Properties of the DASS‐21 in an Australian Community Adolescent Population

Brief cognitive behavioural therapy for eating disorders symptomatology among a mixed sample of adolescents and young adults in primary care: A non-randomised feasibility and pilot study

OBJECTIVE

Brief and accessible therapies for people with an eating disorder is an important health target. Ten-session cognitive behavioural therapy (CBT-T) is a brief treatment evaluated in people with a non-underweight eating disorder. This study aimed to evaluate the feasibility and preliminary effectiveness of CBT-T for young people in primary care.

METHOD

This cohort pilot study used group (adolescents vs. young adults) by time (over four time points) Generalised Linear Mixed Model analysis. Participants included 13-25-year-olds attending an early intervention mental health service, receiving 10 sessions of CBT-T. Feasibility was assessed using recruitment, retention and satisfaction. Eating and other pathology measures were administered at baseline, weeks four and 10, and 12-week follow-up.

RESULTS

Of the 63 commencing treatment, 38 completed 10 CBT-T sessions (60%). Most (94%) reported high treatment satisfaction. Significant reductions in eating pathology, depression and stress were found. Age group did not yield differences in CBT-T outcome, with large to very large effect sizes across outcome variables. Anxiety was associated with attrition.

CONCLUSION

This study provides preliminary support for the use of CBT-T in primary care, across adolescence and early adulthood. Findings require replication in other clinical settings and comparison to other clinical approaches and control populations.

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017-2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam.

Are anxiety, depression, and stress distinguishable in Italian adolescents? an examination through the Depression Anxiety Stress Scales-21

The adolescents' ability to discriminate between different negative emotional states is still under debate. The Depression Anxiety Stress Scales-21 (DASS-21) serves as a useful tool to unravel this issue, yet the literature on its structural validity in young people is ambiguous. Therefore, this study aimed to expand knowledge on the emotional experience of youth by investigating the factor structure and psychometric properties of the DASS-21 in Italian adolescents. Six hundred fifty-five students (60.6% girls) aged 14-18 (M = 16.3 ± 1.29) completed an online survey containing the DASS-21 and Positive and Negative Affect Schedule (PANAS). To evaluate the factor structure of the DASS-21, several alternative models were tested, also adopting an Exploratory Structural Equation Modeling (ESEM) procedure. Measurement invariance, reliability, validity, and latent means differences were addressed. The ESEM model with three correlated factors of Depression, Anxiety, and Stress yielded the best fit to the data, supporting a hierarchical structure of the DASS-21. In addition, this model was invariant across sex and age groups. The Anxiety scale predicted both positive and negative affect, while Depression predicted positive affect only. Finally, girls scored higher than boys on Anxiety and Depression, but no age differences emerged. Overall, our results indicate that anxiety, depression, and stress are distinguishable in Italian adolescents but, simultaneously, share an underlying condition of general distress, which may explain the comorbidity between internalizing problems. Such findings are discussed in terms of clinical and preventive implications for the adolescent population.

Identifying overcontrol and undercontrol personality types among young people using the five factor model, and the relationship with disordered eating behaviour, anxiety and depression

BACKGROUND

Overcontrol and undercontrol personality types have been associated with an increase in eating pathology, depression and anxiety. The aim of the research was to explore whether latent overcontrol and undercontrol personality types could be identified using cluster analysis of the facets of the five factor model (FFM). We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety.

METHODS

A total of 561 participants (394 women and 167 men), aged 16-30 years in Australia completed a survey designed to assess disordered eating, FFM personality traits, anxiety, depression and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify a meaningful 3-cluster solution.

RESULTS

The results revealed a cluster solution that represented overcontrol, undercontrol and resilient personality types, and highlighted facets of the FFM that were associated with each type. Both overcontrol and undercontrol personality types were associated with increased clinical symptoms compared to the resilient types.

CONCLUSIONS

It was concluded that FFM facets may potentially be more meaningful than broad domains in identifying personality types, and that both overcontrol and undercontrol personality types are likely associated with increased clinical symptoms.

Assessment and Psychometric Properties of the 21-Item Depression Anxiety Stress Scale (DASS-21) among Portuguese Higher Education Students during the COVID-19 Pandemic

The COVID-19 pandemic has caused substantial disruptions in the lives of higher education students, with detrimental repercussions for academic performance and overall mental health. Therefore, we aimed to evaluate the prevalence of depression, anxiety, and stress symptoms among Portuguese higher education students during the first wave of the coronavirus pandemic and investigate DASS-21's psychometric characteristics and whether it functions effectively during a pandemic. A convenience sampling procedure was used to recruit 1522 participants (75.1% women and 79.2% undergraduate students) for this cross-sectional research. Participants completed an e-survey created using DASS-21. The results revealed a considerable prevalence of symptoms of depression [≥10] (N = 434, 28.5%), anxiety [≥7] (N = 551, 36.2%), and stress [≥11] (N = 544, 35.7%). Confirmatory factor analysis (CFA) revealed the scale's three-factor structure, which matched the three DASS-21 subscales. Subsequently, the heterotrait-monotrait (HTMT) correlation ratio evaluated the scale's discriminant validity, which was relatively good. Cronbach's alpha measured the internal consistency of the DASS subscales, which was excellent (Cronbach's α > 0.90). DASS-21 was shown to be a reliable and appropriate measure for assessing students' mental health. Furthermore, DASS-21 is recommended for use by academics and healthcare professionals in measuring students' psychological distress. Further validation studies of this scale are needed with larger and more representative samples.

The Youth Internalizing Problems Screener: Validation in Serbian Adolescents and Measurement Invariance across Serbia and the USA

The Youth Internalizing Problems Screener (YIPS) is a recently developed measure of general internalizing problems in adolescence. Validity evidence supporting interpretation and use of the YIPS outside the USA is still limited, and no research to date has examined cross-national invariance of this scale. Using two samples of Serbian adolescents, the present study examined the factor structure, internal consistency reliability, and convergent and incremental validity of a Serbian language version of the YIPS. Following, we evaluated the measurement invariance of the YIPS across Serbian and USA samples. Evidence for a one-factor structure and good internal consistency for the Serbian YIPS was found. The scale scores yielded strong associations with measures of depression, anxiety, life satisfaction, and positive and negative affect, indicating evidence of convergent validity. YIPS scores also had a unique contribution over and above depression and anxiety in predicting subjective well-being, thus supporting incremental validity. Partial scalar invariance for the YIPS measurement model was indicated across Serbian and USA samples. We conclude the YIPS appears to be a psychometrically sound measure of general internalizing problems among Serbian adolescents.

Validation of the combined Patient Health Questionnaire Anxiety and Depression Scale among people with HIV in Vietnam

BACKGROUND

Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam.

METHODS

Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n = 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined.

RESULTS

The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life.

CONCLUSIONS

Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.

Evaluating the psychometric properties of the Chinese Depression Anxiety Stress Scale for Youth (DASS-Y) and DASS-21

BACKGROUND

In recognizing the need for a reliable and valid instrument to assess psychological distress among children and adolescents, the present study translated the newly developed Depression Anxiety Stress Scale for Youth (DASS-Y) into Chinese, while also comparing its psychometric properties with those of the well-established DASS-21 within a primary and middle school demographic.

METHODS

Utilizing a combination of convenience sampling and purposive sampling, a cohort comprising 1,507 primary and 1,131 middle school students was recruited. Rasch analysis, confirmatory factor analysis (CFA), and structural equation modeling (SEM) were used in the data analysis.

RESULTS

Significant differences were observed between the DASS-Y and the DASS-21, notably within the anxiety subscale. The proportions of individuals with clinical mood disorders identified by the two scales demonstrated a significant disparity. Both scales, following an adjustment of responses, exhibited satisfactory internal consistency and convergent validity, with the acceptance of a three-factor structure. Furthermore, the DASS-Y showed superior discriminant validity relative to the DASS-21, providing more compelling evidence regarding concurrent validity.

CONCLUSION

Overall, the Chinese version of the DASS-Y demonstrated superior robustness to the DASS-21 in terms of psychometric properties. The findings provide initial evidence for the psychometric properties of the DASS-Y from another culture.

Digital media and mental health in adolescent athletes

Although digital media are increasingly important for adolescent athletes, few studies explore their influence on mental health in this population. This study aimed to examine this relationship in 591 German adolescent athletes (aged 12-19 years) from 42 different sports. Longer daily social media usage was connected to increased negative affect and dysfunctional eating patterns. Similar results were found for cognitive-behavioral symptoms of excessive media usage and mental health. Structural equation modeling revealed these relationships were mediated by social comparison and quality of sleep. Higher athletic performance level was related to increased social comparison, but not to quality of sleep, negative affect, and dysfunctional eating. The negative relationship between excessive media usage and sleep was stronger in competitive and elite than in recreational athletes. Results imply digital media should receive attention when aiming to improve mental health in athletes. Relevant targets for future intervention could be social comparison and sleep.

Dimensional personality pathology and disordered eating in young adults: measuring the DSM-5 alternative model using the PID-5

Introduction

The Personality Inventory for DSM-5 (PID-5) is a self-report measure of personality pathology designed to measure pathological personality traits outlined in the DSM-5 alternative model of personality disorders. Within the extensive literature exploring the relationship between personality and disordered eating, there are few that explore the relationship between the PID-5 and disordered eating behaviours in a non-clinical sample of males and females: restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building.

Methods

An online survey assessed disordered eating, PID-5 traits and general psychopathology and was completed by 394 female and 167 male participants aged 16-30. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the PID-5 scales, body dissatisfaction and age predicted behaviour.

Results

The results indicated that each of the six disordered behaviours were associated with a unique pattern of maladaptive personality traits. The statistical models differed between males and females indicating possible differences in how dimensional personality pathology and disordered eating relate.

Discussion

It was concluded that understanding disordered eating behaviour in the context of personality pathology may assist formulating potentially risky behaviour.

Protocol for a bandit-based response adaptive trial to evaluate the effectiveness of brief self-guided digital interventions for reducing psychological distress in university students: the Vibe Up study

INTRODUCTION

Meta-analytical evidence confirms a range of interventions, including mindfulness, physical activity and sleep hygiene, can reduce psychological distress in university students. However, it is unclear which intervention is most effective. Artificial intelligence (AI)-driven adaptive trials may be an efficient method to determine what works best and for whom. The primary purpose of the study is to rank the effectiveness of mindfulness, physical activity, sleep hygiene and an active control on reducing distress, using a multiarm contextual bandit-based AI-adaptive trial method. Furthermore, the study will explore which interventions have the largest effect for students with different levels of baseline distress severity.

METHODS AND ANALYSIS

The Vibe Up study is a pragmatically oriented, decentralised AI-adaptive group sequential randomised controlled trial comparing the effectiveness of one of three brief, 2-week digital self-guided interventions (mindfulness, physical activity or sleep hygiene) or active control (ecological momentary assessment) in reducing self-reported psychological distress in Australian university students. The adaptive trial methodology involves up to 12 sequential mini-trials that allow for the optimisation of allocation ratios. The primary outcome is change in psychological distress (Depression, Anxiety and Stress Scale, 21-item version, DASS-21 total score) from preintervention to postintervention. Secondary outcomes include change in physical activity, sleep quality and mindfulness from preintervention to postintervention. Planned contrasts will compare the four groups (ie, the three intervention and control) using self-reported psychological distress at prespecified time points for interim analyses. The study aims to determine the best performing intervention, as well as ranking of other interventions.

ETHICS AND DISSEMINATION

Ethical approval was sought and obtained from the UNSW Sydney Human Research Ethics Committee (HREC A, HC200466). A trial protocol adhering to the requirements of the Guideline for Good Clinical Practice was prepared for and approved by the Sponsor, UNSW Sydney (Protocol number: HC200466_CTP).

TRIAL REGISTRATION NUMBER

ACTRN12621001223820.

Comparing the impact of high versus low lockdown severity on the mental health of young people in Australia during the COVID-19 pandemic

Young Australians have been differentially affected by lockdowns and social restrictions during the COVID-19 pandemic. This study compared the mental health impacts of the COVID-19 pandemic and associated restrictions for young people in two Australian states, Victoria and Queensland, with Victoria experiencing more days in lockdown and greater infection rates. An online survey was completed between 01/04/2021 and 31/07/2021 by 687 young people, aged 16 to 24 years; 337 from Victoria and 350 from Queensland. Levels of negative emotion feelings (as measured by the Depression Anxiety Stress Scale), and COVID-19 risk factors for negative emotions (such as financial hardship, education disruption, loneliness and household conflict), as well as protective factors (resilience and self-esteem) were compared between the Victorian and Queensland samples, also considering some early pandemic data and pre-pandemic norms. No significant differences in negative emotions were found between young people living in the two states, despite substantial differences in pandemic restrictions. The results indicated that young people in Queensland and Victoria had experienced similarly high levels of negative emotions, at levels also seen at the start of the pandemic in Victoria. This is of grave concern, requiring urgent attention as the pandemic continues.

Development and psychometric properties of the Stressors in Breast Cancer Scale

Background

A diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.

Aims

The aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).

Method

A panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.

Results

Validity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.

Discussion

The results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.

Nature experience from yards provide an important space for mental health during Covid-19

Urban dwellers' use of public and private green spaces may have changed during the early years of the Covid-19 pandemic due to movement restriction. A survey was deployed in Brisbane and Sydney, Australia 1 year after the start of Covid-19 restrictions (April 2021) to explore relationships of mental health and wellbeing to different patterns of private yard versus public green space visitation. More frequent yard use during the initial year of Covid-19 was correlated with lower stress, depression, and anxiety and higher wellbeing. However, greater duration of yard visits (week prior to survey) was associated with higher stress, anxiety, and depression scores, potentially because individuals may seek to use nature spaces immediately available for emotional regulation during difficult times. The results highlight the importance of yards for mental health and wellbeing during the Covid-19 pandemic and that relationships between nature interaction and mental health may be context and timeframe dependent.

