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Introduction: Coronavirus disease 2019 (COVID-19) has an extremely high infection rate. This study aimed to investigate emotional states and COVID-19 infection of medical workers during the self-management strategy to COVID-19., Methodology: Questionnaires were collected via an online questionnaire platform from 20 December 2022 to 19 January 2023, including demographic characteristics, number of vaccine doses, COVID-19 test results, occupation, attendant situations of workers, clinical symptoms, disease duration, and the Depression, Anxiety and Stress Scale 21., Results: A total of 748 complete questionnaires were collected. The average age of participants was 33.61 ± 8.94 years, and 79.55% participants were female. The proportion of anxiety was significantly higher in the infection group (52.32%) than in the non-infection group (28.45%) (p < 0.001), as was the proportion of stress (41.47% vs. 31.90%, p = 0.046). Medical students (odds ratios (OR) 0.54, 95% confidence interval (CI) 0.31-0.93) and other staff (OR 0.63, 95% CI 0.40-0.98) had a lower risk for depression than doctors (p = 0.024), and attendant and infective situations of workers was the risk factor for depression (p = 0.007). Occupation (p = 0.029) and infected workers (p = 0.001) were related to anxiety. Infected attendant workers had a higher risk for stress (OR 1.97, 95% CI 1.12-3.48) than uninfected attendant workers (p = 0.019)., Conclusions: Most medical workers infected with COVID-19 had emotional disorders during the COVID-19 pandemic. Attention and useful measures are suggested to support medical workers., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Xue Li, Qian Zhang, Wenkun Li, Jian Wei, Jie Xing, Xun Yang, Peng Li, Shutian Zhang.)

Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald's omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients., (© 2024. The Author(s).)

Objective: To study the effects of playing mother's recorded voice to preterm infants in the NICU on their mothers' mental health as measured by the Depression, Anxiety and Stress Scale -21 (DASS-21) questionnaire., Design/methods: This was a pilot single center prospective randomized controlled trial done at a level IV NICU. The trial was registered at clinicaltrials.gov (NCT04559620). Inclusion criteria were mothers of preterm infants with gestational ages between 26wks and 30 weeks. DASS-21 questionnaire was administered to all the enrolled mothers in the first week after birth followed by recording of their voice by the music therapists. In the interventional group, recorded maternal voice was played into the infant incubator between 15 and 21 days of life. A second DASS-21 was administered between 21 and 23 days of life. The Wilcoxon rank-sum test was used to compare DASS-21 scores between the two groups and Wilcoxon signed-rank test was used to compare the pre- and post-intervention DASS-21 scores., Results: Forty eligible mothers were randomized: 20 to the intervention group and 20 to the control group. The baseline maternal and neonatal characteristics were similar between the two groups. There was no significant difference in the DASS-21 scores between the two groups at baseline or after the study intervention. There was no difference in the pre- and post-interventional DASS-21 scores or its individual components in the experimental group. There was a significant decrease in the total DASS-21 score and the anxiety component of DASS-21 between weeks 1 and 4 in the control group., Conclusion: In this pilot randomized control study, recorded maternal voice played into preterm infant's incubator did not have any effect on maternal mental health as measured by the DASS-21 questionnaire. Data obtained in this pilot study are useful in future RCTs (Randomized Controlled Trial) to address this important issue.

Background and Objective : This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods : A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results : The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels ( p < 0.001). Conclusions : This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.

Background/aim: Physicians work under high levels of stress due to factors such as excessive workload, emotional factors, and economic variables. This leads to various health problems such as depression, burnout, fatigue, and hopelessness, resulting in decreased interest in a medical career and an increase in career choice regret., Materials and Methods: The study included 300 volunteer resident physicians from Ankara University Medical Faculty Hospital. The data for the research were collected using a survey form prepared by reviewing the literature. The survey consisted of three parts, which questioned the physicians' sociodemographic characteristics and professional choices, including the Depression Anxiety Stress Scale-Short Form (DASS-21) items and the Decision Regret Scale., Results: Of the physicians, 216 (72.0%) chose the medical faculty due to personal preference. The percentage of those who were not regretful about their career choice was 14.3% (n = 43). Those not regretful about their career choice had fewer years in the profession than the others. According to the categorical assessment of the DASS-21, 73.7% (n = 221) of the physicians had depressive symptoms ranging from mild to severe, 78.7% (n = 236) had anxiety symptoms ranging from mild to severe, and 57.7% (n = 173) had stress symptoms ranging from mild to severe., Conclusion: Mental health problems such as depression, anxiety, and stress were common among the resident physicians independent of their sociodemographic characteristics, and this was also associated with the level of career regret. Improving working conditions and personal benefits, addressing economic and other issues for physicians, ensuring their well-being, preventing the development of mental health problems, and early screening and rehabilitation for those affected not only have personal benefits but also contribute positively to job satisfaction, strengthen the patient-physician relationship, and have a significant impact on healthcare services., Competing Interests: Conflict of interest: The authors declare that there are no conflicts of interest., (© TÜBİTAK.)

Background: Comprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children., Method: The test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data., Results: Analysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald's omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good., Conclusions: The DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children., (© 2024. The Author(s).)

Background: Stress, depression and anxiety are prevalent mental health concerns that are getting worse every day in the context of rapidly expanding megacities, where a rising number of people live in slums. The purpose of this study is to evaluate the state of mental health and related variables underlying mental health issues among the impoverished population., Methodology: A total of 384 slum residents from the Khulna division responded to our questionnaire, which included the DASS-21 and other pertinent questions. Using ordinal logistic regression, the significant factors were extracted., Results: The Cronbach's reliability coefficient for the DASS-21 scale lies between 0.79 and 0.89 which indicates the high reliability of the DASS-21 scales. According to the findings, roughly 72.7%, 84.1%, and 69% of participants slum dwellers experienced anxiety, depression, and anxiety problems respectively. The result of ordinal logistic regression shows, slum dwellers of female gender (B = 0.669*, 95% CI 0.141, 1.197), married (B = 1.506*, 95% CI 0.119, 2.893), having only one earning member in the family (B = 1.224*, 95% CI 0.526, 1.922), day laborers (B = 2.294*, 95% CI 1.115, 3.473), not being able to educate children due to financial problem (B = 0.558*, 95% CI 0.183, 0.932) were more likely to report high levels of anxiety, depression, and stress., Conclusion: The study finds that a significant portion of people who live in slums struggle with mental health issues. It also points to the need for further support, intervention, and study on Khulna's slum inhabitants who are experiencing mental health issues. The authors anticipate that the results will spur policymakers and government representatives to enhance financing for slum dwellers and employ psychological intervention strategies, both of which will aid in achieving the Sustainable Development Goal., (© 2024. The Author(s).)

