title: The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems.
abstract: OBJECTIVE
  To (1) evaluate the psychometric properties and (2) examine the ability to detect cases with anxiety disorder and depression in a population of employees absent from work because of mental health problems.
  
  
  METHODS
  Internal consistency, construct validity, and criterion validity of the Depression Anxiety Stress Scales (DASS) were assessed. Furthermore, the ability to identify anxiety disorders or depression was evaluated by calculating posterior probabilities of these disorders following positive and negative test results for different cut off scores of the DASS-Depression and DASS-Anxiety subscales.
  
  
  RESULTS
  Internal consistency of the DASS subscales was high, with Cronbach's alphas of 0.94, 0.88, and 0.93 for depression, anxiety, and stress respectively. Factor analysis revealed a three factor solution, which corresponded well with the three subscales of the DASS. Construct validity was further supported by moderately high correlations of the DASS with indices of convergent validity (0.65 and 0.75), and lower correlations of the DASS with indices of divergent validity (range -0.22 to 0.07). Support for criterion validity was provided by a statistically significant difference in DASS scores between two diagnostic groups. A cut off score of 5 for anxiety and 12 for depression is recommended. The DASS showed probabilities of anxiety and depression after a negative test result of 0.05 and 0.06 respectively. Probabilities of 0.29 for anxiety disorder and 0.33 for depression after a positive test result reflect relatively low specificity of the DASS.
  
  
  CONCLUSIONS
  The psychometric properties of the DASS are suitable for use in an occupational health care setting. The DASS can be helpful in ruling out anxiety disorder and depression in employees with mental health problems.
authors.affiliation: Coronel Institute for Occupational and Environmental Health, Academic Medical Center, AmCOGG, University of Amsterdam, Netherlands TNO Work and Employment, Hoofddorp, Netherlands. K.Nieuwenhuijsen@amc.uva.nl
authors.forename: K
authors.initials: K
authors.lastname: Nieuwenhuijsen
authors.forename: A G E M
authors.initials: AG
authors.lastname: de Boer
authors.forename: J H A M
authors.initials: JH
authors.lastname: Verbeek
authors.forename: R W B
authors.initials: RW
authors.lastname: Blonk
authors.forename: F J H
authors.initials: FJ
authors.lastname: van Dijk
mesh_terms: D000041:Absenteeism; D000328:Adult; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000706:statistics & numerical data; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity