Psychometric properties of the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21)

The Relationship Between Cognitive Disengagement Syndrome in Children and Cognitive Disengagement Syndrome, Depression, and Anxiety Levels in Their Parents

OBJECTIVE

This study aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) symptoms in children/adolescents and their parents within the Turkish population, examining the association with co-occurring ADHD symptoms, peer/social relationships, and total difficulties.

METHOD

The study included 229 parents aged 18 to 50 with children aged 6 to 18 from the staff of Karabuk Training and Research Hospital. Data collection occurred from April to September 2022. Participants completed various scales, including the Adult Concentration Inventory (ACI), Adult ADHD Self-Report Scale (ASRS), Depression Anxiety Stress Scale-21 (DASS-21), Conners' Parent Rating Scale-Revised Short Form (CPRS-R), Strengths and Difficulties Questionnaire (SDQ), and Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT).

RESULTS

A positive correlation was found between CDS symptoms in children/adolescents and their parents. CDS symptoms in children were also associated with significant comorbidities, such as ADHD, oppositional defiance, peer problems, and internalization problems. In parents, CDS was observed to be associated with levels of depression, anxiety, and stress.

CONCLUSION

The study highlights the strong relationship between CDS symptoms in children and their parents, suggesting potential genetic and environmental factors. CDS is associated with significant mental health comorbidities across all age groups. The findings underscore the need for interventions to support the mental health of both children and parents with CDS. Further research is needed to elucidate the impact and etiology of CDS on family dynamics and mental health.

Validating the depression anxiety stress scales (DASS-21) across Germany, Ghana, India, and New Zealand using Rasch methodology

Psychological distress is widespread globally, affects both mental and physical health, and has been significantly exacerbated by the COVID-19 pandemic. Reliable and valid instruments to assess psychological distress are needed so that interventions to address this condition can be directed and evaluated. We evaluated the psychometric statistics of the Depression Anxiety Stress Scales (DASS-21) using the Rasch method and a population survey sample dataset from four nations. To meet the requirements of the Rasch model, we randomly selected 500 participants (at least 110 from each country) from a total sample of 1822 individuals from Germany (n = 475), Ghana (n = 523), India (n = 411), and New Zealand (n = 413). Minor testlet modifications were necessary to achieve a satisfactory model fit for the depression (χ2 (30) = 40.32, p = 0.099), anxiety (χ2 (32) = 31.22, p = 0.510), and stress (χ2 (20) = 29.64, p = 0.076) subscales, and the full-scale (χ2 (18) = 23.93, p = 0.16). The scales were strictly unidimensional with acceptable reliability reflected by Person Separation Index (PSI) values of 0.86 for depression, 0.74 for anxiety, 0.82 for stress, and 0.87 for the total scale. The scales' items showed invariance across the countries and sociodemographic factors. The scales also demonstrated convergent, structural, and external validities. The study supported the reliability and validity of the DASS-21 for assessing psychological distress in four countries. Rasch model algorithms developed in this study enable conversion of the ordinal DASS-21 scale and its subscale scores to interval-level scores, which increases the precision of measurement. Future studies should apply Rasch methodology to the DASS-21 in various cultural contexts, incorporating subgroup analyses.

Spiritual orientation and mental health: an SEM analysis of meaning and death attitudes as mediators in Turkish religious officials

This study examines the relationships between spiritual orientation, meaning in life, attitudes towards death, and indicators of psychological health (depression, anxiety, and stress) among 348 Muslim religious officials in Turkey (28% female). Using structural equation modelling (SEM), the results showed that spiritual orientation directly and indirectly reduces psychological distress by enhancing personal meaning and fostering more accepting attitudes towards death. Results showed a moderate positive association between spiritual orientation and meaning in life, and weak but significant negative associations between meaning/attitudes towards death and psychological symptoms. As one of the first empirical studies to examine the mediating role of death attitudes in this population, the research highlights the theoretical relevance of existential frameworks such as logotherapy. The study offers practical implications for the development of culturally sensitive psychoeducational and spiritual counselling programmes aimed at supporting the mental health of religious professionals exposed to grief and death-related stressors.

The Roles of Interpersonal and Intrapersonal Emotion Regulation on Psychological Distress: A Longitudinal Panel Study

The present study was designed to test the hypothesis that interpersonal emotion regulation leads to increased difficulties in intrapersonal emotion regulation, which in turn, leads to general psychological distress utilizing a three-wave cross-lagged panel design. Undergraduate students rated self-report measurements of interpersonal emotion regulation, difficulties in intrapersonal emotion regulation, and psychological distress at baseline (T1, N = 369) and two follow-up waves (T2 and T3), each separated by 3 months. The results indicated that although some lagged correlations between interpersonal emotion regulation strategies and difficulties in intrapersonal emotion regulation were significant, interpersonal emotion regulation strategies did not prospectively predict difficulties in intrapersonal emotion regulation. Notably, difficulties in intrapersonal emotion regulation significantly predicted psychological distress in subsequent waves. Additionally, psychological distress at T1 predicted distress at T3 through difficulties in intrapersonal emotion regulation at T2. This study is significant as it is the first to test the interpersonal emotion regulation model in a longitudinal design. However, the hypothesized pathway where interpersonal emotion regulation contributes to psychological distress through difficulties in intrapersonal emotion regulation, was not supported.

Factors influencing pain intensity in knee osteoarthritis: a cross-sectional biopsychosocial perspective

BACKGROUND

Pain is pivotal in managing knee osteoarthritis (KOA), necessitating tailored rehabilitative strategies. The biopsychosocial framework suggests that a multifaceted approach is crucial for understanding and managing pain in KOA patients. This study explored the factors that influence pain intensity through biological and psychosocial determinants from a biopsychological perspective in KOA patients.