One size does not fit all: Exploring how the five-factor model facets predict disordered eating behaviours among adolescent and young adult males and females

There is a wealth of research that has highlighted the relationship between personality and eating disorders. It has been suggested that understanding how subclinical disordered eating behaviours are uniquely associated with personality can help to improve the conceptualization of individuals with eating disorders. This study aimed to explore how the facets of the Five-Factor Model (FFM) predicted restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building among males and females. An online survey assessing disordered eating behaviours, FFM and general psychopathology was completed by 394 females and 167 males aged between 16 and 30 years. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the FFM facets, body dissatisfaction and age predicted behaviour. The results indicated that each of the six disordered behaviours were predicted by a unique pattern of thinking, feeling and behaving. Considerable differences between males and females were found for each path model, suggesting differences between males and females in the personality traits that drive disordered eating behaviours. It was concluded that it is important to take personality into account when treating males and females who engage in disordered eating behaviours.

Adolescent sleep, distress, and technology use: weekday versus weekend

BACKGROUND

In adolescents, technology use at bedtime is linked to disrupted sleep and psychological distress. Adolescents are known to sleep later on weekends compared to weekdays but whether this leads to greater technology use, and, hence, additional psychological distress is not known. At greater risk maybe adolescents with a late compared to early chronotype, that is a preference for late versus early sleep onset and offset times.

METHOD

Self-reported measures of sleep timing, chronotype (early, neither early nor late, late), technology medium (social media/texting, TV/streaming, and gaming), and psychological distress (DASS-21) were collected from 462 students attending one Australian high school.

RESULTS

Technology use at bedtime was greater on weekends and especially in adolescents with a late chronotype. Social media/texting on weekends was predictive of delayed sleep onset times (β = .120), and shorter sleep (β = -.172). Shorter sleep on weekdays but not on weekends was associated with greater psychological distress. Technology medium and chronotype were not predictive of psychological distress.

CONCLUSIONS

This study confirmed that technology use and its impact on sleep differed on weekdays compared to weekends and that a late chronotype was associated with greater technology use. However, neither technology medium nor chronotype was found to affect psychological distress. While greater autonomy may be granted to adolescents over the weekend regarding sleep behaviour, young people, parents, and clinicians should be mindful of the link between technology use and sleep.

Social rejection sensitivity and its role in adolescent emotional disorder symptomatology

BACKGROUND

Most emotional disorders first emerge during adolescence, a time characterized by heightened sensitivity to social information, especially social rejection. Social rejection sensitivity (SRS), then, may be a promising intervention target.

METHODS

To explore this, 357 participants (M (SD) age = 19.40 (4.18), 63% female) completed self-report measures of SRS, its proposed antecedent, perceived parenting style, its proposed behavioral correlate, negative interpretation bias, and its proposed  clinical correlate, emotional disorder symptoms. Participants additionally completed a single session of a social interpretation bias modification task, the ambiguous social scenarios task (ASST).

RESULTS

SRS was associated with perceived parental rejection, while controlling for other types of maladaptive parenting. SRS partially accounted for variance in the relationship between perceived parental rejection and emotional disorder symptomatology, as well as the relationship between negative interpretation bias and emotional disorder symptoms. Learning rates (i.e., change in reaction time across the task) on the ASST differed as a function of age and SRS, such that younger participants with higher SRS showed the slowest rate of learning. Moreover, individual differences in SRS accounted for the magnitude of change in negative interpretation bias before and after the ASST. Individuals with greater SRS showed less change in interpretation bias.

CONCLUSIONS

SRS appears strongly associated with emotional disorder symptoms in adolescents. Importantly, SRS was associated with the malleability of negative interpretation bias, which may help account for the mixed findings on the effectiveness of interpretation-bias-modification-paradigms in adolescents.

Examining the role of brooding, distress, and negative urgency in dysregulated behaviors: A cross-sectional study in treatment-seeking young people

OBJECTIVE

Dysregulated behaviors including substance use, disordered eating, and nonsuicidal self-injury (NSSI) have significant negative implications for individuals and health systems. It is therefore paramount to understand factors influencing behavioral dysregulation, to inform prevention and treatment approaches. The literature suggests that distress and rumination (brooding) prompt individuals to engage in behavioral dysregulation for distraction (Emotional Cascade Model), although these concepts have limited investigation in clinical, treatment-seeking samples, particularly alongside negative urgency. This cross-sectional study sought to examine the relationships of brooding, distress, and negative urgency with behavioral dysregulation, as well as the moderating effect of negative urgency between brooding and behavioral dysregulation, in treatment-seeking young people.

METHOD

A total of 385 treatment-seeking young people completed cross-sectional, self-report measures of distress, rumination, negative urgency, and engagement in dysregulated behaviors (NSSI, alcohol use, drug use, binge eating, and purging) over the past 1-3 months.

RESULTS

Structural equation modeling revealed that only negative urgency, and not brooding or distress, had a significant positive relationship with behavioral dysregulation. Negative urgency did not significantly moderate the relationship between brooding and behavioral dysregulation.

CONCLUSIONS

These findings reinforce the importance of considering negative urgency in the conceptualization, prevention, and treatment of behavioral dysregulation, and contribute to the knowledge of the relationship between brooding and various dysregulated behaviors within a treatment-seeking sample.

Dimensionality and reliability of the Depression Anxiety Stress Scales 21 among adolescents in North Macedonia

This study examined the structural validity and reliability of the DASS-21 in a large sample (N = 4,202) of secondary school students from North Macedonia (M_age = 16.43 ± 1.04, 65% girls). Based on theoretical and empirical considerations, five structural models were compared using confirmatory factor analysis. The original three-factor model provided good fit to the data; however, high interfactor correlations indicated that the depression, anxiety, and stress factors were indistinguishable. The bifactor solution yielded superior fit relative to other tested models. Factor loading patterns revealed a strong general factor and some specificity of the depression and anxiety factors, whereas the stress items were primarily markers of general distress. Model-based reliability and ancillary bifactor indices revealed that the DASS-21 is essentially unidimensional. Thus, only the total score could be used as a reliable measure of general emotional distress, while subscale scores should be avoided. Overall, the findings provide further support for the cross-cultural validity of the DASS-21 and confirm that it is suitable for use among older adolescents in North Macedonia.

Using a bifactor exploratory structural equation modeling framework to examine the factor structure of the Depression Anxiety and Stress Scales-21

This study proposed an improved representation of the DASS-21 factor structure developed by Lovibond and Lovibond in Behaviour Research and Therapy, 33, 335-342 (1995) using bifactor exploratory structural equation modeling (bifactor ESEM). This research was conducted by reference to 521 Turkish adults (45.3% females; M age = 27.86, SD = 8.23). The bifactor ESEM findings indicated a strong general factor of negative affect underlying responses to all DASS-21 items but also that despite the presence of three specific factors (depression, anxiety, and stress), the depression subscale explained a high degree of variance and could be considered to constitute a specific factor. The results obtained from this study show that there is a common factor associated with DASS-21 scales, the total score of DASS-21 can be identified as a measure of general negative affect, and the bifactor ESEM structure of DASS-21 ensures measurement invariance across genders.

Translation and validation of the Depression Anxiety Stress Scales for menopausal women in Indonesia

OBJECTIVE

This study evaluated the construct validity of the Depression Anxiety Stress Scales-21 (DASS-21) for menopausal women in Indonesia.