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., Competing Interests: The authors declare no conflicts of interest.

Given that there is limited evidence concerning the psychometric properties of DASS-21 when applied to primary school students, the present study undertook a comprehensive exploration of the psychometric evidence supporting the use of the DASS-21 within this demographic. The research comprised three studies. In Study 1, the basic psychometric properties of internal consistency and construct validity were examined. A total of 3138 primary school students from three provinces in mainland China participated. The internal reliability of the overall scale was 0.93, and for all the subscales, it was higher than 0.80. Construct validity was partially supported. Both exploratory and confirmatory factor analyses upheld the factorial validity of the original three-factor structure. While convergent validity was established, the results showed unsatisfactory discriminant validity. The bifactor model showed that DASS-21 raw scores predominantly indicated the general factor, evidenced by the high explained common variance and omega-hierarchical values. However, the contributions from the three specific factors were minimal, with their omega hierarchical values all below 0.15. In Study 2, a longitudinal design was adopted, tracking 1366 primary school students from Southwest China over a three-month interval. The results further confirmed that the DASS-21 exhibited scalar time-invariance. The latent mean analysis showed that there were no statistically significant differences in the latent means of depression, anxiety, and stress between Time 1 and Time 2. In Study 3, which included 364 college students and 483 enterprise workers, the results demonstrated that the DASS-21 had measurement invariance across different populations. The latent mean analysis further confirmed that, in terms of the latent mean of all three subscales, both college students and enterprise workers had significantly higher scores than primary school students. Overall, the findings indicated that the DASS-21 is a suitable tool for screening schoolchildren for general psychological distress, but it is not suitable for discerning distinct negative mood state disorders., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier B.V.)

‌BACKGROUND: Women are at a higher risk for depression progression, especially during pregnancy. The current study purposed to investigate depression, anxiety, and stress levels of pregnant mothers in the initial stage of the COVID-19 infection in the southwest of Iran., Methods: This cross-sectional study was conducted during March and April, 2020, in Shiraz, Iran. Pregnant mothers registered in maternity clinics affiliated with Shiraz University of Medical Sciences were included. An online self-administered checklist was used. It included socio-demographic, obstetric and medical histories, and the short form of the Depression Anxiety Stress Scales (DASS-21) to evaluate depression, anxiety, and stress. A p-value < 0.05 was considered significant., Results: In total, 540 pregnant mothers answered the questionnaire. 83.5% had no comorbidity. Abnormal depression scores were significantly higher in those who had no insurance (OR = 2.5) and in those with poor self-rated health (SRH) (OR = 27.8). Pregnant mothers with lower SRH and two or more comorbidities had a higher chance of having an abnormal level of anxiety subscale (6.9, 3.7 times, retrospectively)., Conclusion: The results revealed that an abnormal level of depression was associated with SRH and medical insurance status. Moreover, the number of comorbidities and poor SRH significantly increased the chance of achieving abnormal anxiety levels in pregnant mothers during the COVID-19 pandemic.

Aim: The aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic., Methods: An anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21)., Results: Of the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001)., Conclusion: In this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further., (Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background Large-scale epidemiological surveys focusing on characteristic differences in psychological and physical health conditions in Chinese adults are lacking. Objective To investigate the association of noncommunicable chronic diseases (NCDs) with depression, anxiety and stress in the Chinese general population. Methods A total of 13784 participants were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH) from 2017 to 2019. Sociodemographic characteristics, lifestyle and NCDs were assessed via questionnaire. Stress, anxiety and depression were assessed by the Depression-Anxiety-Stress Scale (DASS-21). The relationship of NCDs with psychological symptoms was determined through logistic regression analysis. Results Multivariate logistic regression analysis revealed that the prevalence of stress (OR = 1.640; 95% CI: 1.381-1.949), anxiety (OR = 1.654; 95% CI: 1.490-1.837) and depression (OR = 1.460; 95% CI: 1.286-1.658) symptoms were all significantly higher in patients with NCDs. Multimorbidities were associated with a higher risk of stress (OR = 2.310; 95% CI: 1.820-2.931), anxiety (OR = 2.119; 95% CI: 1.844-2.436) and depression (OR = 2.785; 95% CI: 1.499-2.126) than single NCDs. A course of disease within 1 year or more than 5 years also was associated with a higher risk. Limitations The cross-sectional design could not examine the causal link between psychological symptoms and NCDs. Conclusion Psychological symptoms were more prevalent among individuals with NCDs in the Chinese general population. This study suggests that more attention should be paid to the mental health problems of patients with NCDs., (Copyright © 2021. Published by Elsevier B.V.)

Objective: The Coronavirus Disease 2019 (COVID-19) pandemic is a public health emergency of international concern and poses a challenge to people's psychological resilience. Students are reported to have greater psychological impacts from COVID-19. This study aimed to survey international students to better understand their traumatic effects and psychological reactions from COVID-19, to develop evidence-driven strategies to reduce adverse psychological impact during the pandemic., Method: We conducted an online survey that collected information on the demographics, economic conditions, academic conditions, and health statuses of native Chinese students attending university in the U.S. Psychological impact was assessed by the Post-traumatic Stress Disorder (PTSD) Checklist Civilian Version (PCL-C) and mental health status was assessed by the Depression, Anxiety, and Stress Scale., Results: This study included 261 Chinese international students. In total, 37.5% of respondents' PTSD PCL-C scores measured as moderate or severe. International students who were currently in China facing job-hunting or planning to continue studying abroad, severe economic pressure, and poor self-rated health status were significantly associated with greater PTSD PCL-C scores and higher levels of stress, anxiety, and depression., Conclusion: During the COVID-19 pandemic, more than one-third of the respondents rated their PTSD PCL-C score as moderate-to-severe and nearly half of them reported moderate-to-severe anxiety. Our findings identify factors such as future academic plan, economic pressure, and health status are associated with higher levels of psychological impact and worse mental health status. These should receive attention and psychological interventions should be implemented to improve the mental health of international students during the COVID-19 pandemic., Competing Interests: The authors declare they have no conflicts of interest., (© 2020 The Authors. Published by Atlantis Press International B.V.)

Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly spread throughout the world. The Serbian government declared a state of emergency on 15 March 2020, implementing some of Europe's strictest measures to combat the pandemic. The aim of this study was to determine the impact of the COVID-19 epidemic on the mental health of the general adult Serbian population and to identify associated factors during the state of emergency and lockdown. Data were collected with a snowball sampling method between 23 March and 25 April 2020, by using an online questionnaire. Multiple ordinal regression was performed to establish the associations between socio-demographic characteristics, self-estimated health status, and depression, anxiety, and stress. Out of 1057 participants included in the study, 28.9%, 36.9%, and 38.1% reported moderate to severe depression, anxiety, and stress symptoms. Uneasiness related to COVID-19 news, the feeling of helplessness, likeliness of impending death, and presence of COVID-19 symptoms were associated with higher depression, anxiety, and stress scores. Current smoking status was associated with a higher risk of depression and stress. Students had a significantly higher level of depression and stress, while older age was protective against anxiety and stress. Higher socioeconomic status was significantly associated with lower levels of depression, anxiety, and stress.

Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health. Our objective was to assess prevalence of depression, anxiety, and stress among the general population in Saudi Arabia during this pandemic. A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. Psychological impact was assessed using the Arabic version of Depression, Anxiety, and Stress Scale (DASS-21). A total of 1597 participants completed the survey. In total, 17.1% reported moderate to severe depressive symptoms; 10% reported moderate to severe anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, anxiety, and stress were significantly higher among females, younger respondents, and health care providers. Depression was higher among smokers, singles, and non-working respondents. Anxiety was higher among those reporting contacts with COVID-19 positive cases, previously quarantined and those with chronic health problems. Our findings reaffirm the importance of providing appropriate knowledge and specialized interventions to promote the mental well-being of the Saudi population, paying particular attention to high-risk groups.

Cross-culturally measurement invariant instruments are useful for the assessment of mental symptoms across cultures. The current study aimed to investigate the psychometric properties and measurement invariance of the Depression, Anxiety and Stress Scales (DASS-21) (DASS) across Pakistan and Germany. German participants were recruited through an online survey (N = 1323), while Pakistani participants were recruited through online survey or paper-and-pencil survey (N = 1841). The DASS-21 showed good reliability, construct and structure validity in both countries. The DASS-21 indicated partial weak (stress subscale) and partial strong measurement invariance (depression and anxiety subscales) between both countries. Latent mean comparison of depression and anxiety symptoms between Pakistani and German students indicated that Pakistani university students experience more symptoms of depression and anxiety. Results suggest that the DASS-21 could be used in Pakistan and Germany, but caution should be taken when making direct comparisons between the two countries., (© 2020 The Authors. International Journal of Psychology published by John Wiley & Sons Ltd on behalf of International Union of Psychological Science.)

Objectives: The study investigates the psychometric properties of the Depression, Anxiety, and Stress Scales (DASS-21)., Method: The DASS-21 was administered to a community sample twice over the course of 7 months ( N T 1  = 235 and N T 2  = 171; 51% female, M age  = 22 years). A partial credit Rasch model was used to determine the scales' longitudinal invariance and reliability., Results: The DASS-21 mostly demonstrated longitudinal invariance across administrations. The Depression and Anxiety subscales were sufficiently reliable to distinguish among the suggested severity categories, but the Stress scale was not., Conclusion: Several revisions of the DASS are recommended. It is also suggested that the Stress scale should be used with caution, given its low reliability., (© 2020 Wiley Periodicals LLC.)

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.

To assess prevalence and change of depression/anxiety symptoms in spondyloarthritis patients and feasibility of depression/anxiety questionnaires. 43 Patients with axial spondyloarthritis (axSpA) and 27 patients with psoriatic arthritis (PsA) were consecutively recruited. There were 34 patients on biologics and 36 patients on nonbiologics. Patients were not previously treated for depression. The demographic variables, pain, patient global assessment, laboratory, clinical findings, diseases activity scores, Beck Depression Inventory (BDI) and Depression Anxiety and Stress Scale-short version (DASS-21) were collected. The study visits were at the beginning, after 1 month, after 3 and after 6 months. In axSpA and PsA patients on biologics, BDI and DASS-21 were significantly lower compared to nonbiologics group during time. The axSpA patients on biologics had significantly lower BDI and depression severity by BDI at each time point and lower DASS-21 after 1, 3 and 6 months. BDI in PsA patients who received biological therapy was significantly lower after 3 and 6 months. In biologics groups, BDI significantly decreased after 3 months in axSpA patients and after 1 month in PsA patients. In axSpA patients, there was a medium correlation between BDI and axial pain, patient global assessment and disease activity scores. The biological therapy significantly affected the depression/anxiety symptoms in axSpA and PsA during time. BDI moderately correlated with pain and disease activity in axSpA. BDI and DASS-21 are easy to use in daily practice.

Background: We examined the validity and responsiveness of the Depression Anxiety and Stress Scales-21 (DASS-21) in patients with COPD following an 8-week pulmonary rehabilitation program (PRP)., Methods: Five hundred and fifty-seven patients with clinically stable COPD completed an 8-week outpatient multidisciplinary PRP, comprising 2 h (1 h of exercise and 1 h of education) per week. Anxiety, exercise capacity, quality of life, and dyspnea were measured pre- and post-PRP, utilizing the Anxiety Inventory for Respiratory Disease, Incremental Shuttle Walk Test, St. George's Respiratory Questionnaire, and modified Medical Research Council dyspnea scale, respectively. In addition, we administered the DASS-21 to assess both the validity and responsiveness of this tool compared with other, well-established metrics., Results: The mean (SD) age of participants was 71.6 (9.4) years, and 49% were women. The DASS-21 reflected responsiveness to pulmonary rehabilitation. Among participants with a high depression score (> 9), the depression subscale score fell from 18.62 pre-PRP to 13.12 post-PRP (P < .001). Similarly, among participants with a high anxiety score (> 7), the anxiety subscale fell from 14.60 pre-PRP to 10.99 post-PRP (P < .001). Likewise, among participants with a high stress score (> 14), the stress subscale score fell from 23.51 pre-PRP to 16.34 post-PRP (P < .001). Among these subsamples, the effect size was medium at 0.49 for depression and 0.54 for anxiety, and large at 0.81 for stress. The change in DASS-21 subset (depression, anxiety, and stress) correlated with the change in total SGRQ score, at P < .001., Conclusions: The DASS-21 has acceptable validity and is a responsive scale for use in PRP in patients with COPD., (Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

The relationship between autistic traits, stress, and anxiety experienced by the general population was investigated using an adult sample that evaluated the suitability of three theoretical models proposed by Green and Ben-Sasson. Participants completed online questionnaires that were analysed using structural equation modelling and partial correlation analyses. Of the models tested, the model that proposed SOR and stress as mediators of the relationship between autistic traits and anxiety was able to explain the variance in the data better than the other models. Based on these findings, we suggest that sensory neutral environments should be considered for the prevention and management of anxiety and stress symptoms for people in the general population with higher levels of autistic traits.

The DASS-21 is a public domain instrument that is commonly used to evaluate depression and anxiety in psychiatric and community populations; however, the factor structure of the measure has not previously been examined in oncologic settings. Given that the psychometric properties of measures of distress may be compromised in the context of symptoms related to cancer and its treatment, the present study evaluated the psychometric properties of the DASS-21 Depression and Anxiety scales in cancer patients ( n = 376) as compared to noncancer control participants ( n = 207). Cancer patients ranged in age from 21 to 84 years (mean = 58.3, standard deviation = 10.4) and noncancer control participants ranged in age from 18 to 81 years (mean = 45.0, standard deviation = 11.7). Multiple group confirmatory factor analysis supported the structural invariance of the DASS-21 Depression and Anxiety scales across groups; the factor variance/covariance invariance model was the best fit to the data. Cronbach's coefficient alpha values demonstrated acceptable internal consistency reliability across the total sample as well as within subgroups of cancer patients and noncancer control participants. Expected relationships of DASS-21 Depression and Anxiety scale scores to measures of suicidal ideation, quality of life, self-rated health, and depressed mood supported construct validity. These results support the psychometric properties of the DASS-21 Depression and Anxiety scales when measuring psychological distress in cancer patients.

Although depression and anxiety are the most common comorbidities in individuals with Autism Spectrum Disorder (ASD), descriptive data for their prevalence among autistic adults are limited. This study provides descriptive data for a cohort of 155 autistic adults (mean age = 27.1 years, SD = 11.9) of average IQ on the short-form version of the Depression Anxiety Stress Scales and the Mini Social Phobia Inventory. Also included were 79 non-ASD participants (mean age = 26.2, SD = 10.2) who completed the mini-SPIN. A substantial percentage (39-46%) of autistic adults scored within the 'Moderate' to 'Extremely Severe' range on the DASS-21. The DASS-21 would be a valuable rapid screening device for these comorbid conditions in autistic adults.

Aim: This study sought to identify clinical, demographic and service-related factors associated with psychological distress amongst outpatient chemotherapy patients., Background: Distress in cancer patients leads to increased risk of psychological comorbidity, contributing to sub-optimal treatment adherence and potentially leading to poorer health outcomes. Screening and recognition of distress and risk factors is an important aspect of holistic care within a multidisciplinary team environment., Methods: Data were obtained via survey and chart review of ambulatory chemotherapy patients at three public tertiary referral hospitals in Perth, Western Australia. The DASS-21 was used to screen for psychological distress. Regression analyses were used to assess the relationship between distress and a range of cancer, socioeconomic and treatment factors., Results: Patients with a Karnofsky Performance Score≤80 (OR 3.8, 95% CI [1.7, 78.7]) and average waiting time (between oncology outpatient appointment and commencement of chemotherapy infusion) >60min (OR 2.4, 95% CI [1.04, 5.5]) were at increased risk of moderate-severe distress. Patients with a household income between $AU 50-75,000 p.a. had a lower risk of distress compared to <$25,000 p.a. (OR 0.05, 95% CI [0.01, 0.52]). On sub-scale analysis, depression and anxiety contributed more to overall distress than the stress subscales., Conclusions: Performance status, waiting times and household income were key predictors of distress. Findings could assist clinicians to identify higher-risk population subsets that could benefit from targeted screening and additional psychological and social work support. Findings could also assist administrators to consider the contribution of modifiable factors such as waiting times to patient distress., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Juggling-exposure therapy has been employed in the management of anxiety and post-traumatic stress disorder. However, there is little evidence of the effectiveness of juggling-exposure in improving emotional states in subclinical conditions. This study aimed at evaluating the effect of a course of juggling on emotional states, sleep quality and blood pressure among medical students at a critical stage of their academic training. Blood pressure, psychometric and quality of sleep assessments were performed pre- and post-examination period for two groups of students: juggling-exposed (n = 9) and non-juggling-exposed (n = 11). Juggling exposure consisted of practice-drills for one hour per week during the period spanning the student's scheduled exams. Comparisons were made between quantitative measures that were collected pre- and post-the course of juggling drills. Differences in scores and measures were expressed as percentage-change and compared between non-juggling and juggling groups. Overall, there was a decrease in depression and anxiety scores between the pre-to post-exam periods. This decrease was statistically significant for both non-juggling and juggling groups with respect to anxiety, but only the juggling-exposed group had a significant reduction regarding depression scores. However, when calculated as percentage-change over the pre-to post-exam period, there was no significant difference in any of the parameters for either of the two groups. Practicing juggling drills had an influence on emotional states., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to assess whether male and female Iranian medical students perceived the meaning of the items in the Depression Anxiety Stress Scales-21 consistently., Methods: A convenience sample of 783 preclinical medical students from the first to sixth semester was invited to this cross-sectional study. Of the 477 respondents, 238 were male and 239 were female. All participants completed the Persian version of the Depression Anxiety Stress Scales-21. The graded response model was used to assess measurement invariance of the instrument across the gender groups. Categorical confirmatory factor analysis was used to evaluate the construct validity of the measure. Moreover, internal consistency was assessed via Cronbach's Alpha., Results: Statistically significant differential item functioning was flagged for just item 6 in the depression subscales (c 2 =6.5, df=1, p=0.011). However, removing or retaining the item 6 in the stress subscale did not change our findings significantly, when we compared stress scores across two genders. The results of categorical confirmatory factor analysis supported the fit of the three-factor model of Depression Anxiety Stress Scales-21. Moreover, Cronbach's alpha was greater than 0.7 in depression, anxiety and stress subscales., Conclusions: This study revealed that Depression Anxiety Stress Scales-21 is an invariant measure across male and female medical students. Hence, this reliable and valid instrument can be used for meaningful comparison of distress scores between medical student genders. Gender comparisons of medical students' psychological profiles provide a better insight into gender influences on the outcome of medical education and medical practice.

Anxious-depression symptomatology is frequently encountered among Latina/o individuals. There is a dearth of studies that examine this mixed class of anxiety and depression symptomatology, especially among Latina/o college students by the US-Mexico border. A total of 505 participants from rural institutions of higher education completed the DASS21. Psychometric properties were measured by means of confirmatory and exploratory factor analysis (EFA). A multivariate analysis of variance (MANOVA) was conducted to determine gender differences in depression, anxiety and stress. Among women, 18 % reported at least moderate levels of depressive symptoms, 33.1 % reported at least moderate levels of anxiety symptoms, and 16.4 % reported at least moderate levels of stress. In men, 15.9 % reported at least moderate levels of depressive symptoms, 34.1 % reported at least moderate levels of anxiety symptoms, and 12.9 % reported at least moderate levels of stress. The EFA supported a one dimension factor (anxious/stress-depression) among this sample of Latina/o college students (Bartlett's test = 4960.9; df = 210; p ≤ 0.01; Kaiser-Meyer-Olkin = 0.95). The MANOVA found no significant gender differences in depression, anxiety symptomatology and stress [Wilks'Λ = 0.99; F = (3, 500) = 2.41; p = 0.07]. The DASS-21 showed a one dimensional construct of anxious/stress-depression symptomatology in a Latina/o rural undergraduate sample, raising awareness to the need to screen and monitor this constellation of symptoms.

Background: The Depression, Anxiety, and Stress Scale -21 (DASS-21) is a frequently used measure of emotional disturbance symptoms in Parkinson's disease (PD). However, the factor structure of the DASS-21 in PD has yet to be explored., Objective: To assess whether the scale is measuring these symptoms in PD in the same way as the general population., Methods: The present study fit a series of established DASS-21 factor structures with both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) using data from 251 participants with PD., Results: The 3-factor ESEM provided the best fit. The depression and stress scales fit well, however, few items on the anxiety subscale loaded clearly, with several items significantly loading onto the depression or stress factors., Conclusions: Whilst the depression and stress subscales appear suitable in PD, poor loadings and internal consistency indicate the anxiety subscale may not accurately assess anxiety symptomology in PD. This may be due to the scale's reliance on physiological symptoms as indicators of anxiety, when many of these are present in PD. Thus, the anxiety subscale of the DASS-21 may not be a suitable measure of anxiety in PD.

Objectives: Australia has a growing number of graduate-entry medical courses. It is known that undergraduate medical students have high levels of psychological distress; however, little is known about graduate-entry medical students. We examined whether graduate-entry medical students had higher levels of psychological distress than the same-age general population., Method: Psychological distress was assessed in 122 graduate-entry medical students in an Australian graduate-entry medical school using the 21-item Depression Anxiety and Stress Scale. Mean scores and the proportion of students with scores in the highly distressed range were compared with non-clinical population norms. Scores were also compared across demographic characteristics., Results: Medical students reported higher mean depression, anxiety and stress scores than the general population and were more likely to score in the moderate to extremely high range for anxiety (45% vs. 13%; p<0.001) and stress (17% vs. 13%; p=0.003). Anxiety and stress were higher in students aged ≥30 years than in younger students., Conclusions: Despite their maturity, graduate-entry students experienced high psychological distress. Anxiety and stress were higher, not lower, with increasing age. Our results suggest that graduate-entry medical students warrant the same level of concern as their school-leaving counterparts. Further interventions to support these students during medical school are warranted., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

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, η(2) = 0.015, and F(2, 615) = 8.23, p < 0.001, η(2) = 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, η(p)(2) = 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, η(p)(2) = 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.

Objective: This study investigated the reliability of the Nepali version of the 21-item Depression Anxiety Stress Scale (DASS-21) among non-clinical sample. The purpose of this paper is to report the dimensionality and internal consistency of the DASS-21in a sample of non-clinical adults., Method: This study was conducted in Hong Kong among 212 Nepali adults, aged 18-60 years. Life satisfaction was assessed with the Life Satisfaction Scale. The dimensionality of the DASS-21 scale was investigated using exploratory factor analysis. Construct validity was evaluated using the life satisfaction scale., Results: The intercorrelation among depression, anxiety and stress subscales indicates that symptoms of psychological distress as measured by the DASS-21-N can distinguished between the three constructs in adult community sample. The results also showed inverse correlation among DASS-21-N and life satisfaction scale, supporting the assumption that the higher the life satisfaction, the lower the psychological distress., Conclusion: The results of this study indicate that the Nepali version of the DASS-21 demonstrate adequate psychometric properties in relation to internal consistency and validity, lending support to prior studies and suggest that the DASS-21 can be utilized among diverse groups with confidence. It supports the reliability of the 3-factorial dimensionality of the DASS-21, and highlight that it is a valid and useful tool that can distinguish between depression and anxiety., (Copyright © 2013 Elsevier B.V. All rights reserved.)

