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Translation of DASS 21 into Bangla and validation among medical students

June 2017
Bangladesh Journal of Psychiatry 28(2):67

DOI:10.3329/bjpsy.v28i2.32740

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CC BY-NC 4.0

Authors:

Sheikh MD ABU HENA Mostafa Alim

Rajshahi Medical College

Md. Zahir Uddin

National Institute of Mental Health (NIMH), Dhaka, Bangladesh

Show all 7 authorsHide

p>Standard scale to assess the symptoms of depression, anxiety and stress among MBBS students are essential to take necessary steps to treat or prevent any psychiatric morbidity. But there was no such convenient tool in Bangla to measure the stated symptoms. With an objective to obtain a convenient scale to measure severity of above symptoms, short version of Depression Anxiety Stress Scales (DASS 21) was translated into Bangla and the study was carried out to validate this Bangla version with permission from the author of the original instrument. Two translations and back translations were carried out. A harmonized version was produced after meetings by persons involved in translation process in meetings. After pretesting on ten students and reviewing by panel of experts, finalized Bangla version of DASS 21 (DASS 21 -BV) was obtained. A cross sectional study was carried out among MBBS students of Pabna Medical College, Pabna using purposive sampling technique to validate this scale. They were given both Bangla and English version of the scale 3 to 7 days apart. Analysis was done on 15 samples. Correlation for depression subscale was 0.976, anxiety subscale was 0.917 and stress subscale was 0.931. Correlation was significant at the 0.01 level (2-tailed). Cronbach’s Alpha for Depression, Anxiety and Stress subscales were 0.987, 0.957, 0.964 respectively. This Validated Bangla version of DASS 21 can be used to measure severity of depression among medical students and persons having similar academic background treatable. Bang J Psychiatry Dec 2014; 28(2): 67-70</p

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Original article

Translation of DASS 21 into Bangla and validation among medical

students

SM Abu Hena Mostafa Alim,1 Syed Mahbub-E-Kibria,2 Md Jahurul ls|am,3 Md Zahir Uddin,4 Meherun

Nessa,5 Md Abdul Wahab,6 Md Mesbahul lslam7

1Assistant Professor, Department of Psychiatry, Rajshahi Medical College, Rajshahi, Bangladesh; 2Medical

Ofﬁcer, Department of Psychiatry, Khulna Medical College, Khulna, Bangladesh; 3Professor, Department of

English, Rajshahi University, Rajshahi, Bangladesh; 4Assistant Professor (Clinical Psychology), Department

of Psychotherapy, National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka, Bangladesh;

5Assistant Professor, Department of English, Sher-E-Bangla Agricultural University, Dhaka, Bangladesh;

6Professor, Department of Psychiatry, Monno Medical College, Manikganj, Bangladesh; 7Clinical

Psychologist, Mental Hospital, Pabna, Bangladesh.

Article info

Summary:

Received: 23 August 2016

Standard scale to assess the symptoms of depression, anxiety and stress among

MBBS students are essential to take necessary steps to treat or prevent any

psychiatric morbidity. But there was no such convenient tool in Bangla to measure the

stated symptoms. With an objective to obtain a convenient scale to measure severity of

above symptoms, short version of Depression Anxiety Stress Scales (DASS 21) was

translated into Bangla and the study was carried out to validate this Bangla version

with permission from the author of the original instrument. Two translations and back

translations were carried out. A harmonized version was produced after meetings by

persons involved in translation process in meetings. After pretesting on ten students

and reviewing by panel of experts, finalized Bangla version of DASS 21 (DASS 21 -BV)

was obtained. A cross sectional study was carried out among MBBS students of Pabna

Medical College, Pabna using purposive sampling technique to validate this scale.

They were given both Bangla and English version of the scale 3 to 7 days apart.

Analysis was done on 15 samples. Correlation for depression subscale was 0.976,

anxiety subscale was 0.917 and stress subscale was 0.931. Correlation was significant

at the 0.01 level (2-tailed). Cronbach’s Alpha for Depression, Anxiety and Stress

subscales were 0.987, 0.957, 0.964 respectively. This Validated Bangla version of

DASS 21 can be used to measure severity of depression among medical students and

persons having similar academic background treatable.

Bang J Psychiatry 2014,28(2):67-70

Accepted : 26 Sept 2016

Number of tables : 01

Number of figures : 03

Number of refs. : 11

Correspondence:

SM Abu Hena Mostafa Alim

Mobile: +8801711703826,

E-mail: abul458@gmaiI.com

Introduction

A high quality scale to measure depression, anxiety and

stress of medical students is needed as they confront

noteworthy academic, psychosocial, and existential

stressors. Early intervention can be done if severity of above

mentioned symptoms can be measured easily. But there is

lack of such convenient tool in Bangla to measure

rigorousness of above symptoms in a single setting.

Translation of an internationally standard scale for

measuring above symptoms can meet the need. Depression

Anxiety Stress Scales (DASS) could be such an instrument.

DASS was developed in English by researchers Professor

SH Lovibond & Prof PF Lovibond at the University of New

South Wales Australia1 to measure depression, anxiety and

stress among the respondents. It is a set of three self-report

scales having 42 items designed to measure the negative

emotional states of depression, anxiety and stress.2 Each of

these is rated on a four-point Likert scale of frequency or

severity of the participants’ experiences over the last week

with the intention of emphasizing states over traits. These

scores ranged from 0, meaning that the client believed the

item “Did not apply to me at all”, to 3 meaning that the client

considered the item to “Applied to me very much, or most of

the time”. It is also stressed in the instructions that there is

no right or wrong answers. The short-form version of the

Depression Anxiety Stress Scales (DASS 21) created by the

same researchers having 21 questionnaires can be used

instead of full version of DASS. This valid3 set of instrument

has seven questions for each subscale. A sum of the scores

for the seven questions in each of the sub-scales completed

by each participant is evaluated as per the severity-rating

index. During the use of full version of DASS, for depression

0-9 is normal while 10- 13, 14- 20, 21- 27 and 28+ indicate

mild, moderate, severe and extremely severe respectively.

While measuring anxiety, 0-7 counted as normal but 8-9,

10-14, 15-19 and 20+ specify mild, moderate, severe and

Bang J Psychiatry Vol. 28, No. 2, 2014

extremely severe correspondingly. Whereas 0-14 is

normal for stress although 15-18, 19- 25, 26-33 and

34+ state mild, moderate, severe and extremely severe

in that order. For short (21 -item) version, multiplication

of sum by 2 is needed.4 DASS is a very widely used

scale. Sixteen and six numbers of research articles

already published which focused on DASS and DASS

21 respectively.5 There are several published studies

showing that the DASS 21 has the same factor

structure and gave similar results to the full DASS.4

DASS 21 had the advantage of taking only half the time

to administer. In general, the full DASS is often

preferable for clinical work and the DASS 21 is often

best for research purposes. The items in the DASS 21

were selected on the basis of several criteria like good

factor loadings, coverage of all subscales within each

scale and item means that, DASS 21 scores for each

scale should be very close to exactly half the full scale

score.6

With an objective to obtain a convenient scale to

measure severity of depression, anxiety and stress

among medical students, DASS 21 was translated into

Bangla. A study on small sample size was also carried

out to validate this Bangla version.

Materials and methods

Permission from the author of DASS (Prof Lovinbond)

was taken to translate this. Translation process was

according to guideline stipulated in US Census Bureau

Guideline.7 Two forward and 2 backward translations

were done in parallel by 2 medical and 2 language

experts. After the reconcilement of the two forward and

back translations, sentence revision was done by all

experts involved in the translation in meetings. This

Bangla version of DASS 21 was given to a panel of

reviewer consisting of 2 Professors of Psychiatry, an

Associate Professor of English and an Assistant

Professor of Clinical Psychology at different

universities. The format was kept similar to the original

(English) version. At the end of this process, a

harmonized Bangla version of DASS 21 was produced.