METHODS

This cross-sectional study included 150 KOA patients with Kellgren-Lawrence (K/L) grades 2-4. Patients were classified into three groups based on their Visual Analogue Scale scores: mild (n = 79), moderate (n = 40), and severe pain intensity (n = 31). The biological determinants included the body mass index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee function, the 30-second sit-to-stand (30STS) test for functional strength, and the Timed-Up and Go (TUG) test for mobility. Psychological determinants comprised the Depression Anxiety Stress Scale-21 (DASS-21) for emotional well-being, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Activities-Specific Balance Confidence (ABC) scale for balance confidence. Social determinants included educational attainment and the Short Form-36 (SF-36) for health-related quality of life.

RESULTS

Significant differences in biopsychosocial determinants were identified among the various pain intensity groups. Biological factors, including WOMAC scores, TUG, and 30STS tests; psychological factors, such as depression and anxiety (DASS-21) and kinesiophobia (TSK); and social factors, including mean years of education and all SF-36 subscales, were significantly worse in the severe pain group (p < 0.05). However, balance confidence did not differ between groups (p = 0.060). Patients in the severe pain group exhibited poorer outcomes across biological, psychological, and social domains, whereas the moderate pain group displayed worse biological and social outcomes when compared to the mild pain group (p < 0.05).

CONCLUSION

This study emphasizes the significance of a biopsychosocial framework in managing pain in KOA patients. Worsened biological factors like knee function, mobility, and functional strength, alongside psychological issues such as depression and anxiety, influence pain intensity. Social determinants, including lower educational attainment and quality of life, highlight the need for patient-centered care. Future research should include diverse populations and longitudinal data to improve interventions and guide global health policies for integrating the biopsychosocial perspective for KOA management.

The long-term impact of the covid-19 pandemic on patients with obsessive-compulsive disorder

We investigated how patients with obsessive-compulsive disorder (OCD) were affected by coronavirus disease of 2019 (COVID-19)-related stress over the long term compared to healthy individuals. We explored how the pandemic affected changes in obsessive-compulsive symptoms and their contributing factors. The study included 100 patients with OCD and 100 sex-matched healthy controls whose sociodemographic and clinical information were gathered. Participants in the study were recruited between December 2021 and May 2022 from individuals attending to the outpatient clinics of the University Department of Psychiatry. The Depression Anxiety Stress Scale-21, Perceptions and Attitudes Towards COVID-19 Questionnaire, COVID-19 Compliance with Prevention Measures Scale, and COVID-19 Stress Scale were used in this study. Patients were assessed using the Yale-Brown Obsession Compulsion Scale based on their conditions before and during the pandemic. Patients with OCD perceived COVID-19 disease as more dangerous and contagious (respectively P = .01, P = .01) compared to the controls. Fifty percent of the patients with OCD experienced an increase in symptoms. Disease severity was increased in mild and moderate OCD, while no significant change was found in severe OCD. Perceiving COVID-19 disease as more dangerous (P = .031), COVID-19-related traumatic stress (P = .013), compulsive control (P = .022), xenophobia (P = .005), and COVID-19-related thoughts (P = .008) were more frequent in OCD patients with clinical worsening. In regression analysis, younger age (OR: 0.95, 95% CI (0.91-0.99)) and higher levels of COVID-19-related stress (OR: 1.03 95% CI (1.01-1.05)) are associated with worsening OCD symptoms. Patients with OCD were adversely affected by the COVID-19 pandemic. Close monitoring of patients with OCD during the pandemic is recommended.

Turkish adaptation and psychometric evaluation of the Grief Impairment Scale

ABSRACTGrief usually proceeds in a normal course, but sometimes it may become dysfunctional. So psychometrically robust assessments are needed to identify abnormal grief. This study aimed to adapt the Grief Impairment Scale to Turkish and explore its psychometric properties with a sample of 364 bereaved adults. The results of the confirmatory factor analysis supported the unidimensional factor structure of the 5-item GIS. The Turkish version of the GIS demonstrated satisfactory internal consistency (α= .88, ω= .88). The convergent validity analysis revealed a positive correlation between the GIS and traumatic grief (r = .74, p < .001), depression (r = .65, p < .001), anxiety (r = .57, p < .001), and stress (r = .63, p < .001) with strong effect sizes. The study results showed that the GIS is an effective tool for measuring grief-related functional impairment in the Turkish cultural context following the loss of a loved one.

Caregiver Worry of Infection and Family Co-existence Difficulty and Association With Change in Children's Internalizing and Externalizing Symptoms During the Initial COVID-19 Lockdown in the UK and Turkey

The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n = 995) and Turkey (n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis.

Alshehri Y. Cross-cultural adaptation and psychometric properties of the Arabic version of the Central Sensitization Inventory in people with chronic musculoskeletal pain

Background

The Central Sensitization Inventory (CSI) is a patient-reported screening instrument that can be used to identify and assess central sensitization (CS)/Central Sensitization Syndrome (CSS)-related symptoms.

Objective

The aim was to translate the CSI into Arabic (CSI-Ar) and to subsequently validate its psychometric properties.

Design

Cross-sectional.

Methods

The CSI was translated and cross-culturally adapted into Arabic, and validated following international standardized guidelines. This study included patients with chronic musculoskeletal pain (n = 264) and healthy control participants (n = 56). Patients completed the CSI-Ar, Pain Catastrophizing Scale (PCS), Depression, Anxiety, and Stress scale (DASS-21), Tampa Scale of Kinesiophobia (TSK), and 5-level EuroQol-5D (EQ-5D). Patients completed the CSI-Ar twice to assess test-retest reliability. To evaluate discriminative validity, healthy controls participants completed the CSI-Ar. Statistical analyses were conducted to test the internal consistency, reliability, and structural, construct and discriminant validity of CSI-Ar.

Results

The CSI-Ar showed acceptable internal consistency (Cronbach's alpha = 0.919) and excellent test-retest reliability (intraclass correlation coefficient = 0.874). The CSI-Ar scale had significant correlations (P < 0.001) with all PCS subscales and total score (Spearman's rho = 0.459-0.563, P < 0.001), all DASS-21 subscales and total score (Spearman's rho = 0.599-0.685, P < 0.001), the TSK (Spearman's rho = 0.395, P < 0.001), and the EQ-5D (Spearman's rho = -0.396, P < 0.001). The Mann-Whitney U-test showed a statistically significant difference between the patient group and the healthy control group (P < 0.001), with the healthy controls displaying a lower average CSI-Ar score (12.27 ± 11.50) when compared to the patient group (27.97 ± 16.08). Factor analysis indicated that the CSI-Ar is a unidimensional tool.

