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ObjectiveMethodResultsConclusionIn this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample.Treatment-seeking adults (n = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis.Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate.The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone. [ABSTRACT FROM AUTHOR]

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (β =.43 p = <.001), Anxiety (β =.40, p <.001), Stress (β =.49, p <.001), and Adjustment (β =.26, p =.001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (β = -.15, p =.033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation. [ABSTRACT FROM AUTHOR]

In this study, the impacts of service learning (SL) on the spiritual well-being and psychological health of Chinese university students in Hong Kong are determined. The SL programme is a six-month, credit-bearing programme (not less than 80 working hours). The study adopted a pre-test–post-test quasi-experimental design, wherein students enrolled in SL comprised the experimental group (n = 132; 59 male, 73 female), and those who were not enrolled in SL comprised the control group (n = 128; 55 male, 73 female). The students completed the spiritual well-being questionnaire (SWBQ) to evaluate the status of their spiritual well-being (including the personal and communal, environmental, and transcendental domains), and the Depression, Anxiety and Stress Scale-21 (DASS-21) was used to assess their emotional states of depression, anxiety and stress before and after the SL programme. At pre-test, no significant differences were observed between the two groups in SWBQ and DASS-21 scores. Findings indicated that students in the experimental group had greater increases in spiritual well-being in personal and communal, environmental and transcendental domains and decreases in stress, anxiety and depression than those in the control group at the end of the SL programme. [ABSTRACT FROM AUTHOR]

This study examined psychometric properties of scores on the Depression Anxiety Stress Scales-21 (DASS-21) with a nonclinical sample of senior games athletes (N = 383). Information on the internal reliability, item-scale correlations, structural validity, and concurrent validity of the DASS-21 scores is provided to test its applicability to senior games athletes. [ABSTRACT FROM AUTHOR]

Background: Psychiatric comorbidity is common among migraineurs, such as anxiety and depression. This type of comorbidity contributed to migraine chronicity, management efficacy, and increasing the risk for other comorbidities. This study designed to estimate the prevalence of depression, anxiety, and stress (DAS) symptoms among Saudi migraine patients using the validated instrument (DASS-21) and considering socio-demographic factors and individual differences that affect migraine progression and prognosis. Design/methods: Cross-sectional, self-administered, web-based-questionnaire distributed among Saudi Arabia general population. Only migraine patients with clinical diagnosis allowed to complete the survey. Results: A total of 247 migraine patients participated and they are predominantly females, with ages between 16 and 45 years, Saudi nationals, married, non-smokers but do not exercise regularly. About 73.3% met the abnormal score in anxiety on DASS-21, as well as 70.9% in depression and 72.3% in stress. Four statistically significant correlations with DAS were identified. Migraine patients who are smoking have a higher prevalence of depression and stress (p < 0.05). Those who do not exercise regularly have a higher prevalence only for depression (p = 0.03). A higher prevalence of all emotional states was found in patients with more than one co-morbidity and patients with a clinical diagnosis of depression and anxiety disorders (p < 0.02). The sensitivity of DASS-21 for depression and anxiety are 96.9% and 93.3%, respectively. Conclusions: Both smoking cessation and exercise to prevent migraine attacks deserve a clinical trial. A holistic approach is needed to decrease psychiatry-related disability and promote management outcomes in migraineurs. Using DASS-21 for migraine patients as a routine screening instrument is valuable to prevent psychiatric comorbidity. [ABSTRACT FROM AUTHOR]

The recent COVID-19 pandemic has imposed threats on both physical and mental health since its outbreak. This study aimed to explore the impact of the COVID-19 pandemic on mental health among a representative sample of home-quarantined Bangladeshi adults. A cross-sectional design was used with an online survey completed by a convenience sample recruited via social media. A total of 1,427 respondents were recruited, and their mental health was assessed by the DASS-21 measure. The prevalence of anxiety symptoms and depressive symptoms was 33.7% and 57.9%, respectively, and 59.7% reported mild to extremely severe levels of stress. Perceptions that the pandemic disrupted life events, affected mental health, jobs, the economy and education, predictions of a worsening situation, and uncertainty of the health care system capacities were significantly associated with poor mental health outcomes. Multivariate logistic regressions showed that sociodemographic factors and perceptions of COVID-19 significantly predict mental health outcomes. These findings warrant the consideration of easily accessible low-intensity mental health interventions during and beyond this pandemic. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. The current study aimed to investigate the possibility of a relationship between affective temperaments and GDM. This ethically approved cross-sectional study was conducted on 120 pregnant women with impaired glucose tolerance and 120 healthy pregnant women, all of whom were admitted to hospitals affiliated with Mashhad University of Medical Sciences for delivery during 2019. Depression Anxiety Stress Scale (DASS)-21 and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire (TEMPS-A) were used to gather data. Mann–Whitney test was used to compare data between the two groups. A multivariate binary logistic regression model with maternal age, body mass index, and multiparity as the covariates was used to assess factors associated with GDM. Outcomes of TEMPS-A showed significantly higher scores of anxious and irritable temperaments in the GDM group compared to the control group (p = 0.014 and 0.023, respectively). Multivariate regression showed anxious temperament to be the sole independent predictor of GDM (odds ratio = 1.09, 95%confidence interval = 1.030–1.153; p = 0.003). DASS-21 anxiety score was also significantly higher among patients with GDM (p = 0.002). Severity of anxiety and stress according to DASS-21 was also significantly greater in patients with impaired glucose tolerance (p < 0.001 and p = 0.016, respectively). It is ostensible that affective temperaments, especially anxious temperament, are potentially associated with the development of GDM and impaired glucose metabolism during pregnancy. The association of affective temperaments with pregnancy complications has drawn compelling interest. The findings of this study showed significantly higher scores of anxious and irritable temperaments in GDM patients. GDM patients also showed significantly higher levels of anxiety compared to controls. Predominance of anxious temperament can be a potential risk factor that contributes to the development of GDM. Monitoring for GDM is especially recommended in pregnant women with predominant anxious and irritable temperaments. [ABSTRACT FROM AUTHOR]

