Research on translations of tests: Cross-cultural validation of the depression anxiety stress scale-21 in China

Abstract

The gap between the demand and delivery of mental health services in mainland China can be reduced by validating freely available and psychometrically sound psychological instruments. The present research examined the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21). Study 1 administered the DASS-21 to 1,815 Chinese college students and found internal consistency indices (Cronbach's alpha) of .83, .80, and .82 for the Depression, Anxiety, and Stress subscales, respectively, and .92 for the total DASS total. Test-retest reliability over a 6-month interval was .39 to .46 for each of the 3 subscales and .46 for the total DASS. Moderate convergent validity of the Depression and Anxiety subscales was demonstrated via significant correlations with the Chinese Beck Depression Inventory (r = .51 at Time 1 and r = .64 at Time 2) and the Chinese State-Trait Anxiety Inventory (r = .41), respectively. Confirmatory factor analyses supported the original 3-factor model with 1 minor change (nonnormed fit index [NNFI] = .964, comparative fit index [CFI] = .968, and root mean square error of approximation [RMSEA] = .079). Study 2 examined the clinical utility of the Chinese DASS-21 in 166 patients with schizophrenia and 90 matched healthy controls. Patients had higher Depression and Anxiety but not Stress subscale scores than healthy controls. A discriminant function composed of the linear combination of 3 subscale scores correctly discriminated 69.92% of participants, which again supported the potential clinical utility of the DASS in mainland China. Taken together, findings in these studies support the cross-cultural validity of the DASS-21 in China.