Conclusion

The CSI-Ar is a reliable and valid screening tool that can be used to assess CS/CSS-related symptoms in Arabic-speaking people with chronic musculoskeletal pain.

Factor structure and psychometric properties of the Jordanian version of the depression anxiety stress scale (DASS-21)

AIM

Early diagnosis of health conditions such as depression, anxiety, and stress, which have been recognized as global health issues, is essential for providing psychological support to people who experience negative emotions. Therefore, it is important to identify a reliable method for diagnosing depression, anxiety, and stress. To this end, this study investigated the factor structure and evaluated the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) in Jordan.

METHODS

A university sample of 336 Jordanians completed the Arabic version of the DASS-21 and several psychopathology measures. Cross-sectional study and confirmatory factor analysis (CFA) were applied to achieve the study's aims.

RESULTS

CFA favored the bifactor model compared to the other four models. In contrast, the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) strongly correlated with the DASS-21, indicating that the DASS-21 has adequate convergent and divergent validity. Subsequently, the scale's discriminant validity was tested using the heterotrait-monotrait (HTMT) correlation ratio, which was found to be relatively insufficient. While DASS-21 showed strong reliability, Cronbach's α and McDonald's omega values ranged between 0.83 and 0.93.

CONCLUSION

The bifactor model best fits the Jordanian sample data. The DASS-21 has optimum psychometric properties; therefore, it can be used to assess the general distress experienced by the Jordanian community during research investigations and in non-clinical settings.

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.

A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury

BACKGROUND

This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI).

METHODS

The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale.

RESULTS

The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without.

CONCLUSION

Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

The psychometric properties of the Turkish version of the Pre-sleep Arousal Scale

Purpose

The aim of the present study was to examine the psychometric properties of the Turkish version of the Pre-sleep Arousal Scale (PSAS), which measures pre-sleep arousal, a significant predictor of insomnia symptoms.

Methods

651 participants were recruited via social media and the Internet. Confirmatory factor analysis was conducted in the total sample (65.28% females; Mage1 = 28.09 ± 14.00). Convergent, divergent, incremental, and known-groups validity and internal consistency coefficients were assessed in a subsample of 556 participants (62.77% females; Mage2 = 29.25 ± 14.81). A second separate sample of 88 participants (80.68% females; Mage3 = 22.19 ± 4.98) was used to evaluate three-week test-retest reliability.

Results

The results of factor analysis confirmed the two-factor structure of the Turkish PSAS with cognitive (PSAS-C) and somatic (PSAS-S), similar to the original scale. The correlations of the PSAS with convergent and divergent measures showed that the Turkish form had good convergent and acceptable divergent validity. PSAS-C and PSAS-S were able to explain an 18% additional variance in insomnia severity beyond depression and anxiety, an 18% additional variance in depression beyond insomnia severity, and a 35% additional variance in anxiety beyond insomnia severity. Moreover, insomnia patients had significantly higher PSAS-C and PSAS-S scores than good sleepers. Finally, the PSAS, PSAS-C, and PSAS-S had satisfactory internal consistency coefficients (α = 0.92, 0.91, and 0.86, respectively) and three-week test-retest correlations (ICC = 0.82, 0.82, and 0.71, respectively).

Conclusion

The Turkish form of the PSAS was a valid and reliable measure of pre-sleep arousal and can be utilized in sleep studies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00483-z.

Evening type negatively affects semen quality by deteriorating sperm morphology: Results from an infertility clinic

OBJECTIVE

The effect of sleep-related variables on the reproductive system has garnered attention in recent years. One of the mediators that reportedly plays an important role in the relationship between sleep disorders and the reproductive system is a disruption of the circadian rhythm. The aim of curent study is to investigate the effect of chronotype on morning semen quality.

STUDY DESIGN

Three-hundred and fourteen patients who applied to the infertility clinic were included in the study. The patients filled a socio-demographic data form. The "Pittsburg Sleep Quality Index (PSQI) was used to evaluate the sleep quality while the chronotypes of the patients were evaluated with the "Morningness -Eveningness-Questionnaire (MEQ)". Semen analyses and biochemical analysis for testosterone serum plasma level of all patients were performed.

RESULTS

Twenty-one patients were assigned as evening, 187 patients were assigned as intermediate, and 106 were assigned as morning chronotype. No statistically significant difference was identified in the comparison of the mean MEQ scores between patients with low and normal sperm concentrations(p = 0.884). A correlation analysis indicated the presence of a significant positive correlation between normal morphology and MEQ scores (r = 0.13, p < 0.05) and a negative corelation between the hours spent in bed and sperm concentration (r = -0.13, p < 0.05). A general linear model created with independent variables suggested that the presence of varicocele and MEQ scores had a significant effect on normal morphology.

CONCLUSION

The results of present study support that evening type could negatively affect sperm morphology; additionally, the time spent in bed also negatively affected sperm concentration.

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.

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.

Depression, Anxiety, Stress, and Sexual Satisfaction in Couples

Sexual satisfaction is an important concept in relationships contributing to psychological general well-being. The present study examined dyadic associations between mental health variables, particularly depression, anxiety, and stress, and sexual satisfaction. Using data of 102 heterosexual married couples from Turkey (mean age = 30.06 years), we sought to investigate whether a person's depression, anxiety, and stress were associated with his or her own as well as the partner's sexual satisfaction. Actor-Partner Independence Model (APIM) analysis revealed that husbands' anxiety and stress were associated with their own sexual satisfaction and husbands' depression was associated with both their own and the wives' sexual satisfaction. Wives' depression and stress were associated with their own sexual satisfaction but not with the satisfaction of their husbands. Additionally, wives' anxiety was not neither associated with their own nor their husbands' sexual satisfaction.

Competing against COVID-19: what about the mental health problems of athletes with disabilities?

OBJECTIVES

Although there is growing interest in athletes' mental health (MH), there is a paucity of research exploring MH in athletes with disabilities (AWD). The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the psychological state of AWD.

MATERIALS AND METHODS

An online survey including demographic questions, SARS-CoV-2-related questions, and standardized scales assessing depression, anxiety, stress, coronavirus anxiety (CAS), and nonspecific psychological distress was distributed to AWD.

RESULTS

A total of 362 athletes (183 AWD) participated in the study (response rate 31.2%). AWD infected with SARS-CoV-2 reported higher depression, anxiety, and CAS scores than AWD not infected with SARS-CoV-2 (Z = -2.10, ES = 0.15 Z = -3.45, ES = 0.25; Z = -2.43, ES = 0.18; respectively). Female AWD reported higher anxiety scores compared to males (Z = -2.25, ES = 0.16). Depression (Z = -2.80, ES = 0.20), stress (Z = -2.12, ES = 0.15) and K-10 (Z = -2.02, ES = 0.14 scores of individual sport AWD were higher than team sports AWD.

CONCLUSION

MH problems in AWD were associated with a wide range of variables such as being infected with SARS-CoV-2, female gender, competing in an individual sport, and having performance concerns. In light of these results, MH assessment should be undertaken for AWD to ensure appropriate and timely intervention.

Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain

Psychiatric comorbidity and abusive experiences in chronic pelvic pain (CPP) conditions may prolong disease course. This study investigated the psychometrics of the Depression Anxiety Stress Scale 8 (DASS-8) among women with CPP (N = 214, mean age = 33.3 ± 12.4 years). The DASS-8 expressed excellent fit, invariance across age groups and menopausal status, good know-group validity (differentiating women with psychiatric comorbidity from those without comorbidity: U = 2018.0, p = 0.001), discriminant validity (HTMT ratios < 0.85), excellent reliability (alpha = 0.90), adequate predictive and convergent validity indicated by strong correlation with the DASS-21 (r = 0.94) and high values of item-total correlations (r = 0.884 to 0.893). In two-step cluster analysis, the DASS-8 classified women into low- and high-distress clusters (n = 141 and 73), with significantly higher levels of distress, pain severity and duration, and physical symptoms in cluster 2. The DASS-8 positively correlated with pain severity/duration, subjective symptoms of depression/anxiety, experiences of sexual assault, fatigue, headache severity, and collateral physical symptoms (e.g., dizziness, bloating, fatigue etc.) at the same level expressed by the parent scale and the DASS-12, or even greater. Accordingly, distress may represent a target for early identification of psychiatric comorbidity, CPP severity, experiences of sexual assault, and collateral physical complaints. Therefore, the DASS-8 is a useful brief measure, which may detect mental distress symptoms among women with CPP.

Translation and Initial Validation of the Depression Anxiety and Stress Scale (DASS-21) in Ilokano

The Depression Anxiety and Stress Scale (DASS-21) is a self-report screening tool of psychological symptoms used in many countries and translated in different languages. The DASS-21 was translated into Ilokano, one of the major languages in the Philippines spoken by over 9 million people all over the world. The translation process involved independent translations by multilingual clinical psychologists, reviews by two multilingual mental health professionals, and pilot testing. The translation was then validated in a study with 668 Ilokano speakers mainly from three regions of the Philippines where Ilokano was a native language or a lingua franca. A confirmatory factor analysis indicated a good fit of the three-factor model compared to a one-factor model. The three subscales showed good internal consistency were also positively correlated with other measures of depression, anxiety, and negative affect, and negatively correlated with measures of positive affect and flourishing. Using a stringent test of criterion validity, the results also show that DASS-Depression was more strongly correlated with a criterion measure of depression, compared to with measures of anxiety and negative affect, and that DASS-Anxiety was more strongly correlated with a criterion measure of anxiety compare to a measure of negative affect. The results provide good initial evidence for the validity and viability of the DASS-21 in Ilokano, which should be a useful tool in mental health programs in parts of the Philippine community, particularly in identifying individuals who may need attention of mental health professionals.

Evaluation of depression, anxiety, and stress status in parents of patient with congenital clubfoot treated with Ponseti method: A prospective study

Congenital diseases have been reported to increase the incidence of depression, anxiety, and stress among parents. In this study, we aimed to investigate the depression, anxiety, and stress status in parents of patients with congenital clubfoot before and after treatment with the Ponseti method. A total of 20 patients diagnosed with congenital clubfoot at our clinic and treated with the Ponseti method were included in this study. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate the depression, anxiety, and stress status of the parents before and after treatment. We considered the following parameters to investigate the effects of these on the parents: the educational level of the parents; economic status of the family; gender; birth order of the child in the family; time of diagnosis (prenatal or postnatal). The mean DASS and subdomain scores after treatment were significantly lower than those before treatment (P < .05). Moreover, there was a significant difference in the pre- and posttreatment mean DASS and depression scores of the participants in terms of the education level (P < .05). The pre- and posttreatment DASS and depression scores of the participants with an education level of primary school and below were lower than those of the participants with an education level of secondary and high school. Parents may be less concerned during this process if they are fully informed by the orthopedic surgeons about the treatment protocol and the near-perfect results of the Ponseti method as well as are counseled by healthcare professionals.

Psychometric evaluation of the depression anxiety stress scale 8-items (DASS-8)/DASS-12/DASS-21 among family caregivers of patients with dementia

Patients with dementia express a set of problematic and deteriorating symptoms, along with self-care dependency. Over time, the mental health of family caregivers of persons with dementia may be affected, putting them at a high risk for psychopathology, which may be associated with endangered wellbeing of people with dementia. This cross-sectional instrumental design study examined the psychometric properties of the Depression Anxiety Stress Scale 8-items (DASS-8), DASS-12, and DASS-21 in a convenient sample of 571 caregivers from northern Italy and southern Switzerland (mean age = 53 years, SD = 12, range = 24-89 years). A bifactor structure of the three measures had the best fit; some items of the DASS-12/DASS-21 failed to load on their domain-specific factors. The three-factor structure was invariant across various groups (e.g., gender and education), expressed adequate reliability and convergent validity, and had strong positive correlation with the three-item UCLA Loneliness Scale (UCLALS3). Distress scores did not differ among carers of different types of dementia (Alzheimer's disease vs. other types, e.g., vascular dementia). However, distress scores were significantly high among female individuals, adult children caregivers, those caring for dependent patients, and those who received help with care. For 54.9 and 38.8% of the latter, care was provided by relatives and health professionals, respectively. Since the DASS-8 expresses adequate psychometrics comparable with the DASS-21, it may be used as a brief measure of distress in this population.

