Idea Transcript
Screening to Identify Internalizing Distress Using the DASS-21 Stephanie A. Moore, Kathryn Moffa, Oscar Widales-Benitez, Erin Dowdy, Michael J. Furlong, & Katherine W. Carnazzo Department of Counseling, Clinical and School Psychology, International Center for School-Based Youth Development, University of California, Santa Barbara
Introduction • •
Internalizing difficulties are particularly underserved (Cook et al., 2011).
•
Universal self-report screening is one approach to better identify youth for services (Young et al., 2010). Available measures have limited psychometric properties (Levitt et al., 2007).
• •
Female
Depression, Anxiety, Stress Scales-21 (DASS-21) is widely used in Australia and U.K. and is proposed as effective tool. As a first step to determine if it is appropriate for use in U.S. schools, we aimed to: • • •
Analyze the factor structure of the DASS-21 with U.S. adolescents. Help assess the cross-cultural equivalence of the scale. Address current issues regarding its factor structure.
Method •
Grades 9 (25.8%), 10 (29.7%), 11 (23.7%), 12 (20.3%)
•
School 1: 87.6% Latino/a, 4.8% Non-Hispanic White, 2.1% Asian
•
School 2: 54.6% Latino/a, 37.6% Non-Hispanic White, 3.6% Asian
SD
M
SD
t
df
Depression
8.87
9.32
7.82
8.80
8.35
9.07
-2.80**
2301.71
Anxiety
8.97
8.63
7.10
7.57
8.02
8.70
-5.49***
2203.53
Stress
10.94
13.94
10.94
8.45
12.41
9.01
-8.15***
2290.34
Total
31.51
24.61
25.86
22.54
28.64
23.77
-5.87***
2362.90
RMSEA [CI]
CFI
TLI
One-factor
4163.402***
189
.093 [.090, .095]
0.927
0.919
Models
Three-factor
2941.534***
186
.078 [.075, .080]
0.950
0.943
a
Bifactor a
2276.729***
168
.072 [.069, .074]
0.961
0.952
b
2720.896***
175
.077 [.074, .080]
0.953
0.944
Bifactor
Data informed school-based prevention and intervention programs
.67
One-factor Dep.
Three-factor NA
Statistical Analyses •
Four CFA models, WLSMV estimation, Mplus 7.1 (Muthén & Muthén, 1998-2013)
•
DASS-21 Items
Model fit included: • • •
Good fit - CFI & TLI > .95, RMSEA < .05 Adequate fit – CFI & TLI > .90, RMSEA < .08 Adjusted chi-square difference testing
•
Omega hierarchical (ωh = .92), explained common variance (ECV = .96)
•
Omega hierarchical subscale (ωs ) coefficients for Depression (ωs = .03), Anxiety (ωs = .009), and Stress (ωs = .003)
•
Majority of the variance explained by general NA factor.
•
Reliability of the subscale scores substantially reduced after controlling for the general factor.
Implications Subscales reflect a common factor, Negative Affectivity.
•
Bifactor model with general Negative Affectivity factor and three specific factors of Depression, Anxiety, and Stress.
Total score can be derived as a measure of general negative affectivity.
•
Bifactor model with general Negative Affectivity factor and two specific factors of Depression and Anxiety. *** p < .001.
May not adequately differentiate between the experiences of negative affectivity, anxiety, and stress in U.S. adolescents.
•
Negative Affectivity construct offers preliminary support for use of the DASS-21 as a first-step to identify internalizing distress within a multiple-gate screening strategy.
b
3. No positive
NA
Stress
•
Bifactor model with three specific factors yielded the best fit.
•
Path diagram of final DASS–21 bifactor model.
Procedure Students identified as at-risk were referred to school counselors
•
DASS-21 Items
Anx.
•
Fit Statistics for Each of the Tested
df
Depression Anxiety Stress Scales (DASS)-21: 21 items, symptoms of depression, anxiety, and stress in past week (Lovibond & Lovibond, 1995)
Data collected Fall 2014 as part of universal mental health screening
Note. t-values represent comparisons between males and females. **p < .01. ***p < .001.
χ2
Model
Measure
•
for DASS–21 by Gender
M
Anx.
Dep. Bifactorb
.64
Models Tested
N = 2,454 (Southern California), 47.6% female
Overall
SD
Participants •
Male
M
75-80% of youth needing mental health services do not receive them (Kataoka, Zhang, & Wells, 2002).
•
Scale
Results & Discussion
Means and Standard Deviations
Negative Affectivity (NA)
.73 .78 .79 .76 .74 .52 .67 .74 .72 .89 .60 .82
5. No motivation 10. Nothing look forward 13. Sad, down, blue 16. No enthusiasm 17. Not worth much 21. Meaningless 2. Dry mouth 4. Breathing Difficulty 7. Trembling, shaking 9. Panic, fool of self 15. Cope and panic 19. Heartbeat
.48
20. Scared
.60
1. Relax and wind down
.76
6. Over-react
.80
8. Nervous energy
.76
11. Tense, uptight
.79
12. Hard to relax
.78
14. Easily bothered 18. Easily annoyed
†p
Future Directions
> .05
.38 .36 .40 .30 .32 .50
Depression
•
Replicate the findings in additional diverse samples.
•
Investigate measurement and structural invariance.
•
Examine concurrent and predictive validity of the total negative affectivity score with specific symptoms of depression, anxiety, and stress to inform its use as part of universal screening efforts to predict and identify internalizing problems.
.53 .17 .46 .21 -.05† .04† .44
References Anxiety
.15
Levitt, J. M., Saka, N., Romanelli, L. H., & Hoagwood, K. (2007). Early identification of mental health problems in schools: The status of instrumentation. Journal of School Psychology, 45, 163–191. doi:10.1016/u.usp.2006.11.005
.47 -.03† .08 .16 .45 -.17 -.17
Cook, C. R., Rasetshwane, K. B., Truelson, E., Grant, S., Dart, E. H., Collins, T. A., & Sprague, J. (2011). Development and validation of the Student Internalizing Behavior Screener: Examination of reliability, validity, and classification accuracy. Assessment for Effective Intervention, 36(2), 71–79. doi:10.1177/1534508410390486 Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555. doi:10.1176/appi.ajp.159.9.1548
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney, AU: Psychology Foundation.
Stress
Moore, S. A., Dowdy, E., & Furlong, M. J. (2016). Using the Depression, Anxiety, Stress Scales–21 with U.S. Adolescents: An Alternate Models Analysis. Under review. Muthén, L. K., & Muthén, B. O. (1998-2013). Mplus user's guide (6th ed.). Los Angeles, CA: Muthén & Muthén. Young, E. L., Sabbah, H. Y., Young, B. J., Reiser, M. L., & Richardson, M. J. (2010). Gender differences and similarities in a screening process for emotional and behavioral risks in secondary schools. Journal of Emotional and Behavioral Disorders, 18, 225– 235. doi:10.1177/1063426609338858