METHODS

This cross-sectional study included 236 women aged 45-60 years and assessed internal consistency using Cronbach's α. The study used convenience sampling. Test-retest reliability was measured twice on an extra 30 women at 1-week and 2-week intervals. Confirmatory factor analysis (CFA) was employed to investigate its structural model fit.

RESULTS

The intraclass correlation coefficient for the test-retest reliability ranged between 0.95 and 0.96. The overall Cronbach's α coefficient of the DASS-21 was 0.95. The CFA results indicated that the goodness-of-fit index was 0.85, comparative fit index was 0.95, root-mean-square error of approximation was 0.07, related fit index was 0.91 and normed fit index was 0.92.

CONCLUSIONS

This study's results indicated that the DASS-21 has satisfactory validity and reliability for detecting depression, anxiety and stress in menopausal women in Indonesia.

The Relationship Between Children's Problematic Internet-related Behaviors and Psychological Distress During the Onset of the COVID-19 Pandemic: A Longitudinal Study

BACKGROUND

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic has generated negative effects on psychological well-being worldwide, including in schoolchildren. Government requirements to stay at home and avoid social and school settings may impact psychological well-being by modifying various behaviors such as problematic phone and Internet use, yet there is a paucity of research on this issue. This study examined whether the COVID-19 outbreak may have impacted problematic smartphone use (PSU), problematic gaming (PG), and psychological distress, specifically the pattern of relationships between PSU, PG, and psychological distress in schoolchildren.

METHODS

Longitudinal data on psychological distress, PSU, and PG were collected from 575 children in primary schools in 3 waves: Waves 1 and 2 were conducted before the COVID-19 outbreak and Wave 3 during the outbreak. Cross-lagged panel models were used to examine relationships between factors across the 3 waves.

RESULTS

Cross-lagged models found that higher levels of PSU were not significantly related prospectively to greater psychological distress before the COVID-19 outbreak, but this prospective relationship became significant during the COVID-19 outbreak. Whereas PG was associated prospectively with psychological distress before the COVID-19 outbreak (ie, between Waves 1 and 2), this association became nonsignificant during the COVID-19 lockdown (ie, between Waves 2 and 3).

CONCLUSIONS

The COVID-19 outbreak has seemed to change prospective relationships between PSU and psychological distress and PG and psychological distress in schoolchildren. Future research should examine whether restrictions on or information provided to schoolchildren may exacerbate PSUs effects on psychological distress.

The Mental Health and Social Media Use of Young Australians during the COVID-19 Pandemic

Young people may be particularly vulnerable to the mental health impacts of the COVID-19 pandemic and may also be more likely to use social media at this time. This study aimed to explore young people’s mental health and social media use during the COVID-19 pandemic and examined their use of social media to seek and provide support for suicidal thoughts and self-harm during this period. Young people aged 16–25 (n = 371, M = 21.1) from the general population in Australia completed an anonymous, cross-sectional online survey advertised on social media from June to October 2020. Participants reported high levels of psychological distress, with over 40% reporting severe levels of anxiety and depression, and those with a mental health diagnosis were more likely to perceive the pandemic to have had a negative impact on their mental health. Gender-diverse participants appeared the most negatively impacted. Social media use was high, with 96% reporting use at least once a day, and two-thirds reporting an increase in social media use since the start of the pandemic. One-third had used social media to seek support for suicidal thoughts or self-harm, and half had used it to support another person. This study adds to a growing literature suggesting social media can provide an opportunity to support young people experiencing psychological distress and suicide risk. Uniquely, this study points to the utility of using social media for this purpose during high-risk periods such as pandemics, where access to face-to-face support may be limited. To promote the quality and safety of support provided on social media, resources for help-seekers and help-givers should be developed and disseminated. Social media companies must consider the vulnerability of some users during pandemics and do what they can to promote wellbeing and safety.

Mental health status of early married girls during the COVID-19 pandemic: A study in the southwestern region of Bangladesh

BACKGROUND

Due to unemployment, the prolonged lockdown during the COVID-19 pandemic caused panic and deepened poverty, especially among lower-class and marginal people. The related financial crises led to harmful practices such as the early marriage of adolescent girls, which deteriorated these girl's mental state.

AIMS

This study attempted to assess the prevalence of mental health problems among early married girls and determine the associated predictors of the growing mental health burden.

METHODS

This cross-sectional survey was conducted during the third wave of the COVID-19 pandemic in Dumuria Upazila in the Khulna district of Bangladesh. Data were collected purposively from 304 girls who were married off during the COVID-19 pandemic, this was carried out between 22 July and 31 August 2022 by administering a semi-structured interview schedule, with mental health measured by the depression, anxiety, and stress scale 21 (DASS 21). The data were analyzed using IBM SPSS Statistics (version 25), and multiple linear regression was executed in order to predict mental health problems among early married girls.

RESULTS

The findings show that the overall prevalence of depression, anxiety, and stress among early married girls during the COVID-19 pandemic in Bangladesh was 60.9% (95% CI: 0.554-0.663), 74.7% (95% CI: 0.698-0.796), and 23.7% (95% CI: 0.189-0.285). The prevalence was relatively higher among girls from the Sanatan (Hindu) religion and younger girls than among Muslim and older girls, respectively. The multiple linear regressions indicate that age, age at marriage, duration of the marriage, spousal occupation, intimate partner violence (IPV), and subjective happiness were the critical predictors of mental health problems among early married girls.

CONCLUSION

Early marriage, along with various adverse outcomes, i.e., IPV, maladjustment, and poor subjective happiness, has resulted in heightened mental health problems for young girls. Policymakers should implement coercive measures to prevent early marriage, especially during social, economic, political, and health crises; in addition, more research is recommended in order to explore the mechanisms that make early married girls psychologically vulnerable and thus formulate protective and preventive programs for addressing such vulnerabilities.

The development and preliminary validation of a brief scale of emotional distress in young people using combined classical test theory and item response theory approaches: The Brief Emotional Distress Scale for Youth (BEDSY)

Reliable, valid, and brief measures are important for identifying young people in community contexts who experience mental health problems. This paper reports the development and preliminary validation of the Brief Emotional Distress Scale for Youth (BEDSY), a measure based on anxiety and depression symptoms that load strongly upon the general construct of emotional distress. Participants, aged 11-17 years, included 2663 from a community population and 281 referred anxious youth. From a pool of 20 items, eight were selected for the final scale using methods from classical test theory, followed by item response theory (IRT). The final eight items met the pre-specified criteria for skewness and kurtosis, item-total correlations, IRT characteristics, and discrimination between referred vs. community samples. Exploratory structural equation modeling for a bi-factor model indicated that 81% of total variance was explained by the general emotional distress factor. The 8-item BEDSY showed strong internal consistency, good construct validity, and acceptable sensitivity and specificity in discriminating between a community sample vs anxious youth, and between youth with and without high levels of depressive symptoms. As such the scale has strong potential as a brief screen for identifying emotionally distressed young people in community contexts.