Working from home, work-time control and mental health: Results from the Brazilian longitudinal study of adult health (ELSA-Brasil)

This cross-sectional study investigated the association between work-time control (WTC), independently and in combination with hours worked (HW), and four mental health outcomes among 2,318 participants of the Longitudinal Study of Adult Health (ELSA-Brasil) who worked from home during the COVID-19 pandemic. WTC was assessed by the WTC Scale, and mental health outcomes included depression, anxiety, stress (measured by the Depression, Anxiety and Stress Scale, DASS-21), and self-rated mental health. Logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs). Among women, long HW were associated with stress (OR = 1.56; 95% CI = 1.11–2.20) and poor self-rated mental health (OR = 1.64; 95% CI = 1.13–2.38), whereas they were protective against anxiety among men (OR = 0.59; 95% CI = 0.37–0.93). In both sexes, weak WTC was associated with all mental health outcomes. Among women, the long HW/weak WTC combination was associated with all mental health outcomes, and short HW/weak WTC was associated with anxiety and stress. Among men, long HW/strong WTC was protective against depression and stress, while short HW/strong WTC and short HW/weak WTC was associated with all mental health outcomes. In both sexes, weak WTC, independently and in combination with HW, was associated with all mental health outcomes. WTC can improve working conditions, protect against mental distress, and fosterwork-life balance for those who work from home.

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.

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high risk of developing OCD symptoms. Following initial screening (n = 924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n = 25), participants started using the application at baseline (T0), 4 min a day, for 12 days (T0-T1). Participants in the delayed-app group (dApp; n = 20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1-T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.

Cognitive training using a mobile app as a coping tool against COVID-19 distress: A crossover randomized controlled trial

BACKGROUND

The COVID-19 pandemic has been suggested to constitute a broad base stressor with severe mental health consequences. mHealth applications are accessible self-help tools that can be used to reduce psychological distress during the pandemic. This randomized controlled trial evaluated the effects of mobile-based cognitive training exercises on COVID-19 related distress and maladaptive cognitions.

METHODS

Following initial screening (n = 924), participants scoring 1 standard deviations above the mean of the COVID-19 Distress Scale were randomized into two groups. Participants in the immediate-app group (iApp; n = 25) started using the application at baseline (T0) for 12 days (from T0 to T1). Participants in the delayed-app group (dApp; n = 22) started using the mobile application at T1 (crossover) and used it for the following 12 days (T1 to T2).

RESULTS

Intention to treat analyses indicated that the iApp group exhibited lower COVID-19 distress, lower depression, fewer intolerance of uncertainty and obsessive beliefs than the dApp group at T1. In addition, using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from 0.81 to 2.35) in COVID-19 distress and related maladaptive cognitions in the iApp group (from T0 to T1) and the dApp group (from T1 to T2). Moreover, these reductions were maintained at the follow-up.

LIMITATIONS

This study was a crossover trial with a relatively limited sample size and mainly female participants.

CONCLUSION

Our findings underscore the usefulness of brief, low-intensity, portable interventions in alleviating the negative effects of the pandemic on mental health.

Relationship Satisfaction and Well-being During the COVID-19 Pandemic: Examining the Associations with Interpersonal Emotion Regulation Strategies

Background

The COVID-19 pandemic has changed our interpersonal relationships drastically. However, few research studies have examined pandemic-induced stress and its impact on relationship quality. The current research aimed to examine COVID-19 related stress and anxiety in relation to relationship satisfaction, well-being (i.e., positive affect and life satisfaction), and interpersonal emotion regulation strategies (i.e., perspective-taking, enhancing positive affect, social modeling, and soothing), to understand the effects of pandemic-induced stress on both an individual and a relational well-being. The moderating effect of interpersonal emotion regulation strategies toward COVID-19 related stress was also examined.

Methods

The sample consisted of 877 married Turkish adults (N_female = 613, M_age = 35.00; N_male = 264, M_age = 39.21). Data were analyzed with structural equation modeling, and moderation effects were tested.

Results

As hypothesized, structural equation modeling revealed that greater COVID-19 related stress was associated with lower well-being, and that this relationship was mediated by relationship satisfaction. Findings indicated that IER strategy of increasing positive emotions was associated with greater relationship satisfaction and well-being. Unexpectedly, interpersonal emotion regulation strategies moderated neither the relationship between COVID-19 related stress and relationship satisfaction nor the relationship between COVID-19 stress and well-being.

Conclusions

Our findings support the vulnerability-stress-adaptation framework and draw attention to the importance of examining the effects of COVID-19 stress and relationship satisfaction.

Psychological outcomes of COVID-19 survivors at sixth months after diagnose: the role of kynurenine pathway metabolites in depression, anxiety, and stress

