Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample?

Q: What are the key findings of this study?

DASS-21 Depression and Anxiety scales demonstrated structural factor variance/covariance invariance across cancer (α=0.90 and 0.70) and non-cancer (α=0.93 and 0.80) samples.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cancer and psychological distress (depression and anxiety) (n=583). Intervention: DASS-21 Depression and Anxiety scales in cancer patients vs. Non-cancer control participants. Primary outcome: Structural measurement invariance (configural, metric, and factor variance/covariance invariance) and internal consistency reliability of the two-factor DASS-21 Depression and Anxiety scales (p=<0.01).

Q: What does this research mean for the field?

The DASS-21 Depression and Anxiety scales demonstrate structural measurement invariance and construct validity across cancer patients and non-cancer individuals, supporting their validity for distress screening in oncologic settings. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the psychometric properties, factor structure, and measurement invariance of the DASS-21 Depression and Anxiety scales in cancer patients compared to noncancer controls.

Rina S. Fox; Teresa Lillis; James Gerhart; Michael Hoerger; Paul R. Duberstein

doi:10.1177/0033294117727747

August 24, 2017Psychological ReportsOpen Access

Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample?

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Key result

DASS-21 depression and anxiety scales demonstrate consistent measurement invariance across cancer and non-cancer cohorts.

P<0.01
n=583

Why the study?

Do the DASS-21 Depression and Anxiety scales demonstrate structural measurement invariance, reliability, and construct validity in cancer patients compared to non-cancer controls?

Key Points

To evaluate the psychometric properties, factor structure, and measurement invariance of the DASS-21 Depression and Anxiety scales in cancer patients compared to noncancer controls.
Cross-sectional study evaluating the DASS-21 Depression and Anxiety scales among 376 cancer patients (mean age 58.3 years) and 207 noncancer control participants (mean age 45.0 years).
Multiple group confirmatory factor analysis was conducted using the Satorra-Bentler chi-square test statistic to evaluate configural, metric, and factor variance/covariance invariance across groups.
A one-factor general distress model exhibited poor fit for cancer patients (S-Bχ2 = 272.99, p < .01, CFI = .87, RMSEA = .08, SRMR = .07) and controls (S-Bχ2 = 222.77, p < .01, CFI = .86, RMSEA = .10, SRMR = .08), whereas the two-factor variance/covariance invariance model demonstrated the best fit.
Internal consistency reliability was supported in cancer patients (Depression α = .90; Anxiety α = .70) and noncancer controls (Depression α = .93; Anxiety α = .80).
Construct validity was confirmed through positive associations with suicidal ideation in cancer patients (Depression OR = 1.40, 95% CI = 1.29, 1.51; Anxiety OR = 1.28, 95% CI = 1.15, 1.37) and controls (Depression OR = 1.39, 95% CI = 1.25, 1.54; Anxiety OR = 1.40, 95% CI = 1.24, 1.57).

Study Design

Type

Cross-Sectional (n=583)

Structured PICO

Do the DASS-21 Depression and Anxiety scales demonstrate structural measurement invariance, reliability, and construct validity in cancer patients compared to non-cancer controls?

P

Population

583 adult survey participants (376 patients currently receiving cancer treatment aged 21-84 years and 207 noncancer control participants aged 18-81 years) evaluated in a cross-sectional Internet-mediated psychometric study.

E

Exposure

Administration of the 14-item DASS-21 Depression (7 items) and Anxiety (7 items) scales via an Internet-mediated survey among cancer patients

C

Comparator

Administration of the DASS-21 Depression and Anxiety scales among non-cancer control participants

O

Outcome

Structural validity / measurement invariance (configural, metric, and factor variance/covariance invariance via multiple group confirmatory factor analysis) and internal consistency reliability (Cronbach's alpha) of the DASS-21 Depression and Anxiety scalespatient reported

Main Result

p-value: p=<0.01

The DASS-21 Depression and Anxiety scales are structurally invariant, reliable, and valid for screening psychological distress in oncology patients, performing equivalently to non-cancer populations.

Limitations

Cross-sectional design precluded evaluation of test-retest reliability
The DASS-21 Stress scale was not administered, so its psychometric properties could not be evaluated
Sociodemographic variables significantly differed across cancer patients and non-cancer control participants
The DASS-21 Stress scale was not administered to reduce participant burden, preventing evaluation of its psychometric properties
Sociodemographic variables significantly differed between cancer patients and non-cancer control participants

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Implication

Supports equivalent DASS-21 use for distress screening in cancer patients; leaves open prospective validation of clinical utility.

Abstract

The DASS-21 is a public domain instrument that is commonly used to evaluate depression and anxiety in psychiatric and community populations; however, the factor structure of the measure has not previously been examined in oncologic settings. Given that the psychometric properties of measures of distress may be compromised in the context of symptoms related to cancer and its treatment, the present study evaluated the psychometric properties of the DASS-21 Depression and Anxiety scales in cancer patients ( n = 376) as compared to noncancer control participants ( n = 207). Cancer patients ranged in age from 21 to 84 years (mean = 58.3, standard deviation = 10.4) and noncancer control participants ranged in age from 18 to 81 years (mean = 45.0, standard deviation = 11.7). Multiple group confirmatory factor analysis supported the structural invariance of the DASS-21 Depression and Anxiety scales across groups; the factor variance/covariance invariance model was the best fit to the data. Cronbach's coefficient alpha values demonstrated acceptable internal consistency reliability across the total sample as well as within subgroups of cancer patients and noncancer control participants. Expected relationships of DASS-21 Depression and Anxiety scale scores to measures of suicidal ideation, quality of life, self-rated health, and depressed mood supported construct validity. These results support the psychometric properties of the DASS-21 Depression and Anxiety scales when measuring psychological distress in cancer patients.

Discussion

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Cite This Study

Fox et al. (2017) conducted a cross-sectional in Cancer and psychological distress (depression and anxiety) (n=583). DASS-21 Depression and Anxiety scales in cancer patients vs. Non-cancer control participants was evaluated on Structural measurement invariance (configural, metric, and factor variance/covariance invariance) and internal consistency reliability of the two-factor DASS-21 Depression and Anxiety scales (p=<0.01). DASS-21 Depression and Anxiety scales demonstrated structural factor variance/covariance invariance across cancer (α=0.90 and 0.70) and non-cancer (α=0.93 and 0.80) samples.

synapsesocial.com/papers/6a774d841400807f0f1e9d5c https://doi.org/10.1177/0033294117727747

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Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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