The assessment and validation of the depression, anxiety, and stress scale (DASS-21) among frontline doctors in Pakistan during fifth wave of COVID-19

Assessing validity and reliability of Copenhagen burnout tool and DASS-21 amongst faculty members

BACKGROUND

Various tools had been used to measure the level of burnout, anxiety, and depression. The Copenhagen Burnout Inventory assesses personal, work or job, and patient related burnout, whereas DASS21 assesses stress, anxiety, and depression.

OBJECTIVES

This study aimed to evaluate the validity, reliability of Copenhagen burnout tool and DASS-21 amongst the faculty members employed in Pakistan.

METHODS

This cross-sectional research incorporated 384 medical, dental, and nursing faculty working full time at university. Data for research was collected from January to May 2023. Copenhagen and DASS21 survey were the survey tools used to identify the level of burnout and stress. Reliability of both tools was assessed using Cronbach alpha. Confirmatory factor analysis was performed to detect factorial structure of both tools. Pearson correlation was conducted to detect association between various domains. Multiple logistic regression was computed to detect relationship between the domains.

RESULTS

From a total of 384 participants, there were 118 (30.7%) males, 266 (69.3%) females. There were 169 (44%) medical, 140 (36.5%) dental, and 75 (19.5%) nursing faculty. Reliability analysis revealed satisfactory results for both tools. Confirmatory factor analysis demonstrated a four-model fit for the CBI, whilst a three-factor model was observed for DASS21. Personal burnout demonstrated positive and significant correlation with work related burnout, and stress, while it showed significant but negative correlation with depression.

CONCLUSION

Female faculty displaced higher academic burnout as compared to men. A statistically significant correlation between burnout, anxiety, and depression. Both tools displayed high reliability and validity for the current sample.

Association between a healthy lifestyle and the prevalence of depression in radiology residents in China: findings from a nationwide survey

OBJECTIVE

The relationship between a healthy lifestyle and depression in radiology residents remains poorly understood. This study aims to investigate the relationship between a healthy lifestyle and depressive symptoms in radiology residents in a nationwide survey.

DESIGN

Cross-sectional study.

SETTING

The survey was conducted among radiology residents undergoing training in China between December 2020 and April 2021. This encompassed a total of 215 municipalities and 406 training centres.

PARTICIPANTS

3677 radiology residents in 31 provinces of China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was Healthy Lifestyle Score (HLS). A multiple logistic regression analysis was performed to evaluate the association between lifestyle factors and depressive symptoms. Additionally, the weighted quantile sum (WQS) index was utilised to identify the lifestyle factor that had the greatest impact on depressive symptoms.

RESULTS

The study sample consisted of 3677 participants, among whom the prevalence of depression was 34.7%. Participants were categorised based on their Health Lifestyle Score (HLS) into three groups: low HLS (LHLS), moderate HLS (MHLS) and high HLS (HHLS), with proportions of 8.0%, 79.8% and 12.2%, respectively. Those with LHLS were found to have a significantly higher risk of depression (OR: 5.21, 95% CI: 3.72 to 7.30) and a more severe level of depression (p for trend<0.001) compared with those with HHLS. Furthermore, the Well-being Quality of Life Index (WQS) showed a significant association with depression (OR: 0.34, 95% CI: 0.28 to 0.40), with sleep being identified as the most significant factor contributing to a healthy lifestyle.

CONCLUSION

The study establishes a significant association between an LHLS (long and irregular work hours) and an elevated risk of depressive symptoms among the participants, emphasising the crucial role of sleep in this relationship. These findings underline the importance of promoting a healthy lifestyle, specifically emphasising the need for adequate sleep, among radiology residents.

Symptom mapping and personalized care for depression, anxiety and stress: A data-driven AI approach

BACKGROUND

Depression, anxiety, and stress disorders have significant and widespread impacts worldwide, affecting millions of individuals and their communities. According to the World Health Organization, depression impacts the daily lives of more than 300 million people, making it one of the most important diseases globally. Treatment for these mental disorders (MD) typically involves medication and psychotherapies, but also incorporates technological resources like Artificial Intelligence (AI) to indicate personalized therapies and care. While various AI approaches have been applied in the context of MD in the literature, they often focus solely on aiding diagnosis.

OBJECTIVE

This research proposes an AI approach for mapping symptoms and assisting in the personalized care of depression, anxiety, and stress.

METHODS

Symptom mapping utilizes data mining (DM) techniques to generate rules representing knowledge extracted from data of 242 patients collected using the Depression, Anxiety, and Stress Scale (DASS-21). This knowledge elucidates how symptoms impact the severity degrees of considered MDs. Subsequently, the generated rules are employed to construct a Fuzzy Inference System (FIS) for inferring the severities of MDs based on patient symptoms and personal data.

RESULTS AND CONCLUSIONS

The results achieved in the DM (accuracy ≥92.98 %, sensibility ≥86.02 %, specificity ≥97.32 %, and kappa statistic ≥87.98 %), indicating consistent patterns, along with the results produced by the FIS, demonstrate the potential of the proposed approach to assist health professionals in rapidly predicting symptoms of depression, anxiety, and stress, thereby facilitating outpatient screening and emergency care. Furthermore, it can improve the association of symptoms, referral to specialized care, therapeutic proposals, and even investigations of other diseases unrelated to MD.