The recent outbreak of coronavirus disease (COVID-19) has significantly affected the mental health of people globally. This study aimed to investigate the mental health status and associated factors among residents of Pakistan. An online questionnaire survey was conducted from April 3 to May 7, 2020, using convenience and snowball sampling techniques. Data regarding demographics, physical health status and contact history during the last 2 weeks were collected. Furthermore, the Depression, Anxiety, and Stress scales (DASS-21) were utilized to measure the mental health of the participants. The analyses included descriptive statistics and regression analysis. Of the 1663 participants who completed this survey, 1598 met the inclusion criteria. The results revealed mild to moderate depression among 390 participants (24.4%), mild to moderate anxiety among 490 participants (30.7%) and mild to moderate stress among 52 participants (3.3%). A majority of the participants rated their health as good (n = 751, 47.0%). Moreover, students reported significantly higher scores on depression (B = 1.29, 95% CI = 0.71–1.88; p < 0.05), anxiety (B = 0.56, 95% CI = -0.06 to 1.18; p < 0.05) and stress (B = 0.56, 95% CI = –0.12 to 1.23; p < 0.05). Physical symptoms, including fever, cough and myalgia, and contact history in the last 14 days reported significant associations with depression, anxiety and stress (p < 0.05). The mental health status of the people was noted to be affected during the COVID-19 outbreak. Assessment of several factors with significant associations with depression, anxiety and stress may aid in developing psychological interventions for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: A history of depression in post-partum women who have infants admitted to the neonatal intensive care unit (NICU), is associated with higher risk for anxiety and stress. These conditions, which can be harmful to neonates, may be missed if maternal mental health screening is confined to depression.Objective: To determine if the history of a previously diagnosed depression would be associated with an increased risk of both postpartum depression and other stress-related disorders (i.e. anxiety and stress) among mothers with infants in the NICU.Design: Prospective survey questionnaire-based study conducted over a period of 9 months.Setting: Urban inpatient hospital-based setting, serving mainly low-income population.Participants: A total of 118 mothers of newborns who had been in the NICU for 7-29 days were approached for enrollment. Out of 118, 96 mothers consented to be screened and were asked to fill out the 21-item Depression Anxiety and Stress Scale-21 (DASS-21) questionnaire.Outcome: Primary outcome was to determine whether the history of a previously diagnosed depression is associated with an increased risk of both postpartum depression and other stress-related disorders (i.e. anxiety and stress).Results: Out of the 96 subjects, 36 (37.5%) had a previous history of depression before delivery (Group A) while 60/96 (62.5%) did not (Group B) and 46/96 (48%) of the mothers were positive for either depression, anxiety, or stress. This included 22/96 (22.9%) mothers who screened positive for depression; 37/96 (38.5%) who screened positive for anxiety; and 32/96 (33.3%) who screened positive for stress. After adjusting for maternal drug abuse, birth weight and maternal gravidity, the association between a previous history of depression and current depression scores were statistically significant (p = .04), as were the associations between previous depression and current anxiety and stress scores (p = .02 and p = .003, respectively).Conclusions and Relevance: A history of depression, documented in the antepartum medical record, identifies post-partum women who are at higher risk for anxiety and stress. Screening for depression alone may lead to missing these mental health issues. [ABSTRACT FROM AUTHOR]