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]

Background: Although the Depression Anxiety Stress Scales, Short Form (DASS-21) was developed for adults, its authors noted no compelling reasons to not use the measure with youth as young as 12 years. Despite increasingly widespread use with youth, psychometric evidence in support of its use with this population needs to be investigated to fully understand its utility. Objective: The goal of this paper was to conduct a systematic review to identify and appraise evidence for the psychometric properties of the Depression Anxiety Stress Scales, Short Form (DASS-21) when used with youth populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review identified 18 studies that reported relevant information on the psychometrics of the DASS-21 with youth samples. Each article was coded for evidence of three indicators of particular importance to progress monitoring: reliability, validity, and sensitivity to change. Results: Studies have found varied factor structures (i.e., 1–4 factors) for the DASS-21 and validity evidence based on relations to other variables has been limited. As such, further research is needed to understand the utility of the depression, anxiety, and stress subscales. Furthermore, no information is currently available about the sensitivity to change of the measure. Conclusions: Most studies reporting psychometric properties in this review utilized the DASS-21 with mixed-gender groups of secondary school students, thus supporting its use with similar populations. Pending additional inquiry, however, both researchers and practitioners are encouraged to utilize the total score, for which stronger evidence of reliability and validity exist. [ABSTRACT FROM AUTHOR]

Nadia Tiara Putri,1 Faiznur Ridho,1,2 Indah Suasani Wahyuni3,4 1Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Oral Health Polyclinic, Oral Medicine Division, Dr. Rivai Abdullah Central General Hospital, Palembang, South Sumatera, Indonesia; 3Oral Medicine Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia; 4Clinical Research Unit, Dental Hospital, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Nadia Tiara Putri, Email nadia21016@mail.unpad.ac.idIntroduction: The incidence of post-pandemic psychiatric disorders has increased globally in recent decades. Generalized anxiety disorder (GAD) is one of the psychiatric disorders that are partially associated with emotional factors. It can affect the quantity and quality of saliva, present as xerostomia, and trigger the emergence of the geographic tongue (GT).Purpose: This case report aims to discuss the management of xerostomia and geographic tongue in a patient with GAD.Case: A 26-year-old male patient complained of dry and sore mouth for one month after taking medication from the psychiatry department, was diagnosed with GAD, and had already consumed the antidepressant sertraline. Extraoral examination showed dry and exfoliative lips. Intraoral examination showed white plaque with depapilation on the dorsal tongue, frothy saliva, buccal mucosa and dorsal tongue sticking to the dental mirror. The unstimulated salivary flow rate was < 0.2 mL/min (sialometry method). The Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire was used to estimate the psychological condition and showed an extremely severe level of anxiety (score = 13). The established oral diagnoses were GT with mild xerostomia and exfoliative cheilitis.Case Management: For two months, patients received hyaluronic acid gel and mouthwash, as well as a non-pharmacological approach to healthy lifestyle counseling. There was an improvement in xerostomia, and the GT became asymptomatic, with a reduction of DASS score in this patient.Conclusion: Improved psychological conditions will improve xerostomia, but the clinical appearance of the geographic tongue is more difficult to eliminate.Keywords: anxiety, DASS-21, geographic tongue, salivary flow rate, xerostomia

Abstract Objective The objective of this study was to assess the validity, reliability, and factorial structure of the Bengali-translated Depression, Anxiety, and Stress Scale—21 (DASS-21) among Bangladeshi health professionals. Methods This study incorporated the cross-sectional study design, conducted among 312 health professionals from 28 health facilities in 18 districts across Bangladesh. The internal consistency and intraclass correlation coefficient of the DASS-21 was assessed. The confirmatory factor analyses was done to assess the fitness of different structural models of DASS-21. The concurrent validity was estimated by using the PHQ-9 and GAD-7 scales. Results In total, 258 healthcare professionals (82.7%) out of 312 completed the whole survey questionnaire and were included in the study. The internal consistency of the DASS-21 exhibited satisfactory internal consistency (α = 0.93) and ICC = 0.92). The conventional three-factor model appeared to best fit the Bengali-translated DASS-21 scale. The discriminant validity has been affirmed by strong evidence. The convergent validity of Bengali DASS-21 was confirmed by the PHQ-9 and GAD-7 scales. Conclusions This study found good validity, reliability, and suitability of the DASS-21 used among the Bangladeshi healthcare professionals. We warrant future research to explore the validity of this tool in other cohorts in Bangladesh.

Objective: The objective of this study was to assess the validity, reliability, and factorial structure of the Bengali-translated Depression, Anxiety, and Stress Scale—21 (DASS-21) among Bangladeshi health professionals. Methods: This study incorporated the cross-sectional study design, conducted among 312 health professionals from 28 health facilities in 18 districts across Bangladesh. The internal consistency and intraclass correlation coefficient of the DASS-21 was assessed. The confirmatory factor analyses was done to assess the fitness of different structural models of DASS-21. The concurrent validity was estimated by using the PHQ-9 and GAD-7 scales. Results: In total, 258 healthcare professionals (82.7%) out of 312 completed the whole survey questionnaire and were included in the study. The internal consistency of the DASS-21 exhibited satisfactory internal consistency (α = 0.93) and ICC = 0.92). The conventional three-factor model appeared to best fit the Bengali-translated DASS-21 scale. The discriminant validity has been affirmed by strong evidence. The convergent validity of Bengali DASS-21 was confirmed by the PHQ-9 and GAD-7 scales. Conclusions: This study found good validity, reliability, and suitability of the DASS-21 used among the Bangladeshi healthcare professionals. We warrant future research to explore the validity of this tool in other cohorts in Bangladesh. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the factor structure of the Depression Anxiety and Stress Scale (DASS‐21) among caregivers of young children in Southeastern Europe. Background: The DASS‐21 is a widely used measure in prevention and intervention research with families. Studies regarding the scale's psychometric properties among caregivers, particularly from non‐Western countries, are limited and additional research is required. Method: The DASS‐21 was administered to N = 835 primary caregivers from North Macedonia, the Republic of Moldova, and Romania. Competing models were tested with confirmatory factor analysis (CFA). Measurement invariance was assessed using multigroup CFA (MGCFA). Bifactor dimensionality and reliability indices were used to evaluate the validity of the composite and subscale scores. Results: A tripartite bifactor model with two specific factors (depression and anxiety) and one general factor (negative affectivity) represented the data well. This model showed cross‐country configural and partial metric invariance. Dimensionality and reliability indices supported a unidimensional interpretation of the measure, with the general negative affectivity factor accounting for a substantial share of the variance (82%) compared to the specific factors of depression (10%) and anxiety (8%). Conclusion: The tripartite model best represented the data. Configural and partial metric invariance were verified for this model. Dimensionality and reliability indices, however, indicate that the DASS‐21 functions best as a general measure of negative affectivity. Implications: Future intervention studies involving caregivers from Southeastern Europe should consider using the DASS‐21 as an overall measure of negative affectivity and utilize the composite score instead of the subscale scores. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study is to evaluate the quality of life (QoL), depression, anxiety, and stress, along with associated factors among individuals with diabetes in Saudi Arabia. Methods: This survey was conducted at King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA). The assessment of depression, anxiety, and stress related to Type 2 Diabetes Mellitus (T2DM) was conducted using the DASS-21 questionnaire, while diabetes-related QoL was evaluated using the revised version of the diabetes QoL questionnaire (RV-DQoL13). Data were analyzed using SPSS-26. Results: A total of 251 subjects were included in the study (165 [65.7%] males and 86 [34.3%] females, mean age 50.1 ± 14.5 years). The individuals with DM had a mean value of QoL of 29.16 ± 9.23, with 46.9% having poor QoL. Furthermore, in dimensions of QoL, almost half of the individuals reported high worry about the disease (49.6%), followed by a high diabetes impact (46.6%) and low life satisfaction (42.9%). The prevalence of depression, anxiety, and stress was 49.4, 71.7, and 49.8%, respectively. A significant correlation was found between depression, anxiety, and stress and DASS-21 scores with QoL (p < 0.001). The regression analysis indicated an association of distinct factors with QoL like age above 41 years (p = 0.004), being married (p < 0.001), being divorced (p = 0.04), higher education (p = 0.007), regular medicine intake (p = 0.01), regular exercise (p = 0.03), lipid profile (p = 0.01), HbA1c (p < 0.001), and DASS-21 scores (p < 0.001). Poor QoL score (TQoL score > 27) was significantly associated with depression, anxiety, and stress (p < 0.001). The participants with higher monthly income, shorter disease duration, regular medicine use, and altered lipid profile, and older subjects had a lower chance of depression, anxiety, and stress. Conclusion: Approximately half of individuals with T2DM experienced poor QoL, while the prevalence rates for depression, anxiety, and stress were 49.4, 71.7, and 49.8%, respectively. Scores in the domains of impact, worry, and satisfaction were below optimal levels. Several factors were linked to QoL and depression, anxiety, and stress, and an association was observed between DASS-21 scores and QoL. [ABSTRACT FROM AUTHOR]