Associations between Physical Activity and Mental Health in Iranian Adolescents during the COVID-19 Pandemic: An Accelerometer-Based Study

Using self-reported questionnaires, several studies found that social isolation during the COVID-19 pandemic has significantly changed the level of physical activity (PA) in children and adolescents. Since the objectivity of self-reported PA is limited in several ways, we used modern accelerometers in this study to assess the PA levels of male and female adolescents during the pandemic-related lockdown. Moreover, the association of PA with mental health of the adolescents were analyzed. A total of 136 students (76 girls, mean age of 16.28 ± 0.97 years) from various schools in Iran wore the accelerometer (ActiGraph GT3X-BT) for seven consecutive days. Mental health was measured through the Depression, Anxiety, Stress Scale-21 of Lovibond and Lovibond (1995). Descriptive statistics and independent t-tests were used to analyze the PA levels of male and female students, and linear regressions were computed to examine whether PA predicts mental health status. On average, the daily time spent in moderate-to-vigorous PA (MVPA) was 18.47 min, which is clearly below the WHO guideline of at least 60 min of MVPA per day. Only 4% of adolescents showed MVPA for more than 30 min per day. Male students were significantly more active than their female peers (p = 0.015). As expected, MVPA was negatively associated with mental health issues such as depression, anxiety, and stress. However, the majority of adolescents reported symptoms of mild-to-moderate mental health disorders. These results emphasize the need for targeted strategies and offerings geared to young people's needs and preferences to promote an adequate level of PA and good mental health during and after the ongoing pandemic.

DASS-21: assessment of psychological distress through the Bifactor Model and item analysis

Abstract The term distress has been used to refer to a continuous variable operationalized through symptoms of depression, anxiety, and stress. In this study, psychological distress is measured using the Depression, Anxiety, and Stress Scale (DASS-21). Confirmatory Factor Analysis compared the fit of different measurement models for the DASS-21, with the parameters of the items verified through the Andrich rating scale model. A non-clinical sample of 530 participants (mean age=24.35±6.55 years; 71.89% women) responded to the instrument. According to the theoretical hypothesis, the results indicated a better fit for the bifactor model, composed of three specific factors (depression, anxiety, and stress) and a general factor (general psychological distress). The assessment of the item properties allowed for a better understanding of the organization of the continuum represented by the construct psychological distress. It is possible to conclude that the Brazilian version of the DASS-21 is an adequate measure for psychological distress.

Prevention and early intervention of depression in young people: an integrated narrative review of affective awareness and Ecological Momentary Assessment

Depression has a devastating impact on young people around the world. This impact is pervasive and long-long lasting, still causing havoc as young people transition into adulthood. Prevention and timely early intervention efforts are necessary to lessen the disease burden of depression in young people. There is some evidence for the effectiveness of existing prevention and early intervention programs when delivered early. However, there is no consensus on what the active ingredients of these programs are. Identifying these ingredients is important because focusing on those that have maximal benefit will help to minimise the costs and resourcing of (already intensive) therapeutic approaches. We explored whether, and in what circumstances, affective awareness (i.e., knowing how one feels) is a candidate for protecting against and decreasing vulnerability to depression in young people. We specifically looked at how Ecological Momentary Assessment methods (EMA) were used to measure and/or increase affective awareness. We integrated three streams of data, including narrative review findings, perspectives from young people and psychologists, and publicly available information online (e.g., discussion forums). Across data sources, we found converging evidence that affective awareness is important in the prevention and early intervention of depression although there were considerable gaps in knowledge. More work needs to be done with young people and their health care teams to build affective awareness in the right way, at the right time, with individual differences in mind. The identification of how EMA can be best incorporated into young people's lives to facilitate these outcomes is also needed.

Internet-Related Behaviors and Psychological Distress Among Schoolchildren During the COVID-19 School Hiatus

This study assessed the mediating roles of problematic gaming, problematic social media use, and problematic smartphone use in the associations between psychological distress and screen time use among primary school children during the school hiatus due to the outbreak of the novel coronavirus disease 2019 (COVID-19). Students (n = 2,026; mean [standard deviation] age = 10.71 years [1.07]; 1,011 [49.9 percent] girls) in Sichuan, China completed a cross-sectional online survey, and this study was approved by the ethics committee of the Hong Kong Polytechnic University (IRB ref: HSEARS20190718001). The Internet Gaming Disorder Scale-Short Form, Bergen Social Media Addiction Scale, and Smartphone Application-Based Addiction Scale were used to assess problematic gaming, social media use, and smartphone use. The Depression, Anxiety, Stress Scale-21 was used to assess distress, and an item rated on a 0-10 scale was included to assess fear of being infected by COVID-19. Fear of being infected by COVID-19 was assessed because this could be a confounding variable in the association between psychological distress and screen time use. Increased time spent on gaming, social media, and smartphones was associated with greater problematic gaming, problematic social media use, problematic smartphone use, and psychological distress, but was not associated with fear of COVID-19 infection. Mediation analyses showed that problematic gaming, problematic social media use, and problematic smartphone use were significant mediators in the association between psychological distress and increased time spent on Internet-related activities during the COVID-19 outbreak period. Children who had psychological distress during COVID-19 outbreak might have spent longer time on Internet-related activities due to the school hiatus and problematic use of Internet-related activities. Parents/caregivers are recommended to monitor their children's use of Internet while encouraging children to engage in positive activities to ease the concern of negative psychological responses during the COVID-19 pandemic.

Moderating effects of plastic packaged food on association of urinary phthalate metabolites with emotional symptoms in Chinese adolescents

Previous research reports that diet is the main source of phthalate exposure to adolescents, and phthalate is associated with adolescent mental and behavioral problems. However, no study has explored the moderating effects of eating behavior in this association. This study aimed to analyze the moderating effects of plastic packaged food consumption in the longitudinal association between phthalate metabolite concentration and emotional symptoms in adolescents. This school-based survey was carried out among adolescents in two Chinese provinces. We conducted a baseline and follow-up surveys for 893 freshmen using the purposive sampling method from December 2018 to November 2019. We used food frequency questionnaire to assess eating behavior. The Chinese version of 21-item Depression Anxiety Stress Scales was used to assess emotional symptoms, and high-performance liquid chromatography-tandem mass spectrometry was used to analyze the concentration of six urine phthalate metabolites. The results of latent moderation model indicated that plastic packaged food consumption moderated the association of low molecular weight phthalate (LMWP) with depressive symptoms (β = 0.27, P = 0.002), anxiety symptoms (β = 0.89, P < 0.01), and stress symptoms (β = 0.23, P = 0.019). The moderating effects were significant at the higher scores (β = 0.14-0.35, P < 0.05) and/or the lower scores (β = -0.35 to -0.12, P < 0.05) of plastic packaged food consumption. The results suggest that plastic packaged food consumption to some extent moderates the longitudinal association of phthalate exposure with emotional symptoms in adolescents.

Examining the Link Between Character Strengths and Positive and Negative Mental Health Indicators in Iranian Adolescents

Character strengths are an important foundation for positive development and thriving in adolescence. Most research on character strengths has been conducted with youths in Western cultures. We examined character strengths in relation to positive and negative well-being indicators in a sample of Iranian youths. We investigated the reliability and validity of the Farsi version of the Values in Action Inventory of Strengths for Youth (VIA Y-96)—a self-report survey commonly used in Western contexts. Participants were adolescents in Iran ( N = 1,359; 48.5% female; M age = 13.54, SD = 1.00) who completed the VIA Y-96 and questionnaires assessing life satisfaction, positive/negative experiences, depression, anxiety, and stress. We found that reliability coefficients were acceptable for most of the VIA subscales. A confirmatory factor analysis (CFA), as well as a second-order CFA, supported the construct validity of the Farsi VIA Y-96. Correlations between the character strengths and positive and negative well-being indicators supported convergent validity. Measurement invariance for the VIA Y-96 was established in this study comparing boys’ and girls’ response patterns. Sex and grade level differences were found for some of the subscales. Overall, the Farsi VIA Y-96 had acceptable psychometric properties, suggesting that it can be used in research on character strengths with Iranian youths.

Psychological distress and internet-related behaviors between schoolchildren with and without overweight during the COVID-19 outbreak

OBJECTIVE

The novel coronavirus disease 2019 (COVID-19) pandemic, and its resulting social policy changes may result in psychological distress among schoolchildren with overweight. This study thus aimed to (1) compare psychological distress (including fear of COVID-19 infection, stress, anxiety, and depression), perceived weight stigma, and problematic internet-related behaviors between schoolchildren with and without overweight; (2) assess whether perceived weight stigma and problematic internet-related behaviors explained psychological distress.

METHODS

Schoolchildren (n = 1357; mean age = 10.7 years) with overweight (n = 236) and without overweight (n = 1121) completed an online survey assessing their fear of COVID-19 infection, stress, anxiety, depression, perceived weight stigma, problematic smartphone application use, problematic social media use, and problematic gaming.

RESULTS

Schoolchildren with overweight had significantly higher levels of COVID-19 infection fear, stress, depression, perceived weight stigma, and problematic social media use than those without overweight. Regression models showed that perceived weight stigma and problematic internet-related behaviors were significant predictors of psychological distress among schoolchildren with overweight.

CONCLUSION

Strategies to manage perceived weight stigma and problematic internet-related behaviors may have a positive influence on mental health among schoolchildren with overweight under health-threatening circumstances, such as the current COVID-19 pandemic.

Problematic internet-related behaviors mediate the associations between levels of internet engagement and distress among schoolchildren during COVID-19 lockdown: A longitudinal structural equation modeling study

BACKGROUND AND AIMS

Due to the rapid spread of the novel coronavirus disease 2019 (COVID-19), policies based on the nature of "spatial distancing" have been implemented and have resulted in school suspensions and online learning among schoolchildren. In order to examine the impact of such policies on schoolchildren, the aims of the present study were to (i) assess changes in the level of engagement in three internet-related activities (smartphone use, social media use, and gaming) before and during the COVID-19 outbreak, including prolonged and problematic engagement in these activities; (ii) investigate the differences of psychological distress before and after COVID-19 outbreak; and (iii) to use structural equation modeling to investigate the mediating roles of problematic internet-related behaviors in the causal relationships of psychological distress and time spent on internet-related activities.

METHODS

Self-report measures were used to assess internet-related activities and psychological distress. Time spent on internet-related activities, problematic use of internet-related activities, and psychological distress were collected from primary school students (N = 535; 265 boys; M age = 10.32 years [SD = 0.84]). The data were first collected before the COVID-19 outbreak (i.e., early November 2019) and then collected again during the school suspension due to COVID-19 outbreak (i.e., end of March 2020) for comparisons of changes.

RESULTS

Schoolchildren spent significantly more time on the smartphone (increased 1.02 h daily; P < 0.001) and social media (increased 0.73 h daily; P < 0.001) but not gaming (increased 0.14 h daily; P = 0.07) during the school suspension compared to the baseline. Schoolchildren who increased by 15 or 30 min daily on internet-related activities showed an increased level of psychological distress. The association between problematic use of social media and psychological distress was stronger during the school suspension (β = 0.584) than at the baseline (β = 0.451; P < 0.001).

CONCLUSION

Increased problematic use of internet-related activities among schoolchildren was associated with greater psychological distress. Parents should therefore monitor internet-related activities and psychological distress of their children to support their mental health.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.

Prevalence, Psychological Responses and Associated Correlates of Depression, Anxiety and Stress in a Global Population, During the Coronavirus Disease (COVID-19) Pandemic

Uncertainty and isolation have been linked to mental health problems. Uncertainty surrounding the COVID-19 pandemic has the potential to trigger mental health problems, which include anxiety, stress, and depression. This paper evaluates the prevalence, psychological responses, and associated correlates of depression, anxiety, and stress in a global population during the Coronavirus Disease (COVID-19) pandemic. A cross-sectional study design was adopted. 678 completed forms were collected during the COVID-19 quarantine/lockdown. An online questionnaire was designed and DASS-21 was used as the screening tool. A non-probability sampling technique strategy was applied. 50.9% of participants showed traits of anxiety, 57.4% showed signs of stress, and 58.6% exhibited depression. Stress, anxiety, and depression are overwhelmingly prevalent across the globe during this COVID-19 pandemic, and multiple factors can influence the rates of these mental health conditions. Our factorial analysis showed notable associations and manifestations of stress, anxiety, and depressive symptoms. People aged 18-24, females, and people in non-marital relationships experienced stress, anxiety, and depression. Separated individuals experienced stress and anxiety. Married people experienced anxiety. Single and divorced people experienced depression. Unemployed individuals experienced stress and depression. Students experienced anxiety and depression. Canada, the UK, and Pakistan are all countries that are experiencing stress and depression as a whole. An extended number of days in quarantine was associated with increased stress, anxiety, and depression. Family presence yielded lower levels of stress, anxiety, and depression. Lastly, lack of exercise was associated with increased stress, anxiety, and depression.

Internet gaming disorder, psychological distress, and insomnia in adolescent students and their siblings: An actor-partner interdependence model approach

Background

Associations between internet gaming disorder (IGD), psychological distress, and sleep have been reported. However, little is known whether such associations exist across siblings; that is, whether adolescents' IGD symptomatology may impact their siblings' psychological distress and sleep. This study aimed to examine whether siblings' IGD symptoms may relate to depressive, anxiety symptoms or sleep quality among each other.

Methods

Using a cross-sectional design with two-stage cluster sampling, 320 dyads of adolescent students and their siblings participated in the study. Each dyad completed the Internet Gaming Disorder Scale-Short Form (IGDS-SF9), the Depression Anxiety Stress Scale-21 (DASS-21), and the Insomnia Severity Index (ISI). The actor-partner interdependence model (APIM) was applied to examine relationships between IGD, psychological well-being, and insomnia severity in the dyadic data.

Results

Actor effects of IGDS-SF9 scores on depression, anxiety, stress, and insomnia severity were significant in both adolescents (e.g., adolescents' IGDS-SF9 scores on their depression scores) and their siblings (e.g., IGDS-SF9 scores of adolescents' siblings' scores on their depression scores). Partner effects of IGDS-SF9 scores on depression, anxiety, stress, and insomnia severity were significant in both adolescents (e.g., adolescents' IGDS-SF9 scores on their siblings' depression scores) and their siblings (e.g., IGDS-SF9 scores of adolescents' siblings on adolescents' depression scores).