Harmonized Bangla version was pre-tested on 10

students with an objective to identify any ﬂaws in

harmonized version. After pretesting, Bangla version of

DASS 21 BV was ﬁnalized. Validation of DASS 21 BV

was done by doing a pilot study to validate the DASS-

21 BV among ﬁrst year medical students of Pabna

Medical College, Pabna. Students who have got at least

‘A’ and another ‘A+’, in SSC and HSC in English was

chosen for pilot study. 20 students filled up DASS 21-

BV. After 3 days, 15 of them again filled up original

DASS 21 (English). At the end of pre-test and reviewing

by panel of experts, finalized Bangla version of DASS

21 (DASS-21 BV) was obtained. Analysis was done on

the scores of 15 samples.

Results

Among the population, male and female 7 and 8

respectively (M:F = 1:1.14) where age range was 18-

20. Correlation for depression subscale was found

0.976, anxiety subscale was 0.917 and stress subscale

was 0.931 (Table 2). Correlation was significant at the

0.01 level (2-tailed). The result of reliability statistics

were Cronbach’s Alpha for total score 0.989.

Cronbach’s Alpha for Depression, Anxiety and Stress

subscales were 0.987, 0.957, 0.964 respectively. The

scores obtained by Bangla and English versions of the

three subscales were almost similar (Figure 1-3).

Translation of DASS 21 into Bangla and validation among medical students Alim SMAHM et al.

Discussion

US Census Bureau Guideline7 was followed to ensure

that the translated version would be grammatically

sounded and the terms used were correct. At the same

time, meanings and contents of original DASS 21 were

well preserved. Good translations were reflected by

production of two English back translations which almost

similar to original English version. Same guideline were

used to translate DASS 21 into Malaysian language

where there is similarity in religious cultural milieu with

Bangladesh.8 DASS 21 Bangla version was accepted by

the original author and given in DASS website.9 Till now,

this scale was translated into 44 different national

languages; such as: Arabic, Philipino, Hindi, Indonesian,

Malaysian, Singhala, Taiwanese, Thai, Urdu,

Vietnamese etc.10 Among them, 4 other countries of

South Asian region translated DASS 21 into 6 tongues10

where there are similarities in cultural ambiance with

Bengalis.

Validation study of DASS 21- BV produced impressive

correlation between Bangla and original English version.

It was also proved to be very reliable tool as Cronbach’s

Alpha for total score were >0.9. It matched with the

result of validated Bahasa Malaysia version of DASS

21.8 Bangla version of DASS 21 (DASS 21 BV) should

be used in the studies among Bangla speaking

population for measuring depression, anxiety or stress in

place of original English version for better understanding

of the respondents. Though medical students of

Bangladesh might understand English, some statements

of original DASS 21 seemed difficult to understand. As

DASS 21 was previously used to measure depression,

anxiety and stress among ﬁrst year medical student in

Moharastra province of India,11 this could be an

expedient weighbridge to amount alike symptoms

among Bangladeshi students.

Small sample size and sample taken from a single

medical college were the major limitations of the study.

Large sample with heterogeneous population could

strengthen the validation process. However, as the

samples were the 1st year MBBS students having lack

of adequate medical knowledge but passed higher

secondary level of education, this translated scale could

be generally used among similar or higher academic

background of medical as well as students or people of

other disciplines.

Further research is needed for improvement and

generalization of the Bangla version of the DASS 21

scale.

Conclusion

Validated Bangla version of DASS 21 can be used to

measure severity of depression among medical students

and persons having similar academic background.

Further research is required for its generalization.

Bang J Psychiatry Vol. 28, No. 2, 2014

References

1. Lovibond SH, Lovibond PF. Manual for the

Depression Anxiety Stress Scales. 2nd ed. Sydney:

Psychology Foundation of Australia; 1995. p. 1.

2. Lovibond PF, Lovibond SH. The structure of

negative emotional states: comparison of the

Depression Anxiety Stress Scales (DASS) with the

Beck Depression and Anxiety inventories. Behav

Res Ther 1995;33(3):335-43.

3. Henry JD, Crawford JR. The short-form version of

the Depression Anxiety Stress Scales (DASS-21):

construct validity and normative data in a large non-

clinical sample. Br J Clin Psychol 2005;44(2):227-

39.