Introduction: Studies have shown that staying at home for prolonged periods of crisis can pose a significant challenge to individuals and affect their mental health. Hence, this study was conducted to identify the susceptible subgroups among Malaysian citizens that are prone to mental health problems during the lockdown period of the COVID-19 pandemic and its association with sociodemographic factors. Methods: The mental health status was assessed using the Depression, Anxiety, and Stress Scale -21 (DASS-21) questionnaire. The survey link was distributed online between October and December 2020. Results: Of 637 respondents, one-third experienced mild to extremely severe depression and anxiety (31.1% and 35.1%, respectively). Female respondents (odds ratio = 1.516, 95% confidence interval (CI) 1.057-2.172) were 1.5 times more likely to experience mild to severe depression than male respondents. Unmarried and divorced respondents were 2.1 times more prone to experience mild to severe depression than married respondents. A significant association was also found between employment status and age with depression symptoms among the respondents. For anxiety, a significant association was observed between the age group with mild to severe anxiety symptoms. Marital status, age, and employment status were socio-demographic factors significantly impacting stress levels. Conclusion: According to our findings, females, individuals aged 18-30 years old, students, unmarried and divorced respondents were more susceptible to mental health problems, suggesting that mental health support shall also be provided for these vulnerable groups during the COVID-19 crisis. [ABSTRACT FROM AUTHOR]

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Background: The escalating worldwide concerns for mental health, significantly amplified by the COVID-19 pandemic, necessitates understanding the impact on vulnerable populations, such as university students. This study aims to investigate the prevalence and implications of depression, anxiety, and stress among university students in the United Arab Emirates (UAE) using the Depression, Anxiety, and Stress Scale-21 Items (DASS-21). Methods: This study utilized convenience sampling to investigate the mental health of undergraduates in UAE universities using a bilingual DASS-21 questionnaire via Google Forms. Analysis was conducted using SPSS version 29.0, employing descriptive statistics, Chi-squared tests, Mann–Whitney tests, Kruskal–Wallis tests, and Multinomial Logistic Regression to analyze relationships between sociodemographic variables and mental health scores. Results: The study examined 332 students, with most female participants (81 %, n = 269) and individuals aged 18–20 (89.8 %, n = 298). It revealed higher mean DASS scores among females: Depression (M = 15.80, p = 0.030), Anxiety (M = 17.63, p

This cross-sectional study aimed to determine the prevalence of depression, anxiety, and stress among undergraduate dental students at Sofia Medical University and to investigate its associations with some demographic, educational and pandemic-related variables. A self-reported questionnaire that included the validated DASS-21 scale was administered to a group of 2nd, 3rd, 4th, and 5th year students (n=70, response rate 95.7%). Results indicated abnormal levels of depression, anxiety, and stress in 34.3%, 65.7% and 59.7% of the participants, respectively. A much larger proportion of females suffered from abnormal levels of anxiety (56.6%) as compared with males (9%), p=.003. Single students exhibited significantly higher level of depression (25.4%) than those having a partner (9%), p=.037. Third-year dental students demonstrated higher level of depression (19.4%) compared to 5th year students (1.5%), p=.007 as well as higher stress scores (25.4%) than 2nd year students (17.9%), p=.035. Academic performance (assessed by GPA in this study), dentistry as the first students’ choice when applying for MUS, financial responsibilities, and pandemic-related academic responses were not found significant factors for depression, anxiety, and stress (p>.05). These outcomes highlight the need to provide psychological support programs with special attention on susceptible groups. Dental students should implement preventive measures and adopt coping strategies to manage stress and reduce levels of anxiety and depression.

