Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 19;21(4):509.
doi: 10.3390/ijerph21040509.

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

Rebecca H Kim  1 , Yvette C Paulino  2 , Yoshito Kawabata  3
Affiliations

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

Rebecca H Kim et al. Int J Environ Res Public Health. .

Abstract

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.

Keywords: DASS-21; Guam college students; construct validation; health indicators; psychological outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Hypothesized model for Objective 1. This figure shows the three-factor model of DASS-21 proposed by Lovibond and Lovibond [51]. (Generally, the ovals represent the latent constructs, and the rectangles represent the observed variables. The one-headed arrow indicates a linear regression, while the two-headed arrow indicates a correlation).
Figure 2
Figure 2
Hypothesized model for Objective 2. This figure is the hypothesized model of the relationship between the health-related predictor variables and psychological outcome variables.
Figure 3
Figure 3
Results from confirmatory factor analysis. These figures are a diagram of the confirmatory factor analysis of the DASS-21 instrument with factor loadings (a) of all items and (b) without item 2.
Figure 4
Figure 4
Structural-equation model with significant paths. (n = 726).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization Mental Health Disorders Affect One in Four People. In World Health Report 2001. 2001. [(accessed on 19 February 2024)]. Available online: https://www.who.int/news-room/detail/28-09-2001-the-world-health-report-....
    1. World Health Organization World Mental Health Report: Transforming Mental Health for All. 2022. [(accessed on 19 February 2024)]. Available online: https://iris.who.int/bitstream/handle/10665/356119/9789240049338-eng.pdf....
    1. Institute for Health Metrics and Evaluation Findings from the Global Burden of Disease Study 2017. 2018. [(accessed on 19 February 2024)]. Available online: https://www.healthdata.org/sites/default/files/files/policy_report/2019/....
    1. American Foundation for Suicide Prevention Risk Factors, Protective Factors, and Warning Signs. 2024. [(accessed on 19 February 2024)]. Available online: https://afsp.org/risk-factors-protective-factors-and-warning-signs/
    1. American Psychological Association Psychology Topics: Stress. 2019. [(accessed on 19 February 2024)]. Available online: https://www.apa.org/topics/stress.

Publication types