Training and Research Unit of Excellence (TRUE), 1 Kufa Road, PO Box 30538, Chichiri, BT3, Blantyre, Malawi.
Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi.
BMC Psychiatry. 2022 May 24;22(1):352. doi: 10.1186/s12888-022-03994-0.
Approximately one in five women who have recently given birth suffer from common mental disorder (CMD), particularly depression and/or anxiety. Most available CMD screening tools in most low- and middle-income countries do not screen for more than one mental health problem. Having a screening tool that is free to use, short in assessment time, and used to screen for more than one CMD is appealing in a resource-constrained setting.
We conducted a criterion validation study of the Chichewa translated and adapted DASS-21 instrument against gold standard diagnoses of depression and anxiety disorders using an independently administered Structured Clinical Interview for DSM-IV (SCID). We compared the performance of the DASS-depression subscale with the Edinburgh Postpartum Depression Scale (EPDS). Internal reliability was reported using both Cronbach's alpha and ordinal alpha. The DASS-21 and EPDS ability to discriminate cases from non-cases was assessed by receiver operating characteristics (ROC) analysis. We selected cut-off points for DASS-21 and EPDS that maximise both sensitivity and specificity.
One hundred fifteen participants were administered all the measures. Approximately 11.3% and 14.8% had depression and anxiety diagnoses respectively using SCID. The overall Cronbach's alpha for the DASS-21 scale was 0.74. The DASS-21 subscales had Cronbach's alpha values of 0.66, 0.29 and 0.52 for depression (DASS-D), anxiety (DASS-A) and stress (DASS-S), respectively. The ordinal alpha for DASS-D, DASS-A and DASS-S subscales were 0.83, 0.74 and 0.87, respectively. The area under the ROC curve was 0.76 (95% CI: 0.61; 0.91) for DASS-D and 0.65 for DASS-A. At a cut-off point of one or more, the sensitivity and specificity for DASS-D were 69.2% and 75.5%, whilst DASS-A was 52.9% and 75.5%, respectively. Pearson correlation coefficient for the association between DASS-D and EPDS was r = 0.61, p < 0.001.
The DASS-21 had good internal reliability (Cronbach's alpha), and its ordinal alpha demonstrated good internal reliability for all its sub-scales. Regarding the criterion validation, only the DASS-D and EPDS demonstrated a satisfactory ability to discriminate cases from non-cases. Our findings suggest that health practitioners can use DASS-D as an alternative tool in screening depression as it has fewer questions than EPDS.
大约五分之一的近期分娩的女性患有常见精神障碍（CMD），尤其是抑郁和/或焦虑。大多数中低收入国家现有的 CMD 筛查工具都不能筛查出一种以上的心理健康问题。在资源有限的情况下，拥有一个免费使用、评估时间短且可用于筛查多种 CMD 的筛查工具是很有吸引力的。
我们使用独立管理的 DSM-IV 结构化临床访谈（SCID），对经过奇查瓦语翻译和改编的 DASS-21 工具进行了标准验证研究，以评估其对抑郁和焦虑障碍的金标准诊断。我们比较了 DASS-抑郁量表与爱丁堡产后抑郁量表（EPDS）的表现。使用 Cronbach's alpha 和有序 alpha 报告了内部可靠性。通过接受者操作特征（ROC）分析评估了 DASS-21 和 EPDS 区分病例与非病例的能力。我们选择了 DASS-21 和 EPDS 的最佳截断点，以最大化敏感性和特异性。
共有 115 名参与者接受了所有的测量。使用 SCID 诊断，约有 11.3%和 14.8%的人患有抑郁和焦虑。DASS-21 量表的总体 Cronbach's alpha 为 0.74。DASS-21 子量表的 Cronbach's alpha 值分别为抑郁（DASS-D）、焦虑（DASS-A）和压力（DASS-S）的 0.66、0.29 和 0.52。DASS-D、DASS-A 和 DASS-S 子量表的有序 alpha 值分别为 0.83、0.74 和 0.87。ROC 曲线下面积为 0.76（95%CI：0.61；0.91）用于 DASS-D 和 0.65 用于 DASS-A。在截断值为 1 或更高时，DASS-D 的敏感性和特异性分别为 69.2%和 75.5%，而 DASS-A 分别为 52.9%和 75.5%。DASS-D 和 EPDS 之间的关联的 Pearson 相关系数为 r=0.61，p<0.001。
DASS-21 具有良好的内部可靠性（Cronbach's alpha），其有序 alpha 显示出所有子量表的良好内部可靠性。就标准验证而言，只有 DASS-D 和 EPDS 表现出区分病例与非病例的令人满意的能力。我们的研究结果表明，健康从业者可以将 DASS-D 用作筛查抑郁的替代工具，因为它比 EPDS 问题少。