The World Health Organization declared COVID-19 as a pandemic on 11 March, 2020, followed by an unprecedented global increase of the disease in recent times. Healthcare workers, including Nursing Professionals (NP), are more likely to experience psychological distress during the pandemic. The purpose of the study is to examine the stress, depression, and anxiety experienced by the nursing professionals in India, who provide care to COVID positive patients. A cross-sectional, web-based survey collected demographic data and mental health measurements from 187 NPs from 29 April, 2020 to 15 May, 2020. Eligibility criterion was NPs' treating COVID positive patients during the pandemic period. A total of 103 (55.08%) participants were screened positive for depression, 105 (56.14%) for anxiety, and 80 (42.78%) for stress. In addition, 24 (12.83%) participants experienced comorbid conditions, suffering from extremely severe or severe forms of stress-anxiety-depression levels. Participants reported high rates of depression, anxiety, and stress especially frontline NPs directly engaged in providing services for patients with COVID-19. The paper recommends counseling, mentorship, Cognitive Behavioral Therapy, and specialty trainings focused on patient care, as possible interventions for managing the psychological wellness of NPs during these testing times. [ABSTRACT FROM AUTHOR]

Objective: Gestational hypertension (GH) is an important pregnancy complication. Sparse studies have shown a correlation between this complication and psychological disorders in patients. In this study, we aimed to assess the possible association between affective temperaments and GH.Methods: This cross-sectional study was conducted on women with GH hospitalized in hospitals affiliated with Mashhad University of Medical Sciences, compared with healthy women admitted for normal delivery in the same centers during the study. Data were collected via Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) and Depression Anxiety Stress Scale (DASS) 21.Results: TEMPS-A revealed that scores anxious (P < 0.001) temperament was significantly higher in GH patients than in controls. Anxious temperament scores ≥9 were independently associated with GH (odds ratio = 2.768, 95% confidence interval = 1.586-4.832; P < 0.001). Moreover, the mean depression, anxiety, and stress scores in DASS-21 were significantly higher in the GH patients compared with controls (P = 0.014, P < 0.001, P < 0.001, respectively).Conclusion: Affective temperaments, particularly anxious temperament, can be potentially involved in the development of GH and its cardiovascular risk during pregnancy. [ABSTRACT FROM AUTHOR]

The exercise dose required to achieve benefits from cardiac rehabilitation (CR) is unknown and benefits may be independent of exercise supervision frequency. This randomized pilot study examined equivalence in two CR models, hypothesizing ≤10% difference between models. Subjects undertook 6 weeks of supervised low-/moderate-intensity exercise training. Fast-track (n = 25) included once-weekly exercise sessions and a one-off 7 h education session. Traditional (n = 36) included twice-weekly exercise and education sessions. Six-Minute Walk Test distance (6MWD), Timed Up and Go test time (TUGTT), Depression, Anxiety and Stress Scale (DASS-21) score and secondary outcomes were assessed pre-CR, post-CR and 6 months post-CR. Attendance was 100%, 79% and 82%, respectively. Missing data were imputed using last-observation-carried-forward methodology. Although intention-to-treat analysis found minimal between-group differences [7 m,p = 0.76 (6MWD); 0.27 s,p = 0.35 (TUGTT); and 14.6,p = 0.09 (DASS-21)] and similar proportions of subjects achieved a minimal clinically important difference and predicted values for 6MWD and TUGTT post-CR, the effect size was greater for fast-track subjects. A > 10% difference was noted for several secondary outcomes, mostly in favour of the traditional CR model. In conclusion, this pilot study identifies appropriate methodology to assess equivalence in CR models and suggests that one supervised exercise session may be as effective as two sessions for common outcome measurements. [ABSTRACT FROM AUTHOR]

Objective Studies investigating mood in vegetarian diets have yielded conflicting results, either demonstrating risk for mental disorders or mood protection. Our objective was to investigate mood, as well as factors that potentially impact mood in vegans (VG), vegetarians (VEG), and omnivores (OMN). Methods We surveyed mood, diet, and lifestyle factors in a broad geographic online sample of adult VG (n = 283), VEG (n = 109), and OMN (n = 228) who were recruited via diet-related social networks. Mood was measured with the Depression Anxiety Stress Scale-21 (DASS-21). Results The sample was mostly female (78.5%), and age was inversely correlated with all DASS scores (p < 0.05). Mean DASS-A (anxiety) and DASS-S (stress) scores differed by group (F(2,616) = 4.73, p = 0.009, η2 = 0.015, and F(2, 615) = 8.23, p < 0.001, η2 = 0.026, respectively), with VG scores lower than OMN scores, indicating less mood disturbance. Analyses of covariance were conducted by gender, adjusting for age. Anxiety scores were different in males only (F(2,128) = 5.39, p = 0.006, ηp2 = 0.078) and lower anxiety in males was related to a vegan diet and daily fruit and vegetable intake. Mean stress scores were different in females only (F(2,476) = 3.82, p = 0.023, ηp2 = 0.016) and lower stress in females was related to a vegan diet and lower daily intake of sweets. Discussion A strict plant-based diet does not appear to negatively impact mood, in fact, reduction of animal food intake may have mood benefits. The improved mood domains were not consistent with those found in other studies, which may be due to methodological differences. [ABSTRACT FROM AUTHOR]