Since its inception, the coronavirus pandemic has caused serious social, economic, and health problems around the world. Seafarers have been identified as key workers in mitigating the negative impact of the coronavirus on global trade and ensuring the delivery of medical and hygiene supplies to regions in need. However, the complete closure policies implemented by certain countries have led to prolonged periods on board for seafarers with expired contracts and economic hardship for those unable to join new assignments. Seafarers who spend long periods on board a ship must deal with issues that may affect their psychological state. Therefore, it is important to identify the factors that cause seafarers to experience psychological distress and to develop relevant strategies to address them. The aim of this study was to determine the association between seafarers' fear of coronavirus disease-2019 (COVID-19) and psychological distress including symptoms of anxiety, depression, and stress. The questionnaire used the fear of COVID-19 Scale and the expression, Anxiety and Stress Scale), which have strong psychometric properties. Data were collected from 425 qualified seafarers working on international merchant ships and analyzed by structural equation modeling using AMOS-24. The results indicate that seafarers' fear of COVID-19 is positively associated with symptoms of anxiety and stress but not with depression. Maritime companies, sectoral organizations, and policymakers should collaborate to reduce these associations among seafarers. A unified management approach improved access to health services, and regular mental health assessments can be effective solutions.

Background: The COVID-19 pandemic has influenced almost every aspect of life, education being no exception. The sudden shift of teaching and learning using virtual methods was not an easy task. While medicine needs not just knowledge but also skills there were many questions regarding the efficacy of online classes. Aims: To study the impact of the sudden change of teaching method on the mental health of medical students using the DASS 21 questionnaires. Methods and Material: It was a cross-sectional study. This study was done among the 1st, 2nd and 3rd-year medical students over a period of 5 months. Pre-structured DASS-21 questionnaire was used to assess the mental health of these students. We have excluded all the students who already had a history of anxiety, stress, and depression before the corona virus pandemic. Results: Out of 122 students, 34 (27.9%) were males and 86 (70.5%) belonged to the age group 18-21 years. Depression, Anxiety and stress were more among the 1st MBBS students. Conclusions: Sudden changes in the mode of teaching are not easily accepted by the students. The transition should be well-planned.

The current study aims to investigate the psychometric properties of the Arabic DASS-21 questionnaire. A large-scale cross-sectional study of the Arabic adaptation of the DASS-21 scores. The participants (n= 1235) came from a variety of backgrounds. Overall, the reliability coefficient, Cronbach’s alpha, for the gross DASS- 21 score, was 0.94 (95% confidence interval CI between 0.93 and 0.94), indicative of excellent internal consistency. The three- factor model fitted acceptably for the full 21- item dataset. Nonetheless, some items were noted to load onto different factors to their original structure. Our study gives evidence of the excellent reliability, internal consistency, and convergent validity of the Arabic adaptation of DASS- 21. We also confirm the acceptability of the current three- factor composition for the DASS- 21 in its Arabic version. We may conclude that, in its current format, Arabic DASS- 21 can be used in many public and secondary health settings to detect depression, anxiety, and stress symptoms.

Background: Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan. Materials and Methods: This is a health facility–based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff. Results: A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21–40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0). Conclusion: This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase. [ABSTRACT FROM AUTHOR]

Background: The SARS-CoV-2 pandemic greatly impacted healthcare workers (HCWs) dedicated to COVID-19 patients. A cross-sectional investigation was conducted in a large European hospital to study the psychological distress of HCWs engaged in COVID-19 wards in the early phase of the pandemic. Methods: A questionnaire was sent to 1229 HCWs to collect the following information: i) sociodemographic data; ii) depression, anxiety, and stress scales (DASS-21); iii) event impact scale (IES-R); iv) perceived stress scale (PSS); and v) work interface analysis. Regardless of the outcome of the questionnaire, all subjects were offered psychological support voluntarily. Results: Approximately two-thirds of the workers reported no symptoms according to the DASS-21 scales, the corresponding figures for the IES-R and PSS scales being 36% and 43%, respectively. There were no differences in the levels of depression investigated through the different scales in the various occupational categories. Symptoms of anxiety, stress, and depression were more pronounced in women, whereas the highest stress levels were observed in the younger age groups. The highest scores were observed on the DAS-21 scales of anxiety and IES-R but not on the others. Only 51 workers, most with previous SARS-CoV-2 infection, sought clinical psychological counseling, and more than half received subsequent psychological support. Conclusions. Our results agree with most of the literature data that anxiety, depression, and stress are associated with gender (female), age (18-44 vs. over 55), and having cared for patients with COVID-19. [ABSTRACT FROM AUTHOR]

The Depression, Anxiety and Stress Scale (DASS-21) is one of the most used instruments to measure negative emotional states in different populations. Despite this, its dimensionality and consistency are still questioned, especially in less studied populations such as employees. The present study aimed to determine the DASS-21 dimensionality in a sample of service employees from a Chilean organization (N=1143), using a non-experimental design survey. Structural equation models were used to evaluate four models: unidimensional, oblique, second order, and bifactor. Results showed that all models had an adequate fit, although the ancillary bifactor measure supports the unidimensional structure of the DASS-21 in this samples of employees. We suggest further research on the conceptual and operational nature of this scale in the employee population. [ABSTRACT FROM AUTHOR]

Abstract Background To estimate the determinants of anxiety and depression among university teachers in Lahore, Pakistan, during COVID-19. Methods A cross-sectional study was conducted by enrolling 668 teachers from the universities of Lahore, Pakistan. Data were collected using a questionnaire. Chi-square for significance and logistic regression for the association were used. Results Majorly, the university teachers, with an average age of 35.29 years, had regular jobs (72.8%), job experience of > 6 years (51.2%) and good self-reported health (55.4%). The majority of the teachers were working as lecturers (59.6%), lecturing in arts (33.5%) or general science (42.5%) departments, having MPhil (37.9%) or master (28.9%) degrees, and teaching via synchronous video (59.3%) mode. Anxiety and depression, severe and extremely severe, were higher among lecturers, MPhil or master degree holders, teachers lecturing arts and general science subjects, and in those on contract employment. Anxiety was significantly associated with academic departments; arts (OR;2.5, p = 0.001) and general science (OR;2.9, p = 0.001), poor health status (OR;4.4, p = 0.018), and contractual employment (OR;1.8, p = 0.003). Depression was associated with academic departments; arts (OR;2.7, p = 0.001) and general science (OR;2.5, p = 0.001), and health status (OR;2.3, p = 0.001). Conclusion Among university teachers, anxiety and depression, severe and extremely severe, were prevalent among lecturers having MPhil or master degrees, belonging to arts and general science departments, and among contract employees. Anxiety and depression were significantly associated with academic disciplines, lower cadre, and poor health status.