Conclusions

The present study demonstrated that adolescent students and their siblings had mutual impacts of IGD on psychological health and sleep. Thus, healthcare providers may consider involving siblings when they design programs reducing IGD-related problems or improving psychological health and sleep for adolescents.

Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak

BACKGROUND

For many individuals, the COVID-19 outbreak has increased their psychological distress, changed their behaviors, and impacted their health. With more time spent indoors, many individuals have engaged in increased videogame playing. However, the associations between such behaviors during the COVID-19 outbreak period is unclear.

OBJECTIVE

The present study examined the mediating role of psychological distress (depression, anxiety, and stress) in the association between internet gaming disorder (IGD) and two health outcomes (insomnia quality of life) among adolescents during this COVID-19 pandemic.

METHODS

A cross-sectional study comprising adolescents (N = 1512) aged 13-18 years (mean age = 15.51 years) was utilized to assess measures on insomnia, depression, anxiety, and stress, IGD, and quality of life during the COVID-19 pandemic.

RESULTS

There were small to large significant relationships between the variables. Psychological distress (i.e., depression, anxiety, and stress) served as a strong mediator in the association between IGD and insomnia and quality of life. IGD directly influenced insomnia and quality of life among the participants.

CONCLUSIONS

IGD is associated with different psychosocial outcomes comprising multiple pathways. Parents need to pay special attention to how much time and how frequently their children play videogames. Parents may need to assist their children in coping with psychological distress during the ongoing COVID-19 pandemic period.

Mental Health Measurement in a Post Covid-19 World: Psychometric Properties and Invariance of the DASS-21 in Athletes and Non-athletes

Psychological science faces a call to action researching the implications of the corona virus disease 2019 (Covid-19) pandemic. Rapid reviews have reported that maintaining rigorous research standards is a priority for the field, such as ensuring reliable and valid measurement, when investigating people’s experience of Covid-19 (O’Connor et al., 2020). However, no research to date has validated a measure mental health symptomology for an athlete population. The current research addresses this gap by examining the internal consistency, factor structure, invariance, and convergent validity of the Depression Anxiety and Stress Scale (DASS-21; Lovibond and Lovibond, 1995) in two athlete samples. Participants completed the DASS-21 and sport-specific measures of mental health such as the Profile of Mood States – Depression subscale (POMS-D), Sport Anxiety Scale-2 (SAS-2), Athlete Burnout Questionnaire (ABQ), and Athlete Psychological Strain Questionnaire (APSQ). In sample one (n = 894), results of exploratory structural equation modeling indicated that a three-factor model provided good fit to the data, but a bifactor model provided better fit. Factor loadings indicated minimal misspecification and higher loadings on the general-factor. Invariance testing suggested equivalence across gender, athletic expertise, sport type, and injury status. Further, latent mean differences analyses indicated that females and injured athletes scored higher than male and non-injured athletes on all DASS-21 factors reporting higher mental health symptomology, those with more expertise scored higher on the general-factor and depression and those with less expertise scored higher on anxiety and stress, and no differences between team and individual athletes. In sample two (n = 589), the bifactor structure was replicated. Results largely supported the scales convergent validity with depression predicting POMS-D scores, whereas all three subscales predicted the SAS-2, ABQ, and APSQ scores. Internal consistency was acceptable in both samples. The current work provides initial support for use of the DASS-21 as an operationalisation of mental health symptomology in athletes. Theoretical and practical implications of these results are discussed.

Association of urinary phthalates metabolites concentration with emotional symptoms in Chinese university students

Previous studies have shown the associations between phthalates exposure and psychological behavior problems in children and adolescents, but such associations have not been fully elucidated in university students, especially among Chinese university students. This study aims to examine the association between urinary phthalates metabolites concentration and emotional symptoms in Chinese university students. A school-based cross-sectional survey was carried out among 990 university students aged 17-24 years from two universities in Anhui and Jiangxi provinces of China. Concentration of six phthalate metabolites in urine was determined by high-performance liquid chromatography-tandem mass spectrometry and the emotional symptoms were assessed by the 21-item Depression, Anxiety, and Stress Scale. The detection rate of six phthalate metabolites in urine ranged from 79.6% to 99.7%. The median concentration of six phthalate metabolites ranged from 2.90 to 119.64 ng/mL. The positive rates of depressive symptoms, anxiety symptoms, and stress were 17.4%, 24.8%, and 9.5%, respectively. After adjusting for the confounding variables, mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was found to be associated with depressive symptoms (β = 8.84, P = 0.017), anxiety symptoms (β = 8.46, P = 0.015), and stress symptoms (β = 9.95, P = 0.012) in males; whereas, monobutyl phthalate (MBP) was found to be associated with depressive symptoms (β = 1.86, P = 0.002), anxiety symptoms (β = 1.81, P = 0.005), and stress symptoms (β = 1.48, P = 0.047) in females. Our study demonstrates that Chinese university students are widely exposed to phthalates; and high- and low-molecular weight phthalates are associated with emotional symptoms in males and females, respectively.

The Mediating Effects of Eating Disorder, Food Addiction, and Insomnia in the Association between Psychological Distress and Being Overweight among Iranian Adolescents

With obesity and excess weight remaining a serious concern worldwide, investigating the mechanisms underlying this is of great importance. Psychological distress is a possible trigger contributing to excess weight for adolescents. Moreover, the association between psychological distress and excess weight may be mediated by eating disorder, food addiction, and insomnia. The present study utilized parallel mediation analysis to assess the aforementioned associations and possible mediation effects among Iranian adolescents. Through stratified and clustered sampling, adolescents (N = 861; mean ± SD age = 15.9 ± 3.2; 372 males) participated and were followed for a one-year period. Excess weight (standardized body mass index, z-BMI); psychological distress (Depression, Anxiety, and Stress Scale-21); eating disorder attitudes (Eating Attitude Test-26); food addiction (Yale Food Addiction Scale for Children); and insomnia (Insomnia Severity Index) were assessed. Eating disorder attitudes, food addiction, and insomnia were significant mediators in the association of psychological distress and z-BMI. Additionally, psychological distress had direct effects on z-BMI. Given that eating disorder attitudes, food addiction, and insomnia showed mediated effects in the temporal association of psychological distress and excess weight, healthcare providers are encouraged to design programs on improving these three mediators to help adolescents overcome excess weight problems.

A prospective study on the link between weight-related self-stigma and binge eating: Role of food addiction and psychological distress

OBJECTIVES

This prospective study investigated the link between weight-related self-stigma and binge eating by (a) examining the temporal association between weight-related self-stigma and binge eating; (b) investigating the mediating role of food addiction in the association between weight-related self-stigma and binge eating; and (c) examining the mediating role of psychological distress in the association between weight-related self-stigma and binge eating.

METHOD

Participants comprised 1,497 adolescents (mean = 15.1 years; SD = 6.0). Body mass index and weight bias were assessed at baseline; psychological distress (i.e., depression, anxiety, and stress) assessed and food addiction at 3 months; and binge eating at 6 months. The mediation model was analyzed using Model 4 in the PROCESS macro for SPSS with 10,000 bootstrapping resamples.