Coronavirus disease 2019 (COVID-19) has resulted in long-term psychiatric symptoms because of the immunologic response to the virus itself as well as fundamental life changes related to the pandemic. This immune response leads to altered tryptophan (TRP)-kynurenine (KYN) pathway (TKP) metabolism, which plays an essential role in the pathophysiology of mental illnesses. We aimed to define TKP changes as a potential underlying mechanism of psychiatric disorders in post-COVID-19 patients. We measured plasma levels of several TKP markers, including KYN, TRP, kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK), and quinolinic acid (QUIN), as well as the TRP/KYN, KYNA/3-HK, and KYNA/QUIN ratios, in 90 post-COVID-19 patients (on the first day of hospitalization) and 59 healthy controls (on the first admission to the Check-Up Center). An online questionnaire that included the Depression, Anxiety and Stress Scale-21 (DASS-21) was used 6 months after the initial assessment in both groups. A total of 32.2% of participants with COVID-19 showed depressive symptoms, 21.1% exhibited anxiety, and 33.3% had signs of stress at follow-up, while 6.6% of healthy controls exhibited depressive and anxiety symptoms and 18.6% had signs of stress. TRP and 3-HK were negative predictors of anxiety and stress, but KYN positively predicted anxiety and stress. Moreover, TRP negatively predicted depression, while KYNA/3-HK was a negative predictor of anxiety. The correlation between depression, anxiety, and stress and TKP activation in COVID-19 could provide prospective biomarkers, especially the reduction in TRP and 3HK levels and the increase in KYN. Our results suggest that the alteration of TKP is not only a potential biomarker of viral infection-related long-term psychiatric disorders but also that the therapy targets future viral infections related to depression and anxiety.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Fear of Relapse Scale (FoR) in individuals with multiple sclerosis

OBJECTIVE

The study aimed to translate and cross-culturally adapt the Fear of Relapse Scale (FoR) into Turkish and determine its psychometric properties.

METHODS

International guidelines were used for the translation and adaptation process. The patients were asked to fill the FoR, Intolerance of Uncertainty (IUS-12) and Depression Anxiety and Stress Scale (DASS-21). One week later, participants refilled the FoR. The test-retest reliability, internal consistency, and construct validity of the FoR were analyzed.

RESULTS

A total of 101 MS patients (37.6 ± 10.0 years, 81.2% women) were included in the research. The test-retest reliability of the FoR was excellent (ICC:0.883; CI:0.64-0.92). The reproducibility of the items of the FoR ranged from 0.2 to 0.8. The Cronbach's alpha coefficient of the FoR was 0.914. The internal consistency of the items was ranged between 0.90 and 0.91 The relationship between FoR with IUS-12, DASS-21 (depression), DASS-21 (anxiety), DASS-21 (stress) was 0.609, 0.641, 0.648 and 0.631, respectively. The correlation coefficients were greater than 0.50 (p < 0.01).

CONCLUSION

The Turkish version of the FoR is a reliable and valid tool to measure relapse fear in patients with MS.

The associations between metacognition problems, mindfulness, and internalizing symptoms in university students quarantined due to Covid-19 in Turkey

PURPOSE

To investigate the associations between internalizing problems, metacognition problems, and mindfulness levels in university students during the COVID-19 pandemic.

DESIGN AND METHODS

Depression, anxiety, and stress levels were compared between university students quarantined in dormitories and their homes under curfew conditions. The direct and indirect associations between internalizing problems, metacognition problems, and mindfulness levels of students under quarantine were evaluated.

FINDINGS

Metacognition problems and low mindfulness levels were associated with higher depression, anxiety, and stress symptoms under quarantine conditions.

PRACTICE IMPLICATIONS

Therapeutic interventions focusing on metacognition problems and mindfulness levels may reduce the negative psychological effects of quarantine.

The Depression Anxiety Stress Scale 8-Items Expresses Robust Psychometric Properties as an Ideal Shorter Version of the Depression Anxiety Stress Scale 21 Among Healthy Respondents From Three Continents

To examine the cultural limitations and implications in the applicability of the Depression Anxiety Stress Scale 8-items (DASS-8)-a shortened version of the DASS-21 recently introduced in an Arab sample-this study evaluated its psychometric properties, including measurement invariance, among healthy subjects from the United States, Australia, and Ghana. Confirmatory factor analysis revealed good fit of the DASS-8 relative to a 12-item version (DASS-12). Both the DASS-8 and the DASS-12 were invariant at all levels across genders, employment status, and students vs. non-students. The DASS-8/DASS-12 also expressed invariance at the configural and metric levels across all countries, albeit scalar invariance was not maintained due to misspecification of the factor loadings in the Ghanian sample. Mann-Whitney U test revealed significantly lower levels of mental symptomatology on the DASS measures among Ghanian students than in English-speaking respondents (both students and non-students). The DASS-8 expressed excellent internal consistency (coefficient alpha = 0.89), good convergent validity-noted by high values of item-total correlations (r = 0.87 to 0.88), good predictive validity-indicated by significantly strong correlation with the DASS-21 and its subscales (r = 0.95 to 0.80), and adequate discriminant validity-indicated by heterotrait-monotrait ratio of correlations <0.85. The DASS-8 correlated with the Internet Gaming Disorder-9, the Adult attention-deficit/hyperactivity disorder Self-Report Scale, and the Individualism and Collectivism Scale/Culture Orientation Scale at the same level as the DASS-21 and the DASS-12, denoting its adequate criterion validity. The DASS-8 can be used as a brief alternative to the DASS-21 to screen for mental symptomatology in English-speaking and African cultures. However, the same scores on the DASS-8 and the DASS-12 may not always indicate the same level of symptom severity in subjects from different countries. Further inter-cultural evaluations of the DASS-8 are needed.

Health anxiety model of cyberchondria, fears, obsessions, sleep quality, and negative affect during COVID-19

The aim of the study was to explore the relationships among cyberchondria, fear of COVID-19, health anxiety, obsessions, sleep quality, and negative affect in a national community sample of Turkish participants. A sample of 8,276 volunteers, aged between 18 and 65, were recruited via an online platform. The Perceived Vulnerability about Diseases Questionnaire, Fear of COVID-19 Scale, Cyberchondria Severity Scale, Short Health Anxiety Inventory, Depression Stress Anxiety Scale-21, Obsessive-Compulsive Inventory-Revised, and Pittsburgh Sleep Quality Index were completed by participants. Data were analyzed using mixture structural equation modelling approach. Results revealed that perceived vulnerability to disease was found to be positively related with cyberchondria, poor sleep quality, health anxiety, and obsessive-compulsive symptoms. Negative affect was positively associated with obsessive-compulsive symptoms, fears of COVID-19, cyberchondria severity, and poor sleep quality. Additionally, fear of COVID-19 was positively related to health anxiety. Also, cyberchondria severity was found to be positively associated with poor sleep quality and obsessive-compulsive symptoms. Mixture analysis classified participants into six latent classes: 1) Risk-Aversive Healthy Group, 2) Incautious Healthy Group, 3) Infection Obsessions Group, 4) Health Anxiety Group, 5) Negative Affect Group, and 6) General Psychopathology Group. The national survey data showed that perceived vulnerability to diseases, negative affect, fear of COVID-19, cyberchondria, health anxiety, obsessive-compulsive symptoms, and sleep quality appeared to be at the center of pandemic health anxiety.

Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study

Background

Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses.

Methods

This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach’s alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability.

Results

The Cronbach’s alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ²/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale.

Conclusion

The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

Childhood maltreatment and emotional distress: The role of beliefs about emotion and psychological inflexibility

The current study aimed to investigate the mediating role of negative beliefs about emotion and psychological inflexibility on the relationship between childhood maltreatment and emotional distress. A total of 519 participants completed the Childhood Trauma Questionnaire (CTQ), Depression Anxiety Stress Scale-21 (DASS-21), the Leahy Emotional Schema Scale II (LESS-II), and the Acceptance and Action Questionnaire-II (AAQ-II). All scales were significantly correlated. Two mediation analyses were tested. In the first model negative beliefs about emotion and psychological inflexibility mediated the relationship between childhood maltreatment and emotional distress measured by DASS-21 total score. In the second model, negative beliefs about emotion and psychological inflexibility mediated the relationship between childhood maltreatment and depression, anxiety, and stress measured by the subscales of DASS-21. Results suggest that maltreatment in childhood is associated with the individuals' approaches, plans and strategies in response to emotions, and psychological inflexibility which together further determine emotional distress.

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.

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World

Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

Predictors of depression, anxiety and stress among remote workers during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had a massive impact on work and home life, changing all daily routines of remote workers. It is extremely important to figure out some changes in home and work life that may affect the mental health of remote workers more.

OBJECTIVES

The first aim of the study was to investigate the predictors of depression, anxiety, and stress among first-time remote workers during the COVID-19 pandemic. The second aim was to explore sex differences regarding work and home life during the COVID-19 pandemic.

METHODS

The sample consisted of 459 participants who have been working from home for the first time during the COVID-19 pandemic. An online survey used included questions relating to sociodemographic characteristics, changes in work and home life, Depression Anxiety Stress Questionnaire-Short Form, Jenkins Sleep Scale, and Leisure-Time Exercise Questionnaire.

RESULTS

The prevalence of depression, anxiety, and stress was 17.9%, 19.6%, and 19.6% of the participants, respectively. Poor sleep quality, trouble focusing at work, being female, workplace loneliness, low levels of control over working hours, and low levels of physical activity were predictors of depression. Poor sleep quality, increased workload, and being female were predictors of anxiety. Poor sleep quality, trouble focusing at work, being female, financial concern, and workplace loneliness were predictors of stress. It was observed a higher increase in both housework and working hours during the COVID-19 pandemic in women.

CONCLUSION

Determining the variables that can affect the mental health of remote workers is highly important for timely psychological intervention.

Psychometric properties of the Tilburg Pregnancy Distress Scale-Persian version (TPDS-P)

BACKGROUND

Given the importance of screening pregnant women's distress, it was intended to investigate the psychometric properties of the Persian version of the Tilburg Pregnancy Distress Scale (TPDS-P) for screening pregnancy distress.

METHODS

This methodological psychometric study was conducted with participation of 360 pregnant women. The TPDS was translated into Persian. Factor analysis was used to investigate the construct validity. The results of the correlation test between the results of the two questionnaires, Depression Anxiety Stress Scales-21 (DASS-21) and TPDS-P, were used to determine the criterion validity of TPDS-P. Internal consistency of the items was calculated by the Cronbach's alpha coefficient. Stability of the results was examined by test-retest method and Intra-class Correlation Coefficient (ICC) was calculated. Examining the structure of the factors derived from exploratory factor analysis, fitness of the model was done through confirmatory factor analysis. Statistical analysis was done using SPSS software.

RESULTS

Kaiser-Meyer-Olkin (KMO) was 0.846 (p = 0.001). Sixteen items of TPDS-P accounted for 51.42 percent variances. The TPDS-P exhibited appropriate fitness. There was poor to moderate but significant direct correlation between the subscales of DASS-21 and TPDS-P. Cronbach's alpha coefficient of the TPDS-P was 0.81 and ICC was 0.70.

CONCLUSIONS

TPDS-P, with appropriate validity and reliability, can be used as a practical scale to evaluate women's distress during pregnancy in Farsi-speaking societies.

Evaluation of the effect of shift working and sleep quality on semen parameters in men attending infertility clinic

We aimed to evaluate the effect of shift work on semen parameters together with the effect of sleep quality in men attending infertility clinic. The participants were divided into two groups as follows: 104 shift worker men (Group 1) and 116 nonshift worker men (Group 2). Groups were compared in terms of semen parameters, Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburg Sleep Quality Index (PSQI) scores. A higher rate of oligozoospermia and poor sleep quality and a lower mean normal morphology percentage was observed in shift workers than nonshift workers (p = .006, .039 and .036 respectively). In addition, a positive correlation was seen between sleep duration and sperm concentration, while a negative correlation was found between sleep latency and total sperm count. Shift working together with high PSQI score was also a significant association with oligozoospermia when controlling for the other variables of age, total testosterone, DASS-21 stress score, smoking and varicocele (OR = 2.11, 95% CI 1.03-4.34 and OR = 1.18, 95% CI 1.01-1.39 respectively). In this study, infertile shift workers had a lower percentage of normal morphology and higher rates of oligozoospermia and poor sleep quality. Considering that shift workers have lower sleep quality, it seems that shift working negatively affects the circadian rhythm.

Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses

BACKGROUND

Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors.

METHODS

For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes.

RESULTS

Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective.

CONCLUSIONS

This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.

