Dear Editor, Mental health disorders among adolescents are emerging as an important public health concern, with one in seven individuals in this age group globally experiencing a mental disorder, contributing to nearly 15% of the global burden of disease.1 We have gone through with great interest the article by Bruce et al.2 recently published in the October issue of your journal. We want to appreciate the authors for their effort in conducting this study related to the assessment of validity and reliability of DASS among school-going adolescents. However, we want to highlight some issues related to the methodology and result section of this article. Firstly, the authors used multistage cluster sampling with stratification as a sampling technique, which increases the generalisability of their findings. However, they have not used intraclass correlation and design effect during sample size calculation as suggested by previous studies.3 Furthermore, the inclusion of a non-response rate adjustment would have strengthened the sample size estimation. Secondly, the result section lacks descriptive statistics of sociodemographic variables, as it would be helpful to understand the diversity and background characteristics of the study participants. Authors have assessed stability of the scale with ICC, which demonstrated good test–retest reliability over time. However, it remains unclear whether the questionnaire was re-administered to all study participants for evaluating stability, or only to a subset of the sample. In the validity section, authors have analysed content validity but did not report quantitative indices like content validity index or content validity ratio, which could have provided standardised measurement of expert agreement and item relevance. They explored criterion validity by calculating correlation coefficients between DASS scores with established measures of ‘anxiety, depression, stress’ like Nordic Musculoskeletal Questionnaire (NMQ) scores and Health Questionnaire Scores. However, it is important to note that these instruments are not primarily designed to assess anxiety, depression, or stress among adolescents. Use of measures like the Depression Anxiety Stress Scales—Youth version (DASS-Y), specially developed to measure general psychological distress and the negative emotional states of depression, anxiety, and stress among adolescents, would have been more appropriate for reporting concurrent validity.4 Another point we want to emphasise is the assessment of construct validity. Use of confirmatory factor analysis and/or exploratory factor analysis would have provided a comprehensive evaluation of the underlying factor structure of the DASS and allowed them reporting the overall model fit and dimensionality of the instrument. List of abbreviationsFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Dey et al. (Thu,) studied this question.