RESULTS

There was no significant direct association between weight-related self-stigma and binge eating. However, food addiction and psychological distress significantly mediated the association between weight-related self-stigma and binge eating.

DISCUSSION

These findings highlight the indirect association between weight-related self-stigma and binge eating via food addiction and psychological distress. Consequently, intervention programs targeting food addiction and psychological distress among adolescents may have significant positive effects on outcomes for weight-related self-stigma and binge eating. The findings will be beneficial to researchers and healthcare professionals working with adolescents during this critical developmental period.

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale–21 (DASS-21) Across Eight Countries

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale–21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States ( N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Psychometric Properties of Three Simplified Chinese Online-Related Addictive Behavior Instruments Among Mainland Chinese Primary School Students

BACKGROUND/OBJECTIVE

There are inadequate screening instruments for assessing specific internet-related addictions among mainland Chinese primary school students. Therefore, the present study validated the psychometric properties of three simplified Chinese online-related addictive behavior instruments among mainland Chinese primary school students.

METHOD

Fourth to sixth graders (n = 1108; 48.3% males; mean [SD] age = 10.37 years [0.95]) completed the nine-item Internet Gaming Disorder Scales-Short Form (IGDS-SF9), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application-Based Addiction Scale (SABAS) in a classroom. The factorial structures and the unidimensionality of the three scales were examined using confirmatory factor analyses (CFAs). Measurement invariance of the three scales was examined using multigroup confirmatory factor analyses (MGCFAs) across gender.

RESULTS

The findings demonstrated that the three scales (Cronbach's α = 0.73 to 0.84) had unidimensional structure as supported by satisfactory fit indices (comparative fit index = 0.98 to 1.00). The MGCFA findings indicated that the unidimensional structures of the three scales were invariant across gender.

CONCLUSIONS

The findings indicate that the three simplified Chinese scales (IGDS-SF9, BSMAS, and SABAS) are valid instruments for assessing online-related addictive behaviors among mainland Chinese primary school students irrespective of their gender.

In-person vs. eHealth Mindfulness-based Intervention for Adolescents with Chronic Illnesses: A Pilot Randomized Trial

Background:

Mindfulness-Based Interventions (MBIs) can improve mental health and well-being in adolescents with chronic illnesses. However, there are many barriers such as reduced mobility and distance which compromise accessibility to MBIs.

Objective:

The aim of this study was to determine the effectiveness of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program in youth with chronic illnesses delivered in person or via eHealth.

Method:

In this mixed method randomized controlled trial, participants received weekly 90- minute long MARS-A sessions for 8 weeks, either in person or via a secure eHealth audiovisual platform allowing group interactions in real time. Data was collected at baseline, immediately after and two months post-MBI through saliva analyses, electronic participant logs and validated questionnaires assessing mindfulness skills and mental health outcomes.

Results:

Seven participants per group completed the intervention (total n=14, completion rate 77.8%). Paired t-test analyses revealed a significant reduction in depression/anxiety scores immediately post-intervention (p=0.048, Cohen’s d=0.934) and a significant reduction in pre-post mindfulness cortisol levels at week 8 (p=0.022, Cohen’s d=0.534) in the eHealth group. Frequency and duration of weekly individual home practice (eHealth: 6.5 times; 28.8 minutes; in-person: 6.0 times; 30.6 minutes) were similar in both groups and maintained at follow-up.

Conclusion:

This is the first study comparing in-person and eHealth delivery of an 8-week MBI for adolescents with chronic illnesses. Although the study was limited by the small size of the sample, our results suggest that eHealth delivery of MBIs may represent a promising avenue for increasing availability in this population.

Escala de Depressão, Ansiedade e Estresse: propriedades psicométricas e prevalência das afetividades

RESUMO Objetivo: Estimar as características psicométricas da Escala de Depressão, Ansiedade e Estresse (DASS-21) para universitários e comparar as prevalências de depressão, ansiedade e estresse segundo o sexo. Métodos: Avaliou-se o ajustamento da DASS-21 aos dados por análise confirmatória utilizando os índices razão de qui-quadrado pelos graus de liberdade (χ2/gl), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) e Root Mean Square Error of Approximation (RMSEA). As prevalências de depressão, ansiedade e estresse foram calculadas e comparadas segundo o sexo. Resultados: Participaram 1.042 estudantes [idades entre 18 e 35 anos, com média de 21,13 anos (desvio-padrão = 2,81), 65,7% mulheres]. O ajustamento da DASS-21 à amostra foi adequado (χ2/gl = 5,83; CFI = 0,96; TLI = 0,97; RMSEA = 0,07), contudo o item 2 apresentou baixo peso fatorial, sendo, portanto, excluído (χ2/gl = 6,05; CFI = 0,98; TLI = 0,97; RMSEA = 0,07). Em relação ao grau de acometimento dos estudantes pela depressão, ansiedade e estresse, verificou-se que 4,7%, 1,7% e 4,5% dos estudantes apresentaram, respectivamente, escores moderados a extremamente severos. Não houve diferença significativa entre as prevalências dos estados emocionais avaliados segundo o sexo. Conclusão: A DASS-21 apresentou adequada validade e confiabilidade para amostra. A prevalência de depressão, ansiedade e estresse foi semelhante entre homens e mulheres, apontando para a necessidade de um olhar igualitário na investigação desses estados emocionais.

Protocol for psychosocial screening of adolescents and young adults with chronic illness

BACKGROUND

One in five adolescents and young adults (AYA) has a chronic health condition necessitating on-going engagement with healthcare systems. Despite increasing prevalence there remains limited understanding of the burden of illness they experience. Living with a chronic illness can challenge healthy adolescent development, with the unique health and developmental issues affecting AYA requiring different responses from the healthcare system.

AIMS

To examine and compare the burden of illness in this group across a large range of chronic health conditions.

METHODS

In a dedicated health service for AYA aged 15-25 years with chronic health conditions, (13-25 years for those with substance use issues) we detail a protocol where demographics, general health, disease-specific indicators and comprehensive psychosocial variables will be collected. The health conditions include chronic gastrointestinal disease, cystic fibrosis, chronic rheumatic disease, phenylketonuria, craniomaxillofacial deformities, renal transplant patients and problematic substance use. Results will be compared to AYA without chronic illness and AYA with diabetes.

RESULTS

This protocol outlines a comprehensive screening study for AYA with a large range of chronic health conditions, inclusive of medical, mental health, impairment and quality of life variables. It will inform service planning and provide a foundation upon which allied health service requirements (e.g. psychology) can be based. Whilst currently cross-sectional we anticipate further utility in broadening outcomes to include non-physical illness-related constructs.

CONCLUSIONS

The commonalities and differences between conditions will be examined to facilitate efficiencies of scale for systems and supports. Further iterations including quantifying access to allied health services will facilitate studying the impact of such interventions on treatment adherence and improving psychosocial functioning, quality of life and disease outcomes.

Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory (M = 19.7 years of age) and confirmatory factor analytic methods (M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.