Depression Anxiety Stress Scales (DASS)

Abstract

The development of Depression, Anxiety and Stress scales were originally formulated by the University of South Wales researchers based in Australia. Validation of DASS is significant in the sense that the tool is applied as a screening instrument for anxiety, stress and depression. Medical practitioners argue that anxiety and depression are serious problems in the public health, mainly among the low income countries, which contributes significantly to mental disorders in the society (Beiling et al, 1998). Anxiety, stress and depression are considered common non psychotic disorders of the mind in the twenty first century that is characterized with diverse changes in the world due to modernization. Health care practitioners and psychologists argue that detection of the health problem early plays a critical role in the management of the disorder, before the negative consequences affect the health and the day to day activities of an individual.

DASS tool is psychometrically useful and adequate in defining anxiety, depression and stress levels; which subsequently enables initiation of mechanisms of managing stress, anxiety and depression in a healthy pattern. It is estimated that more than three million Australian people suffer from anxiety, depression and stress; the number is huge prompting a need for a long lasting and workable solution to the problem. There is a need of customizing a DASS tool into local languages in Australia so that to reflect on the local Australian norms in order to maintain coherences in different samples in communities under consideration. Surveys argues that DASS-42 is better than DASS-21 in terms of the observed results, although most clinicians in Australia prefer DASS-42 and general researchers opt for DASS-21.

There is a need for extensive research in DASS in distinguishing symptoms assigned to generalized anxiety and symptoms attached to arousals, it is recommended that for the DASS to be accurate, a larger random sample is preferred as compared to a small random sample. There is also a need of effectively addressing correlation coefficients, an indication that sample homogeneity is at times compromised; such issues in the future are addressed through engaging diverse and heterogeneous sample, with the main focus at people suffering from anxiety, depression and stress (Antony et al, 1998). Researchers argue that discriminate and convergent validity of the DASS versions is supported by the diversity of the information under consideration.

Description of DASS

DASS identifies with the Depression Anxiety Stress Scales that constitutes forty two self report particulars expected to be completed within five to ten minutes. It has been noted that each item in the DASS represents an emotional symptom attached to negativity. A four point Likert scale is used in rating each of the items with severity and frequency depending on the experiences of the participants as per the last week of observation (Watson et al, 2005). The instructions on DASS argue that there are no wrong or right answers, it depends on diverse situations.

Scales and Subscales have allocated fourteen items for each of the Depression, Anxiety and Stress. The forty-two items are randomized in order, in a way that each item is never clustered together in the scale. The scales are subsequently subdivided into subscales, which then is made up of two to five items in each subscale, the scaling makes it possible to make sound inferences on depression levels, anxiety levels and on the stress levels (Watson et al, 2005).

Introduction and overview

It has been noted that Depression scale is characterized with subscales identifying with hopelessness, dysphoria, self deprecation, inertia, lack of involvement or interest, life devaluation and anhedonia. Anxiety scale is characterized with skeletal muscle effects, anxious effect attached to subjective experience, autonomic arousal and situational anxiety. Stress is characterized with subscales of the main scale with difficult relaxations brought about by non-chronic arousal effects, easily agitated or upset, nervous arousal, impatience and issues of over-reactive and irritability.

The main purpose attached to DASS is to identify and isolate emotional disturbance aspects. Some of the common aspects identify with assessing the severity degree as per the core symptoms of anxiety, depression and stress (Watson et al, 2005). It has been noted that the initial aims associated with the construction of the scale is applied in defining the attributes of core symptoms attached to anxiety, depression and stress; at the same time the levels of psychometric adequacy as per the preset standards, this is used in the development of the highest discrimination levels in the scales of anxiety and depression. It has been noted that DASS has the capability of being scored or administered by individuals lacking qualifications in psychology, therefore user friendly (Lovibond & Lovibond, 2005). Recommendations put forward on the decisions and interpretations reflects that the results collected by clinicians who are experienced, is backed up by data collected from diverse forms of assessments.

Content

Depression according to Watson and Clark, argues that DASS has little contributions on positive effects such as confidence, happiness and enthusiasm among others (Nieuwenhuijsen et al, 2003). On the other hand, physiological hyperrousal has some attributes of uniqueness, and to some extent related to anxiety. It is argued that anxiety and depression has a different conception, although the states overlap to some degrees, attributes that make it very difficult to make sensible distinctions while screening (Crawford & Henry, 2003).

DASS over the last decade has been substantial as a screening tool in the society, in defining anxiety, stress and depression levels. DASS has two forms identifying with short twenty one item version and the full forty two item version; although the two versions play the same role in providing similar factor structure. Full DASS to some extent provides more reliable scores and provides detailed and more specific information on particular symptoms than short DASS. The advantages of short DASS are attached on the short time taken in administering the processes, mostly half time.

DASS 42 is preferred in clinical purposes while DASS 21 is preferred in research work (Beck et al, 2008). Evidence has proved that DASS is most applicable in the community settings and also in the clinical settings according to surveys conducted in Australia, United States, United Kingdom and Canada (Beck et al, 2008). DASS has been validated and translated into a number of languages of the world. It has been noted that non English versions and English versions have different levels of internal consistency (Beck et al, 2008).

