Development and Psychometric Properties of the DASS-Youth (DASS-Y): An Extension of the Depression Anxiety Stress Scales (DASS) to Adolescents and Children

Mind-Body Correlates in Early Adolescence: Insights From Temporomandibular Disorder Pain and Somatic Symptoms

BACKGROUND

Previous studies on temporomandibular disorders (TMDs) in early adolescence have predominantly featured Western samples, with a focus on mental ill-being.

OBJECTIVES

This pioneering study investigated the relationships between TMD pain, somatic symptoms, and both mental well-being and ill-being. It also examined mind-body correlates in Asian young adolescents.

METHODS

Participants, aged 14, were enrolled in a public school. They completed a survey that included socio-demographics, the TMD Pain Screener, Patient Health Questionnaire-15, Life Goals Questionnaire, Meaning in Life Questionnaire, Child and Adolescent Social Support Scale, Satisfaction With Life Scale, and Depression, Anxiety and Stress Scales-21. Data were analysed using chi-square/Mann-Whitney U tests and Spearman's correlation (α = 0.05).

RESULTS

Among the 142 participants (52.8% female), 12.0% presented with TMD pain and 35.2% experienced medium-to-high somatic symptoms. Individuals with TMD pain and moderate-to-high somatic symptoms had significantly higher scores for somatic symptom burden/TMD pain, depression, anxiety and stress, while having substantially lower scores for the presence of life meaning and life satisfaction, compared to those without TMD pain and none/minimal-to-low somatic symptoms. Moderate correlations were observed between TMD pain and somatic symptoms (rs = 0.40), as well as between somatic symptoms and depression, anxiety and stress (rs = 0.51 to 0.57). Life satisfaction was negatively correlated with emotional distress (rs = -0.43 to -0.61).

CONCLUSIONS

TMD pain was associated with somatic symptoms but not with emotional distress. The moderate relationships between somatic symptoms and depression, anxiety and stress highlight the concept of somatisation in Asian cultures, even during early adolescence.

Comparing the psychometric evidence of the Depression, Anxiety, and Stress Scale-21 (DASS-21) between Spanish and Chinese primary schoolteachers: insights from classical test theory and rasch analysis

BACKGROUND

Primary schoolteachers play a pivotal role in the education of children, highlighting the importance of addressing their psychological well-being and mental health. While the Depression, Anxiety, and Stress Scale-21 (DASS-21) is a globally recognized instrument for evaluating mental health, its systematic validation among primary schoolteachers, particularly in a cross-national context, remains understudied. The present cross-cultural study evaluated the psychometric properties of DASS-21 among primary schoolteachers in Spain and China to compare the DASS-21 between teachers across Western and Eastern cultures.

METHODS

The study sample comprised 1,350 Spanish and 2,580 Chinese primary schoolteachers. The DASS-21, alongside the Emotional Exhaustion Scale for Teachers, was used to evaluate its psychometric properties. The construct and concurrent validity of the DASS-21 were examined using Rasch analysis, Confirmatory Factor Analysis (CFA), and Structural Equation Modeling (SEM). Additionally, measurement invariance was tested across two national teacher cohorts.

RESULTS

Rasch analysis confirmed the validity of most DASS-21 items among both the Spanish and Chinese teachers, with only the same item from the Anxiety subscale showing inadequate fit in both countries. CFA across both countries initially favored a bifactor model, which was subsequently excluded due to problematic factor loadings. Instead, a single-factor model provided the best fit for Chinese teachers, while a correlated three-factor model was optimal for Spanish teachers. SEM demonstrated the DASS-21's concurrent validity with emotional exhaustion, with consistent findings across both samples. After excluding Differential Item Functioning (DIF) items, strict measurement invariance between Spanish and Chinese teachers was achieved, as verified by multi-group CFA.

CONCLUSION

The DASS-21 exhibits commendable psychometric properties, rendering it a suitable instrument for evaluating the mental illness of primary schoolteachers in both Spain and China.

The Depression Anxiety Stress Scales for Youth (DASS-Y): evidence of validity and cross-national and gender measurement invariance

The Depression Anxiety Stress Scales for Youth (DASS-Y) is a recently developed measure of unpleasant emotional experiences for children and adolescents; however, the evidence for its validity is still limited. The present study evaluated the evidence for the structural, convergent, and incremental validity of the DASS-Y on a sample of Serbian adolescents aged 15-19 years (N = 421; 48% female, mean age = 16.86). Measurement invariance across gender and two countries (Serbia and Australia) was also tested. The findings supported the bifactor exploratory structural equation modeling (bifactor-ESEM) representation of the DASS-Y, which includes the General factor of negative affect/emotional distress, and three specific factors of Depression, Anxiety, and Stress. The DASS-Y factors showed evidence of incremental validity in predicting global externalizing symptoms and demonstrated convergent validity in relation to measures of global internalizing and externalizing symptoms as well as subjective well-being. The bifactor-ESEM model of the DASS-Y was found to be invariant across gender and two countries. The present study findings highlight the importance of distinguishing between general and specific components of unpleasant emotional states.

Exploring the psychometric properties of the Persian Depression Anxiety Stress Scale for Youth (DASS-Y): factor structure and reliability in Iranian children and adolescents

Background

The Depression Anxiety Stress Scale for Youth (DASS-Y) is a self-report instrument recently developed to evaluate negative emotional states in children and adolescents. However, the Persian version's factor structure and psychometric properties have yet to be investigated in Iranian youth. The study aimed to assess the factor structure and reliability of the Persian DASS-Y in a sample of Iranian children and adolescents.

Methods

The study recruited 1,277 children and adolescents, 703 (55.1%) being girls and 574 (44.9%) being boys (aged 7-18 years), from schools in Tehran, Iran. Confirmatory factor analysis (CFA) was conducted to evaluate structural validity and test the fit of three-factor models. Internal consistency reliability was examined using Cronbach's alpha and McDonald's omega coefficients for the DASS-Y total and subscale items. Convergent and discriminant validity were also assessed.

Results

The CFA results supported the original 3-factor structure of the DASS-Y, consisting of Depression, Anxiety, and Stress subscales in both groups of Iranian children and adolescents. Subsequently, the Pearson correlation coefficient assessed the scale's convergent and discriminant validity, which was relatively appropriate. Also, the DASS-Y's internal consistency reliability was satisfactory.

Conclusion

The Persian DASS-Y is a reliable and valid Instrument for measuring depression, anxiety, and stress in Iranian children and adolescents. It can be helpful for both research and clinical work, helping to assess psychological distress in children and adolescents.

An evaluation of Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) in a youth outpatient eating disorders service: A protocol paper

Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder for which there are very few evidence-based treatments. Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) is a novel exposure-based treatment which is suitable for people aged ten and older. The primary aims of the study are to undertake a real-world evaluation of the feasibility, acceptability, and preliminary effectiveness of CBT-AR for young people aged 12-25 years old in an outpatient eating disorders service where the patient population has high levels of psychiatric comorbidity. Clinicians, patients, and parents/guardians will be involved in the evaluation. Assessments will be carried out at baseline, during weekly sessions, at the end of each treatment stage, at end of CBT-AR treatment, and at 3-month follow-up. Assessments will measure ARFID symptoms, mood, quality of life, therapeutic alliance, and feedback on the treatment. The study will take place over a 12-month period and will evaluate the use of CBT-AR within real-life clinical practice conditions, noting how and why deviations from the treatment have occurred. The findings of this research will inform future ARFID treatment delivery and the implementation of CBT-AR at outpatient mental health services.

Prevalence and risk factors associated with psychological distress among children in Penang, Malaysia: A stratified multistage cluster study

Mental health is a state of mind influences one thinking, feeling and acting from inside and outside that are vital for children's normal growth and development. Psychological distress may results in serious mental health problem if left untreated. Hence, early diagnosis can largely improve the condition from being deteriorating. This study determined the prevalence of psychological distress and its associated risk factors among children in Penang, Malaysia. The study applied stratified multistage cluster sampling for the recruitment of children, and their socio-demographics background, health and lifestyle practices, and the prevalence and risk factors of psychological distress were succinctly studied. The study provides a fundamental platform for informing parents and policy makers about psychological distress, and the need to strategize potential health intervention for achieving optimum human well-being.•Stratified multistage cluster sampling was useful to study the prevalence and risk factors of psychological distress in a children population.•DASS-Y is robust for brief dimensional measure of depression, anxiety and stress among children.

Validation and psychometric properties of the Depression Anxiety Stress Scale for Youth in Chinese adolescents

Introduction

Depression and anxiety are the most common mental health problems among adolescents. The Depression Anxiety Stress Scales for Youth (DASS-Y) is a newly developed instrument designed to assess these problems in adolescents.

Aim

The present study aims to evaluate the psychometric properties of the DASS-Y among Chinese adolescents.

Methods

A total of 326 secondary school students aged 14-18 years participated in the study. A convenience sampling method was adopted to conduct a test-retest of the DASS-Y among Chinese secondary school students. McDonald's omega, Cronbach's alpha, and intraclass correlation coefficient (ICC) along with their 95% CI were used to assess the internal consistency and test-retest reliability of the DASS-Y. Confirmatory Factor Analysis (CFA) evaluated the structural validity and convergent validity of the DASS-Y through the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), as well as Average Variance Extracted (AVE) and Composite Reliability (CR). Pearson correlation coefficients with the General Health Questionnaire-12 (GHQ-12), and the Pittsburgh Sleep Quality Index (PSQI) assessed criterion validity.

Results

The CFA confirmed the validity the DASS-Y three-factor model consisting of depression, anxiety, and stress. The internal consistency reliability of the DASS-Y was found to be robust, with McDonald's omega and Cronbach's alpha values exceeding 0.8 for all dimensions across two measurements. The test-retest reliability was stable. The structural validity was reasonable and effective. Additionally, convergent validity is satisfactory, while criterion validity is also satisfactory. The three-factor model consisting of depression, anxiety and stress was confirmed through CFA.

Conclusion

The DASS-Y exhibits satisfactory psychometric properties among Chinese secondary school adolescents, reliably and appropriately screening for mental health issues such as depression and anxiety within this population. Consequently, it can be employed as a standard tool for routine mental health surveillance in secondary schools.

Everyone is searching for it and those who acquired it enjoy better mental health: a latent profile analysis of Chinese adolescents' meaning in life

Objective

One factor associated with rising rates of depression and anxiety among youth is a lack of meaning in life (MIL). The importance of living a meaningful and purposeful life cannot be overstressed, especially for adolescents who are in a critical life stage and have recently experienced a 3-year-long global health crisis, namely the COVID-19 pandemic. Although previous studies have examined adolescents' MIL, the majority of them adopted a variable-centered approach. The present study adopts a person-centered approach to investigate the updated MIL among Chinese adolescents in the aftermath of the COVID-19 pandemic, the demographic factors related to profile classification, and the differences in mental health among adolescents in different MIL classes.

Methods

A questionnaire assessing MIL, depression, anxiety, stress, and demographic information was administered to 1,196 Chinese adolescents (mean age = 13.07 ± 0.58; 44.73% were female individuals). A three-step latent profile analysis was conducted.

Results and discussion

This study revealed that (1) adolescents can be categorized into three classes: high MIL, medium MIL, and low and searching MIL. (2) Adolescents from intact families with higher educated mothers were more likely to be classified as high MIL class rather than low MIL class. Furthermore, (3) adolescents with high MIL experienced the best mental health outcomes, those with medium MIL experienced moderate mental health, and those with low MIL, who were still searching for MIL, exhibited the poorest mental health. External support may be necessary in the search process for Chinese adolescents. Future research could explore the process of searching for MIL and identify the challenges adolescents encounter when developing their sense of MIL.

Examining problematic internet use, mattering, and distress in interpersonally vulnerable senior high school students: A longitudinal study during summer holidays and academic terms

BACKGROUND

Problematic Internet Use (PIU) among adolescents is a growing concern. This longitudinal study examined changes in PIU between summer holidays and the academic period among Chinese senior high school students (n = 710; Mage: 16.68, SD = 0.54; 50 % female), focusing on interpersonally vulnerable individuals.

METHODS

Anti-Mattering Scale (AMS) and UCLA Loneliness Scale was applied to identify the interpersonally vulnerable groups. Latent Profile Analysis (LPA), Mixed ANOVA and Network Analysis (NwA) were employed to identify differences and interrelationships between groups at the two described times, in terms of PIU, mattering, and distress.

RESULTS

An interpersonally vulnerable group was identified with higher PIU severity, lower mattering perception, higher fear of not mattering, and higher distress compared to their peers (21.5 % of the total analyzed sample). PIU levels were higher during holidays than the academic term for all groups. The interpersonally vulnerable group showed higher reductions in fear of not mattering and distress from holidays to academic period. NwA revealed the central role of loneliness and distress in mediating the relationships between mattering and PIU.

CONCLUSIONS

Interpersonally vulnerable adolescents are at higher risk for PIU, particularly during holidays. Targeted interventions promoting a sense of mattering and belonging are needed to mitigate PIU risk and support healthy development among this group.

Cross cultural adaptation and psychometric evaluation of the Indonesian version of the depression anxiety stress scales for youth (IDASS-Y)

Depression and anxiety represent significant global health concerns, with a particularly high prevalence observed in economically disadvantaged developing countries. The availability of reliable and culturally relevant assessment instruments is crucial for the effective diagnosis and intervention of mental health issues, particularly among adolescents. The objective of this study was to adapt the Depression Anxiety Stress Scales for Youth (DASS-Y) into an Indonesian version (IDASS-Y) and to evaluate its psychometric properties among Indonesian adolescents. A multicenter cross-sectional study was conducted in West Sumatra Province and Yogyakarta Province, Indonesia. The study entailed a cross-cultural adaptation of the DASS-Y into the IDASS-Y through a five-step process and a psychometric evaluation. The study sample consisted of 255 adolescents between the ages of 16 and 18, recruited from two public senior high schools. The psychometric assessment comprised content validity testing, construct validity testing through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and reliability testing. The IDASS-Y has demonstrated robust psychometric properties. The content validity was found to be high, with an overall S-CVI/Ave of 0.95. The EFA demonstrated a consistent three-factor structure corresponding to depression, anxiety, and stress, with no alterations to the item dimensions. The CFA results yielded a good model fit, as indicated by the following values: χ2/df ratio = 2.553; RMSEA = 0.022; CFI = 1.000; SRMR = 0.083. The internal consistency of the scale was satisfactory, with Cronbach's alpha coefficients of 0.897 for depression, 0.893 for anxiety, and 0.884 for stress, and an overall alpha of 0.948. Additionally, McDonald's omega coefficients were notably high, at 0.897 for depression, 0.894 for anxiety, and 0.874 for stress, with an overall omega of 0.949. The Indonesian version of the Depression Anxiety Stress Scales for Youth (IDASS-Y) is a valid and reliable instrument for assessing depression, anxiety, and stress among Indonesian adolescents. It retains the original conceptual framework of the DASS-Y and demonstrates strong psychometric properties, making it suitable for both research and clinical use.

Coping with COVID-19: a prospective cohort study on young Australians' anxiety and depression symptoms from 2020-2021

BACKGROUND

Studies have shown that the coronavirus (COVID-19) pandemic negatively impacted the mental health of young Australians. However, there is limited longitudinal research exploring how individual factors and COVID-19 related public-health restrictions influenced mental health in young people over the acute phase of the COVID-19 pandemic. This study aimed to identify risk and protective factors associated with changes in individual symptoms of anxiety and depression among young Australians during the COVID-19 pandemic.

METHODS

This prospective cohort study collected data on anxiety and depression symptoms of young Australians aged 15-29 years old using the Depression, Anxiety and Stress Scale short form (DASS-21). We delivered four online questionnaires from April 2020 to August 2021 at intervals of 3, 6, and 12 months after the initial survey. We implemented linear mixed-effects regression models to determine the association among demographic, socioeconomic, lifestyle and COVID-19 public health restrictions related factors and the severity of anxiety and depression symptoms over time.

RESULTS

Analyses included 1936 young Australians eligible at baseline. There was a slight increase in DASS-21 anxiety mean scores from timepoint 3 to timepoint 4. DASS-21 depression scores showed slight fluctuations across timepoints with the highest mean score observed in timepoint 2. Factors associated with increases in anxiety and depression severity symptoms included LGBTQIA + identity, financial insecurity both before and during the pandemic, higher levels of loneliness, withdrawal or deferral of studies, spending more time on social media, and difficulties to sleep. Risk factors for only depression symptoms include unemployment during COVID-19 pandemic and being in lockdown. Living with someone was a protective factor for both anxiety and depression symptoms, pre-COVID-19 unemployment for depression symptoms, and older age and unemployment during the pandemic for anxiety symptoms.

CONCLUSION

These findings indicate that during the first year of the pandemic in Australia, there were significant changes in young people's mental health which were associated with multiple demographic, socioeconomic, lifestyle, and lockdown factors. Hence, in future public health crises, we suggest more inclusive guidelines that involve young people in their development and implementation ensuring that their unique perspectives and needs are adequately considered.

Understanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and lifestyle in children and adolescents through behavioural change actions: the DELICIOUS project

Over the last decades, the abandonment of traditional dietary patterns, such as the Mediterranean diet, represents an important threat for human health and environmental safeguard. The DELICIOUS project aims to promote healthy lifestyles among children and adolescents by implementing activities and tools to increase the adherence to the Mediterranean Diet with an attention to the environmental impacts of the diet. This study protocol describes the DELICIOUS project as a single-arm, uncontrolled behavioural intervention providing formal and non-formal education activities, development of new snacks and recipe reformulation, web/mobile app development, and physical activities to school children and adolescents in five European countries. The project aims to increase awareness of the nutritional benefits and the sustainability aspects of the Mediterranean Diet and to promote consumers' empowerment through an online platform for sustainable and healthy meal planning in the school canteen.

Menstrual Practice Needs Scale short form (MPNS-SF) and rapid (MPNS-R): development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda

OBJECTIVES

Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36).

DESIGN

Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency and validity in multiple cross-sectional surveys.

SETTING AND PARTICIPANTS

Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49).

RESULTS

The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: root mean square error of approximation (RMSEA)=0.064, 90% CI 0.043 to 0.084, Comparative Fit Index (CFI)=0.94, Tucker-Lewis Index (TLI)=0.92. Cohort baseline: RMSEA=0.050, 90% CI 0.039 to 0.062, CFI=0.96, TLI=0.95. Uganda: RMSEA=0.039, 90% CI 0.028 to 0.050, CFI=0.95, TLI=0.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092, 90% CI 0.000 to 0.158, CFI=0.93, TLI=0.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable.

CONCLUSIONS

The MPNS-SF offers a reliable and valid measure of adolescent girls' menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to short surveys and including menstrual health within broader research topics.

Developing a Tool for Assessing Perceived Parental Socialization of Emotions in Adolescents and Young Adults

INTRODUCTION

Parenting practices have been described as the practices employed by a parent and the parent-child communication, with the focus on raising a child in the best possible manner while instilling cultural, ethical, and personal values. One similar yet different construct that holds significance in the development of a child is parental socialization of emotion. Parental socialization of emotion is the interaction between the parents and child regarding the emotional experience of the child. This has been considered an essential marker of the development of the emotional and social competence of an individual. There are several scales in the aspect of parenting practices. However, scales for parental socialization of emotion especially considering the perception of adolescents and young adults have yet to fully be explored.

METHODS

The aim of the study is to establish a comprehensive tool that enables the measurement of perceived parental socialization of emotion (PPSE). The process of tool construction, data collection, and analysis was done in five phases that included reviewing existing tools and identification of domains (Phase 1); generation of an item pool (Phase 2); content validity, face validity, and inter-rater reliability (Phase 3); finalization of the tool for data collection (Phase 4); and data collection and analysis (Phase 5). The study for tool construction included participants from ages 13-28 years representing adolescents and young adults from schools and colleges located in New Delhi, India, as well as Gwalior, Madhya Pradesh, India. The research design used was a cross-sectional design, and the data were collected through purposive sampling, including males (N = 337) and females (N = 424). Exploratory factor analysis (EFA) was used to check the factorability and for item reduction.

RESULTS

The results aided in reducing the number of items from 160 to 46 including the process of content validity, inter-rater reliability, item-total statistic, and factor loading of EFA. The factors above the eigenvalue of 3 were retained while items above the factor loading of 0.50 were taken into consideration. A good Cronbach's alpha coefficient of 0.88 for the overall tool was established, with 0.89, 0.84, and 0.87 for the domains Awareness, Acceptance, and Coaching, respectively.

CONCLUSION

The scale constructed includes both the positive and negative emotions of an individual and tries to understand the perspective of the receiver of the parenting practice. The study helps in understanding the phenomenon of PPSE, which might also aid in creating awareness regarding efficient parenting practices.

Diet quality and anxiety: a critical overview with focus on the gut microbiome

Anxiety disorders disproportionally affect females and are frequently comorbid with eating disorders. With the emerging field of nutritional psychiatry, focus has been put on the impact of diet quality in anxiety pathophysiology and gut microbiome underlying mechanisms. While the relationship between diet and anxiety is bidirectional, improving dietary habits could better facilitate the actions of pharmacological and psychological therapies, or prevent their use. A better understanding of how gut bacteria mediate and moderate such relationship could further contribute to develop personalized programs and inform probiotics and prebiotics manufacturing. To date, studies that look simultaneously at diet, the gut microbiome, and anxiety are missing as only pairwise relationships among them have been investigated. Therefore, this study aims at summarizing and integrating the existing knowledge on the dietary effects on anxiety with focus on gut microbiome. Findings on the effects of diet on anxiety are critically summarized and reinterpreted in relation to findings on (i) the effects of diet on the gut microbiome composition, and (ii) the associations between the abundance of certain gut bacteria and anxiety. This novel interpretation suggests a theoretical model where the relationship between diet and anxiety is mediated and/or modulated by the gut microbiome through multiple mechanisms. In parallel, this study critically evaluates methodologies employed in the nutritional field to investigate the effects of diet on anxiety highlighting a lack of systematic operationalization and assessment strategies. Therefore, it ultimately proposes a novel evidence-based approach that can enhance studies validity, reliability, systematicity, and translation to clinical and community settings.

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

BACKGROUND

Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh.

METHODS AND ANALYSIS

AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

ETHICS AND DISSEMINATION

AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

Cell-free DNA as a potential diagnostic biomarker in academic stress: A case-control study in young adults

Background

Stress is a pervasive issue in modern life, affecting both physical and mental health. Identifying biomarkers like cell-free DNA (cfDNA) could provide insights into stress response and help detect individuals at risk for stress-related disorders.

Objective

The aim of this study is to investigate the potential use of cfDNA as a diagnostic biomarker in individuals experiencing stress.

Methodology

A case-control analysis was conducted using convenient sampling on university participants (N = 285 cases, N = 500 controls) aged 18-24. The study assessed haematological and lipid profile parameters using the Sysmex XP-300TM automated analyzer and an automated biochemistry analyzer, and cfDNA was extracted using a standardized in house developed Phenol-Chloroform protocol and estimated using Agarose Gel Electrophoresis and Nanodrop. Statistical analysis was performed using SPSS ver. 21.0.

Results

The results indicated a significant difference between stressed individuals and healthy controls in demographic, haematological and biochemical parameters. Specifically, stressed cases had significantly higher levels of cholesterol, LDL cholesterol, triglycerides, glucose, VLDL cholesterol, and lower levels of HDL compared to healthy controls. Stressed cases also showed significantly elevated levels of circulating cfDNA relative to healthy controls.

Conclusion

These findings suggest that cfDNA may have potential as a diagnostic biomarker for stress.

Comparative Study of the Long-Term Impact of the COVID-19 Pandemic on Mental Health and Nutritional Practices Among International Elite and Sub-Elite Athletes: A Sample of 1420 Participants from 14 Countries

BACKGROUND

Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior.

RESULTS

The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p < .001), as well as a lower REAP-S score indicating lower diet quality (p = .013).

CONCLUSION

In conclusion, two years into the pandemic, elite athletes were likelier to have better mental health profiles than sub-elite athletes but surprisingly had lower diet quality.

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.

Online support seeking, co-rumination, and mental health in adolescent girls

Introduction

Adolescents frequently use informal support seeking to cope with stress and worries. Past research in face-to-face contexts has shown that the relationship between informal support seeking and mental health is influenced by the specific strategy used and the mode through which support is sought. To date, little research has considered the relationship between support seeking online and adolescent mental health.

Methods

In this study, structural equation modeling (SEM) examined the mediating role of co-rumination in the relationships between seeking support from friends or online and two measures of mental health: depression and anxiety. Participants were 186 adolescent girls, drawn from four independent girls' schools in Sydney, Australia. Four brief vignettes described common social stressors and participants rated their likelihood of seeking support from close friends and from informal online sources. Co-rumination was measured using a short form of the Co-rumination Questionnaire and depression and anxiety were measured with the youth version of the Depression, Anxiety, and Stress Scale-Youth (DASS-Y).

Results

Different patterns of findings were found for support seeking from close friends and support seeking online. First, support seeking from friends was related to lower levels of depression and anxiety while seeking support online was related to higher levels depression and anxiety. Second, co-rumination suppressed the relationship between seeking support from friends and depression, but not online support seeking and depression or anxiety.

Discussion

These findings suggest that co-rumination reduces the benefits of seeking support from friends but is unrelated to online support seeking. The findings also confirm the problematic nature of online support seeking for adolescent girls' mental health, particularly in response to social stressors.

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.