Validation of depression, anxiety, and stress scales (DASS-21) among Thai nursing students in an online learning environment during the COVID-19 outbreak: A multi-center study

Abstract

The Depression, Anxiety and Stress Scale (DASS-21), an introductory scale used to identify common mental disorders (CMDs) among adults, was validated across cultures in Asian populations; nevertheless, its capacity for screening these disorders may be limited for some specified groups, including nursing students. This study attempted to investigate the psychometric scale’s unique features of DASS-21 for Thai nursing students in an online learning environment during the COVID-19 outbreak. A cross-sectional study using the multistage sampling technique recruited 3,705 nursing students from 18 universities located in south and northeast Thailand. The data were gathered using an online web-based survey, and then all respondents were divided into 2 groups (group 1, n = 2,000, group 2, n = 1,705). After using the statistical methods to reduce items, exploratory factor analysis (EFA) using group 1 was performed to investigate the factor structure of the DASS-21. Finally, group 2 used confirmatory factor analysis to verify the modified structure proposed by the EFA and assess the construct validity of the DASS-21. A total of 3,705 Thai nursing students were enrolled. For the factorial construct validity, a three-factor model was initially suggested containing 18 items (DASS-18) spread across 3 components: anxiety (7 items), depression (7 items) and stress (4 items). The internal consistency reliability was acceptable with Cronbach’s alpha in the range of 0.73–0.92for either the total or its subscales. For convergent validity, average variance extracted (AVE) showed that all the DASS-18 subscales achieved convergence effect with AVE in the range of 0.50–0.67. The psychometric features of the DASS-18 will support Thai psychologists and researchers to screen CMDs more easily among undergraduate nursing students in tertiary institutions who enrolled in an online learning environment during the COVID-19 outbreak.