages.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

Catastrophic thinking has widely been recognized in the development and maintenance of hypochondriasis and anxiety disorders. This broadly accepted understanding has classified catastrophizing as a tendency to misinterpret and exaggerate situations that may be threatening. Pain is an undesirable sensory and emotional experience in response to potential or actual tissue damage. A general consensus of pain catastrophizing involves an exaggerated negative perception to painful stimuli. The components of catastrophizing that are considered primary were long under debate until the development of the Pain Catastrophizing Scale (PCS) by Michael J. L. Sullivan and Scott R. Bishop of Dalhousie University in 1995. The PCS is a 13 item scale, with each item rated on a 5-point scale: 0 to 4. The PCS is broken into three subscales being magnification, rumination, and helplessness. The scale was developed as a self-report measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations. The results of the initial development and validation studies indicated that the PCS is a reliable and valid measurement tool for catastrophizing. The high test-retest relationships concluded that individuals may possess enduring beliefs with regards to the threat value of painful stimuli. It was also found that from a clinical perspective, the PCS may be useful in identifying individuals that may be more susceptible to high distress responses from aversive medical procedures such as chemotherapy or surgery.

The Children's Depression Inventory is a psychological assessment that rates the severity of symptoms related to depression or dysthymic disorder in children and adolescents. The CDI is a 27-item scale that is self-rated and symptom-oriented. The assessment is now in its second edition. The 27 items on the assessment are grouped into five major factor areas. Clients rate themselves based on how they feel and think, with each statement being identified with a rating from 0 to 2. The CDI was developed by American clinical psychologist Maria Kovacs, PhD, and was published in 1979. It was developed by using the Beck Depression Inventory (BDI) of 1967 for adults as a model. The CDI is a widely used and accepted assessment for the severity of depressive symptoms in children and youth, with high reliability. It also has a well-established validity using a variety of different techniques, and good psychometric properties. The CDI is a "Level B test," which means that the test is somewhat complex to administer and score, with the administrator requiring training.

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.

Emotional approach coping is a psychological construct that involves the use of emotional processing and emotional expression in response to a stressful situation. As opposed to emotional avoidance, in which emotions are experienced as a negative, undesired reaction to a stressful situation, emotional approach coping involves the conscious use of emotional expression and processing to better deal with a stressful situation. The construct was developed to explain an inconsistency in the stress and coping literature: emotion-focused coping was associated with largely maladaptive outcomes while emotional processing and expression was demonstrated to be beneficial.

The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD). The CAPS includes 30 items administered by a trained clinician to assess PTSD symptoms, including their frequency and severity. The CAPS distinguishes itself from other PTSD assessments in that it can also assess for current or past diagnoses of PTSD.

Watson and Clark (1991) proposed the Tripartite Model of Anxiety and Depression to help explain the comorbidity between anxious and depressive symptoms and disorders. This model divides the symptoms of anxiety and depression into three groups: negative affect, positive affect and physiological hyperarousal. These three sets of symptoms help explain common and distinct aspects of depression and anxiety.

The Connor-Davidson Resilience Scale (CD-RISC) was developed by Kathryn M. Connor and Jonathan R.T. Davidson as a means of assessing resilience. The CD-RISC is based on Connor and Davidson's operational definition of resilience, which is the ability to "thrive in the face of adversity." Since its development in 2003, the CD-RISC has been tested in several contexts with a variety of populations and has been modified into different versions.

The nine-item Patient Health Questionnaire (PHQ-9) is a depressive symptom scale and diagnostic tool introduced in 2001 to screen adult patients in primary care settings. The instrument assesses for the presence and severity of depressive symptoms and a possible depressive disorder. The PHQ-9 is a component of the larger self-administered Patient Health Questionnaire (PHQ), but can be used as a stand-alone instrument. The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than three minutes to complete. It is scored by simply adding up the individual items' scores. Each of the nine items reflects a DSM-5 symptom of depression. Primary care providers can use the PHQ-9 to screen for possible depression in patients.

References

  1. 1 2 3 4 5 6 Lovibond, S.H.; Lovibond, kP.F. (1995), Manual for the Depression Anxiety Stress Scales (2nd ed.), Sydney: Psychology Foundation (Available from The Psychology Foundation, Room 1005 Mathews Building, University of New South Wales, NSW 2052, Australia)
  2. 1 2 Lovibond, P.F.; Lovibond, S.H. (March 1995). "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. 33 (3): 335–343. doi:10.1016/0005-7967(94)00075-U. PMID   7726811.
  3. University of New South Wales Depression Anxiety Stress Scales http://www2.psy.unsw.edu.au/groups/dass/