Reading and research conducted, Relevance of the material

(DASS-D) Depression is a common occurrence according to surveys done by the World Health Organization; it is estimated in the globe that roughly four hundred and fifty million people are struggling with problems of mental health, with depression topping the list (Beck et al, 2008). Issues of mental health in the world are significant to nations, particularly reflecting on the issues of mental distress. Depression over the decades has been on the increment, it is estimated that roughly three million people in Australia living with anxiety, stress and depression (Beyondblue.org.au, 2013).

There are a number of organizations working together in improving the condition, Beyondblue is one such organization that specializes on developing mechanism of reducing the impact of anxiety, stress and depression in Australia; this is made possible by raising understanding and awareness in the community (Beyondblue.org.au, 2013). Australian people are encouraged and empowered to seek the necessary help, it has been noted that Beyondblue has been supporting management, recovery and resilience among the Australian communities (Beyondblue.org.au, 2013). Anxiety in women doubles anxiety in males, mainly starting at adolescence stages, most surveys have confirmed that one adult in every four adult persons are suffering from the mental ailments (Lovibond & Lovibond, 2005).

(DASS-A) Anxiety affects all human beings at one particular part in life or another, it has been noted that anxiety is a result of conflicts and stressful situations through work, life, schools, partners, family, social commitments and life expectations among others. Surveys argue that mild anxiety is fine, since it makes individuals more focused and alert on immediate challenges, threats and other important issues. Anxiety becomes a metal problem when the effects are prolonged, an indication that side effects of anxiety becomes unhealthy since it influences the daily operations of individuals (Crawford & Henry, 2003).

Surveys argue that in most cases, anxiety feelings are concealed within an individual, this is where DASS tool becomes useful in solving the mystery. Anxiety in most cases is suffered in silence by the individuals, an indication that people suffering from anxiety are the least expected in the community, and such people fail to admit that in one way or another they extensively suffer from anxiety.

(DASS-S) Stress is another mental disorder affecting human beings; Stress Management Society is one of the organizations dealing with stress in the society. Stress according to the researchers happens when the demands in life exceed the ability or resources of an individual, in a way that pressure is the key term in defining stress. Stress has diverse definitions depending on the severity and degree of feelings and emotions related to the stress. Pressure and stress in a number of situations are critical in enhancing the productivity, performance and motivation in people. Surveys indicated that prolonged and too much pressure has high chances of developing into stress, which affects the human body and human mind negatively, and considered unhealthy; scientifically referred to as chronic stress.

The emotion and feeling of stress is believed to be contributed by the release of some chemicals in the human body; the chemical is released when an individual faces stressing conditions, some of the chemicals are adrenaline, cortisol and noradrenaline. The chemicals are used in invoking a flight or a fight depending on the situations, where an individual is involved in making rational choices on the possible ways of addressing situations (Beck & Steer, 2000). Responses pegged on a Flight or a fight is considered as a reaction to pressure or challenge; individuals identify threats and potentially harmful situations, hence taking the necessary measures. Continuous exposure to the flight state or fight state is an indication that the chemicals related with stress are constantly being produced in the human body, a condition that results in negative and harmful effects to the health of individuals (Clark, 2009).

It is argued that build up of noradrenaline and adrenaline are responsible for the increased heart rate, blood pressure and sweating. In the same way, cortisol is responsible for preventing the immune system in the human body from functioning in the right way, and at the same time increase sugars and fats in the blood stream of the human body. Stress in one way or another inhibits the normal operations of the human body, which can lead to negative long term health effects. DASS comes in handy in recognizing the stress levels in defining whether the feelings are harmful or helpful to the individuals. Noting the levels of stress is critical in understanding the starting point in managing and responding to the negative feelings and emotions (Clark & Watson, 2001).

Review of the Clinical Research

DASS is administrated for research purposes in individual persons or in groups; the research tool has the capacity to effectively discriminate issues relating to the three states identifying with anxiety, depression and stress. DASS has been influential in etiology, nature and in mechanisms working on emotional disturbances of the human beings (Endler et al, 2003). DASS is used in screening normal adults and normal adolescents; although the tool has been found less effective to persons aged twelve years and below.

DASS in clinical use clarifies the specific source of emotional disturbance, as part of the clinical assessment; DASS then functions as an essential tool in assessing the severity attached to the core symptoms of stress, anxiety and depression. DASS is expected to meet the needs and the requirements of the professional clinicians and the needs of the researchers. Severity is measured through the application of a four point frequency or severity scales in defining the extent of the ratings experienced by each and every state in the course of the exercise. Clinicians argue that clinically stressed, anxious and depressed patients have high capabilities of developing additional ailments symptoms; the common additional symptoms identify with appetite, sleep and sexual disturbances among others. Such clinical disturbances are identified through clinical examination as pertains to the check list of the general symptom.