Mental and Physical Factors Influencing Wellbeing among South Korean Emergency Workers

Emergency workers are frequently exposed to hazardous situations and such life patterns can influence their wellbeing. This study examined the relationships among South Korean emergency workers’ precedents and consequences of positive emotion, engagement, relationship, meaning, and achievement (PERMA), a wellbeing concept, and offered solutions. A total of 597 emergency workers in Daegu, South Korea, participated in a survey. This study measured post-traumatic stress disorder syndrome, burnout, depression, PERMA, quality of life, life satisfaction, and sleep quality to test the relationships. Results demonstrated that post-traumatic stress disorder syndrome and burnout predicted distracting sleep behavior and sleep health. Depression was significantly related to PERMA. The better the emergency workers’ PERMA was, the better their quality of life and life satisfaction were. PERMA significantly predicted sleep behavior, a portion of sleep quality. Depression had an indirect influence on quality of life mediated by PERMA. Post-traumatic stress disorder syndrome, burnout, and PERMA were significant predictors of low sleep health and sleep behavior. The results indicate that South Korean emergency workers struggle with depression and sleep quality. As the data were collected during the coronavirus disease 19 pandemic, individual efforts and relevant programs to improve South Korean emergency workers’ PERMA and sleep quality in a crisis are recommended. Possible solutions to improve the wellbeing of South Korean emergency workers are suggested.

Turkish Version of the Traumatic Grief Inventory-Self Report (TGI-SR): Validity and reliability

This study aimed to adapt the Traumatic Grief Inventory-Self Report (TGI-SR) to Turkish in a sample of 403 bereaved individuals. The results of the confirmatory factor analysis indicated a correlated two-factor structure for the 18-item version. The Cronbach's alpha coefficient was .94 for the entire scale. Correlation analysis indicated that the TGI-SR was positively correlated with grief-related symptoms. To test discriminant validity, Latent Profile Analysis was performed, and profiles significantly differed from each other in terms of the impact of event, depression, anxiety, and stress levels. Findings showed that the Turkish version of the TGI-SR is a valid and reliable tool.

How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries

OBJECTIVE

This study examined the impact of the COVID-19 pandemic and subsequent social restrictions or quarantines on the mental health of the global adult population.

METHOD

A sample of 6,882 individuals (M_age  = 42.30; 78.8% female) from 59 countries completed an online survey asking about several pandemic-related changes in life and psychological status.

RESULTS

Of these participants, 25.4% and 19.5% reported moderate-to-severe depression (DASS-21) and anxiety symptoms (GAD-7), respectively. Demographic characteristics (e.g. higher-income country), COVID-19 exposure (e.g., having had unconfirmed COVID-19 symptoms), government-imposed quarantine level, and COVID-19-based life changes (e.g., having a hard time transitioning to working from home; increase in verbal arguments or conflict with other adult in home) explained 17.9% of the variance in depression and 21.5% in anxiety symptoms.

CONCLUSIONS

In addition to posing a high risk to physical health, the COVID-19 pandemic has robustly affected global mental health, so it is essential to ensure that mental health services reach individuals showing pandemic-related depression and anxiety symptoms.

Fear of COVID-19 and Positivity: Mediating Role of Intolerance of Uncertainty, Depression, Anxiety, and Stress

This study aimed to investigate the mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. The participants consisted of 960 individuals, including 663 females (69.1%) and 297 males (30.9%). The age of the participants ranged between 18 and 76 (29.74 ± 9.64). As a result of the correlation analysis, a positive relationship was found between fear of COVID-19 and intolerance of uncertainty, depression, anxiety, and stress, and a negative relationship was determined between the fear of COVID-19 and positivity. The result of the analysis for the study model indicated that there was a mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. Eliminating uncertainty from the fear of COVID-19 will contribute to reducing depression, anxiety and stress, and increasing positivity.

When adolescents face both Internet addiction and mood symptoms: A cross-sectional study of comorbidity and its predictors

This study aimed to determine the prevalence of comorbid Internet addiction (IA) and mood symptoms and to identify common and unique risk profiles for individual and comorbid mental health problems among adolescents. A total of 2272 high school students in Changchun, China, were included in a cross-sectional study. Participants were asked to complete paper-based questionnaires on sociodemographic characteristics, lifestyle factors, Internet use, parent-child relationships, IA, and mood symptoms. Multivariate logistic regressions were used to compare the risk profiles for IA, mood symptoms, and their comorbidity. The Bonferroni correction was used for multiple tests. Students who were girls, were current smokers, had more than 1.5 h sleep deprivation per day on weekdays, used the Internet for more than 30 and 240 min per day on weekdays and weekends, respectively, used social networking sites more than 6 times per day, were Internet gamers, and/or reported poor parent-child relationships reported higher rates of comorbid IA and mood symptoms. Adolescents exposed to more of these correlates would have a higher risk of IA, mood symptoms, and their comorbidity. Public strategies for the prevention of mental illnesses should expand their capacity to identify and limit the co-occurrence of IA and mood symptoms.

Factor structure of the depression anxiety stress Scale-21 (DASS-21): Unidimensionality of the Arabic version among Egyptian drug users

BACKGROUND

Emotional distress is common among illicit drug users, and it can negatively affect treatment outcomes and increase the risk of relapse. Nonetheless, instruments that properly measure emotional distress are lacking. Therefore, this study investigated the factor structure of the Arabic Depression Anxiety Stress Scale-21 (DASS-21) in that population.

METHODS

The DASS-21 and the Self-stigma of Alcohol Dependence Scale (SSAD) were completed by 149 inpatient Egyptian drug users. The DASS-21 was examined using exploratory factor analysis, partial confirmatory factor analysis, and parallel analysis. For validation testing, correlations between stigma scores and DASS scores were computed.

RESULTS

A one-factor solution provided the best fit to the DASS-21 data. Four items with low loadings were removed. The resulting DASS-17 was also unidimensional, and its reliability was high (0.88). On the validation tests, the DASS scores correlated with the stigma scores as hypothesized.

CONCLUSION

Subscales of the Arabic version of the DASS-21 do not differentiate between depression and anxiety. A modified 17-item version (the DASS-17) was suitable for measuring overall distress, and the results of convergent validation testing indicated that it was superior to the DASS-21.