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Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women
– Reported, May 24, 2013
Depression and anxiety are the common non-psychotic mental disorders experienced most frequently by women living in resource-constrained low and lower-middle income countries . Early detection of these problems in primary health care is essential to identifying women who might be offered targeted treatments and therefore to improving prognosis among them and reducing disability in the community . As the competing health priorities of infectious illness and malnutrition are diminishing in these settings, awareness of mental health is growing. There is an increasing need for screening tools, which primary health care staff can use, to identify people experiencing common mental disorders in the community.
The Depression Anxiety and Stress Scales (DASS) is a widely used screening tool to assess symptoms of depression, anxiety, and stress in community settings. This instrument comprises three sub-scales: (1) the Depression sub-scale which measures hopelessness, low self-esteem, and low positive affect; (2) the Anxiety scale which assesses autonomic arousal, musculo-skeletal symptoms, situational anxiety and subjective experience of anxious arousal; and (3) the Stress scale which assesses tension, agitation, and negative affect. There are two forms of the DASS, the full 42-item and the short 21-item versions. Both assess the same domains.
The results of EFA, analyses of the median scores of the three sub-scales by diagnostic groups and ROC analyses are consistent in indicating that in this setting, there is only one dimension of psychological functioning underlying the 21 items of the DASS21-Vietnam Validation (DASS21-V). None of the subscales was able to distinguish women experiencing depression from those with an anxiety disorder. These findings, are similar to our previous validations of other psychometric instruments in this setting , and suggest that while screening tools are able to detect clinically significant psychological states, they are not able to distinguish which state an individual woman is experiencing. It is possible that the symptoms which distinguish between depression and anxiety in Vietnamese women were absent in the screening tools and this warrants further investigation in future studies.
The other interpretation is that non-psychotic psychological morbidity is more accurately conceptualised in this setting as a continuum, rather than a distinct series of separate conditions. The term common mental disorders which refers to depression and anxiety is widely used in existing research to indicate that these are not readily distinguishable from each other in resource-constrained settings . We have shown that in rural Vietnam there are the same risk factors for depressive and anxious states: intimate partner violence, low household wealth and coincidental adverse life events which are common among women in resource-constrained countries.
CREDITS.
Thach Duc Tran, Tuan Tran, and Jane Fisher
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566910/
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