4. Gomez F. A Guide to the Depression, Anxiety and

Stress Scale (DASS 21). Central and Eastern

Sydney primary health networks. [Online]. [cited

2016 Sep 20]; Available from URL:

https://www.cesphn.org.au/images/mental_health/F

requently_Used/Outcome_Tools/Dass21.pdf

5. Psychology Foundation of Australia. DASS

publications: Depression Anxiety Stress Scales

(DASS). [Online]. 2014 Nov 10 [cited 2016 Sep 6];

Available from URL:

http://www2.psy.unsw.edu.au/dass//pub.htm

6. Psychology Foundation of Australia. DASS FAQ

(Frequently Asked Questions): Depression Anxiety

Stress Scales (DASS). [Online]. 2014 Nov 10 [cited

2016 Sep 6]; Available from URL:

http://vwwv2.psy.unsw.edu.au/dass/DASSFAQ.htm

7. US Census Bureau. Census Bureau Guideline:

Language Translation of Data Collection

instruments and Supporting Materials (Working

Paper). 2004 May 4. Washington DC: US Census

Bureau; 2009.

8. Musa R, Fadzil MA, Zain Z. Translation, validation

and psychometric properties of Bahasa Malaysia

version of the Depression Anxiety and Stress

Scales (DASS). ASEAN J Psychiatry 2007;s(2):s2-

9. Psychology Foundation of Australia. DASS

translations: Depression Anxiety Stress Scales

(DASS). [Online]. 2014 Nov 10 [cited 2016 Jun 21];

Available from

URL:http://www2.psy.unsw.edu.au/dass/Bangla/Ba

ngla.htm

10. Psychology Foundation of Australia. DASS

translations: Depression Anxiety Stress Scales

(DASS). [Online]. 2014 Nov 10 [cited 2016 Sep 6];

Available from URL:

http://wvwv2.psy.unsw.edu.au/dass//translations.ht

11. Vaidya PM, Mulgaonkar KP. Prevalence of

depression anxiety & stress in undergraduate

medical students & its correlation with their

academic performance. IJOT 2007;39(1):7-10.

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Manual for the Depression, Anxiety and Stress Scales (DASS)

Book

Jan 1995

The Structure of Negative Emotional States: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories

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Apr 1995
BEHAV RES THER

The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.

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To test the construct validity of the short-form version of the Depression anxiety and stress scale (DASS-21), and in particular, to assess whether stress as indexed by this measure is synonymous with negative affectivity (NA) or whether it represents a related, but distinct, construct. To provide normative data for the general adult population. Cross-sectional, correlational and confirmatory factor analysis (CFA). The DASS-21 was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1,794). Competing models of the latent structure of the DASS-21 were evaluated using CFA. The model with optimal fit (RCFI = 0.94) had a quadripartite structure, and consisted of a general factor of psychological distress plus orthogonal specific factors of depression, anxiety, and stress. This model was a significantly better fit than a competing model that tested the possibility that the Stress scale simply measures NA. The DASS-21 subscales can validly be used to measure the dimensions of depression, anxiety, and stress. However, each of these subscales also taps a more general dimension of psychological distress or NA. The utility of the measure is enhanced by the provision of normative data based on a large sample.

A Guide to the Depression, Anxiety and Stress Scale (DASS 21). Central and Eastern Sydney primary health networks

Sep 2016

F Gomez

Gomez F. A Guide to the Depression, Anxiety and Stress Scale (DASS 21). Central and Eastern Sydney primary health networks. [Online]. [cited 2016 Sep 20];

Guideline: Language Translation of Data Collection instruments and Supporting Materials (Working Paper)

May 2004

Available from URL: http://vwwv2.psy.unsw.edu.au/dass/DASSFAQ.htm 7. US Census Bureau. Census Bureau Guideline: Language Translation of Data Collection instruments and Supporting Materials (Working Paper). 2004 May 4. Washington DC: US Census Bureau; 2009.

Prevalence of depression anxiety & stress in undergraduate medical students & its correlation with their academic performance

Jan 2007
7-10

P M Vaidya
K P Mulgaonkar

Available from URL: http://wvwv2.psy.unsw.edu.au/dass//translations.ht m 11. Vaidya PM, Mulgaonkar KP. Prevalence of depression anxiety & stress in undergraduate medical students & its correlation with their academic performance. IJOT 2007;39(1):7-10.