Knowledge of the Clinical and research application of DASS

DASS has been embraced fully in the medical field, in that it is scored and administered even by non-psychologists. Interpretation of the DASS information is mostly attached to clinicians that are experienced so that to define the correct score profiles depending on the extent of the clinical examinations (Nieuwenhuijsen et al, 2003). Surveys have indicated that suicidal tendencies were ignored in the DASS items since suicidal tendencies did not have significant load depending on the scales. Clinicians who are experienced have the capability of recognizing the exact need of the patient and at the same time in defining possibilities of suicide risk as noted with disturbed persons.

Review of the Reliability and Validity

The diagnosis of patients through DASS concentrates on dimensional conceptions and not categorical conception. There are a number of assumptions in the development and application of DASS, and that research data is critical in setting the right model of data analysis in getting the right information. Experienced clinicians are preferred in the data analysis in order to make sensible conclusions, in line to anxiety levels, depression levels and stress levels (Lovibond & Lovibond, 2004).

Clinically disturbed patients have the possibility of emanating varying degrees of stress, depression and anxiety. It has been noted that the DASS tool does not include direct implications as pertaining the patient allocation, experienced clinicians at these juncture plays a crucial role in classificatory systems; examples being ICD and DSM depending on the discrete diagnostic levels that are postulated. DASS manual has a clearly stipulated recommended cutoff in cases of convectional severity labels such as severe, moderate and normal. It can be generally argued that DASS is valid and reliable in most cases.

Using DASS in measuring elevated anxiety and mood symptomalogy

It is important to understand emotions, reactions and the attributes of moods; this is made possible by measuring and defining the emotional states of an individual, comprehending the causes that are underlying, explaining feelings and developing mechanisms of managing and controlling the feelings, as a way of improving the life of the individuals (Clara et al, 2001). It has been noted that DASS is relevant since depression; anxiety and stress are common and real in the community. The society in the recent decades has become very busy, competitive and stressful; an indication that more people than never are increasingly struggling to make ends meet.

Critical thought and analysis

Public awareness on issues of anxiety and depression has been emphasized by the psychologists, with massive investments in research and design in developing tools with capability of detecting common challenges facing human beings in relation to the mental disorder in the society. Scientists argue that there have been strong relationships between anxiety and depression; a topic that has drawn widespread reactions from psychologists, researchers and clinicians.

Globalization is contributing to high levels of depression, anxiety and stress. The world is changing fast with modernization, an indication that emotional and mental pressures are ever increasing in Australia and in the world as people struggle coping with the global changes. People react differently while under depression, anxiety and stress; to an extent that there are stressing situations in one person that would translate to motivation in other persons. Depression, anxiety and stress in many cases are caused by relationships, work and financial challenges among other factors.

It is wise managing depression, anxiety and stress since it affects day to day activities of the affected individuals; in ways that it affects how people feel, behave, think and the general functioning of the human body. Common symptoms of depression, anxiety and stress identify with difficulty in concentrating, irritability, low self esteem, racing thoughts, excessive worry, loosing temper fast, indulging in irresponsible behaviors, dizziness, muscle tension, constant headaches, sleeping problems, loss of appetite and sweating among others. DASS has been useful in defining the levels of depression, anxiety and stress; and in developing mechanisms of coping with the conditions.

Summary and Conclusion

DASS according to clinicians is relevant in the assessment of mental health, particularly in measuring the degree of anxiety, stress and depression. DASS enables individuals to understand depression levels, anxiety levels and stress levels as part of regaining control of the emotional states in achieving the desired levels as per the positive change in life (Brown et al, 1997). DASS is professionally developed and designed in providing the information and tools in understanding and defining emotions related with depression, stress and anxiety; which enables individuals to take actions in reducing and managing the negative feelings.

Further Research Identified

DASS in a theoretical perspective coincides with tripartite model of stress and anxiety; surveys have shown that the model supports the notion that depression and anxiety in a number of aspects have both unique and shared features. Tripartite model is supported by diverse studies. There is a need of developing a mechanism that will make early detection of depression and anxiety since they correlate and overlap in a number of instances; hence differentiating with other issues like muscle tension, worry and agitation among others (Beck et al, 2008). DASS to some extent has made it easy to detect stress states, depression state and anxiety state, particularly at the later stages. Further research in DASS is critical in distinguishing symptoms assigned to generalized anxiety and symptoms attached to arousals. DASS has been reliable in according to the three scales, particularly in clinical samples and factor analytic studies (Imam, 2006).

Limitations of DASS

Diagnostic assessment made by DASS influence the counseling and clinical settings in psychometrically proven measures that is influential in remedial and supportive services in psychology and in clinical applications. It has been noted that DASS-21 and DASS-42 displays consistency depending on the validity of anxiety, depression and stress. It is recommended that for the DASS to be accurate, a larger random sample is preferred as compared to a small random sample.

There is also a need of effectively addressing correlation coefficients, an indication that sample homogeneity is at times compromised; such issues in the future are addressed through engaging diverse and heterogeneous sample, with the main focus at people suffering from anxiety, depression and stress (Antony et al, 1998). Researchers support DASS-42 with longer states than DASS-21 that has a shorter version of the states, the two yields the same results although DASS-42 is more detailed and accurate as compared to the DASS-21. Researchers argue that discriminate and convergent validity of the DASS versions is supported by the diversity of the information under consideration.

References

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