Multicultural personality traits of Chinese university students and their effects on the psychological adjustment in the aftermath of COVID-19 in Shanghai: a scale validation

Objective

This study aims to explore Chinese university students' multicultural personalities and examine how they predict the psychological adjustment of students in Shanghai. In addition, the validation of Multicultural Personality Questionnaire Short Form (MPQ-SF) scale developed to assess the multicultural personality traits of individuals is also aimed in Chinese context. Data were collected after the psychological stresses from restrictions imposed by COVID-19 in China that influenced life adjustments for nearly three years.

Method

A total of 1,099 university students participated in this multi-stage study. First, the Chinese version of MPQ-SF (MPQ-SF-C) was developed and validated. The impact of MPQ-SF-C dimensions was then tested through path analysis to establish the effects of Chinese university students' multicultural personality traits on their psychological adjustment using the Schwartz Outcome Scale (SOS-10).

Results

The MPQ-SF-C yielded a five-factor solution which accounted for 60.14% of the common variance. The findings indicated that cultural empathy (β = 0.23, p < 0.05), certainty seeking (β = 0.13, p < 0.05), open-mindedness (β = 0.48, p < 0.05), and emotional stability (β = 0.24, p < 0.05) had significant influences on adjustment. Only flexibility was found to have a statistically insignificant impact on adjustment at this time in this context. MPQ-SF-C and SOS-10 scales represented very good psychometric properties in terms of their reliability and validity.

Conclusion

The MPQ-SF-C shows good psychometric properties and appropriateness for evaluating multicultural personalities in Chinese contexts. The multicultural personality characteristics of university students using this scale well predicted their psychological adjustment.

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

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

Mental health impact on patients with COVID-19 in the community under a long period of full lockdown in Vietnam

OBJECTIVE

We aimed to investigate the impact on the mental health of patients with COVID-19 in a centralized isolation facility in the community who experienced a long period of full lockdown during the fourth wave of the COVID-19 pandemic in Vietnam.

METHODS

We performed a retrospective cross-sectional study among 125 patients with COVID-19 in a centralized isolation facility in the community of Ho Chi Minh City from September to November 2021. We collected data on depression, anxiety, and stress symptoms, as indicated by scores on the Depression Anxiety Stress Scale-21, as well as sociodemographic characteristics.

RESULTS

The prevalence of depression, anxiety, and stress among patients with COVID-19 was 14.4%, 20.8%, and 20.0%, respectively. Depression scores were significantly and positively correlated with body mass index whereas stress scores were significantly and positively correlated with age.

CONCLUSION

Our findings indicated an increased prevalence of depression, anxiety, and stress among patients with COVID-19 who were in a centralized isolation facility during the fourth COVID-19 wave in Vietnam. Overweight and older age were identified as risk factors for adverse mental health in patients with COVID-19. Psychological intervention programs should be implemented in isolation facilities for individuals with COVID-19 infection.

Stress, Burnout, and General Mental Health among Healthcare Workers in Poland during the Long-Lasting COVID-19 Pandemic

Medical professions are characterized by a great responsibility for human health and life; they are also vulnerable to burnout. The outbreak of the COVID-19 pandemic has brought new challenges and threats. This study aimed to assess the mental health of healthcare workers after a year and a half of working in COVID-19 pandemic conditions. The Perceived Stress Scale (PSS-10), the Link Burnout Questionnaire (LBQ), and the General Health Questionnaire (GHQ-28) were utilized in this cross-sectional investigation. A total of 335 healthcare employees from Polish hospitals (median age 44 years) filled out online questionnaires between the 16 August 2021 and the 30 March 2022. Most of the sample was female (86%). In this study, 40.0% of the surveyed healthcare workers reported a high stress intensity. Burnout was reported by 9.6% of the workers, and the most frequently experienced symptom was psychophysical exhaustion. Almost half of the healthcare workers surveyed (49.6%) reported health disorders at both the mental and physiological levels. Interestingly, working in a COVID-19 ward did not significantly differentiate healthcare workers in any of the evaluated variables: PSS-10 (gr. A F = 1.21; gr. B F = 0.71; p > 0.05), LBQ (gr. A F = 1.89, F = 0.94, F = 1.08, F = 2.57; gr. B F = 0.32, F = 1.14, F = 0.77, F = 0.36; p > 0.05), and GHQ-28 (gr. A F = 0.85, F = 0.52, F = 0.57, F = 0.31; gr. B F = 0.31, F = 0.06, F = 0.06, F = 0.54; p > 0.05). Furthermore, there were no statistically significant differences between the compared occupational groups of healthcare workers: PSS-10 (F = 1.08; p > 0.05) and GHQ-28 (F = 1.78; F = 0.85; F = 0.62; F = 0.54; p > 0.05). The mental health of healthcare workers is alarming, and psychophysical conditions can affect the quality of work and relations with patients. Psychological care in workplaces and workshops that build resources for dealing with difficult situations are necessary.