Original Paper
Psychometric properties of Bahasa Malaysia version of the Depressive Anxiety and Stress Scales 42-item (DASS-42)
Ramli M1, Mohd Ariff F2, Nora MZ1, Rosnani S3 Aidil Faszrul AR1,
Kulliyyah of Medicine, International Islamic University Malaysia, Bandar Indera Mahkota, 25200 Kuantan, Pahang,
Malaysia.
1
2Faculty
of Medicine, University of Technology MARA, 40450 Shah Alam, Selangor, Malaysia,
3Kulliyyah
of Nursing, International Islamic University Malaysia, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Dr. Ramli Musa, M.D., M.Med.(Psych)
Dr. Mohd Ariff Fadzil, MBBS, MPH
Dr. Nora Mat Zin, M.D., M.Med.(Psych)
Rosnani Sarkarsi, SN, B.N.S.
Aidil Faszrul Abdul Rahim, B.Sc.Hons(Biotechnology)
Correspondence:
Dr. Ramli Musa
M.D.(UKM) M.Med(Psych)(UKM)
Department of Psychiatry, Kulliyyah of Medicine,
International Islamic University Malaysia,
Jalan Hospital, 25150 Kuantan, Pahang MALAYSIA
Tel: (+609) 5716400, Fax: (+609) 5133 615, H/P: (+6012) 2485 076
ramlidr@yahoo.com @ drramli@iiu.edu.my
Abstract
Background: The Depressive Anxiety and Stress Scale (DASS) had been widely used to measure psychological parameters
in many studies. It is suitable to be used among clinical and non-clinical populations. The Bahasa Malaysia version of DASS
21-item had been translated and validated among Malaysians in earlier efforts. Objectives: To analyse and establish the
psychometric properties of Bahasa Malaysia version of the DASS 42-item (BM DASS-42) among medical students. Methods:
Dual forward and backward translations of original English DASS-42 were completed. Construct validity of the DASS-42 was
established by looking at its exploratory factor analysis. Results: Reliability of DASS-42 revealed excellent Cronbach’s alpha
values of 0.94, 0.90 and 0.87 for depressive, anxiety and stress domains respectively. Construct validity yielded 90.5% or 38
items out of 42 items had good factor loadings of o.4 and more. Conclusions: The BM DASS-42 had admirable psychometric
properties among the tested population. Hence it is reliable and validated tool to measure depressive, anxiety and stress
levels.
Extensive study to generalize it to Malaysian population.
Keywords: Depressive, anxiety, stress, Bahasa Malaysia, validation.
INTRODUCTION
The Depression Anxiety Stress Scales (DASS) has been translated in various languages. It also has been broadly used
across the globe as a research tool to measure psychological aspects. This is due to the fact that it’s convenient and practical
to administer. By a single administration the researchers can gauge 3 main psychological domains. it will . The original
version of DASS is 42-item. DASS 21-item is a modified and shorter version. The DASS-21 has been translated into Bahasa
Malaysia (BM) and this BM version also has been validated in the previous project (Ramli M, Ariff MF, Zaini Z) [1]. The whole
project report has been published in the ASEAN Journal of Psychiatry 2007.
Ever since the validation and publication of this effort, Bahasa Malaysia DASS-21 has received overwhelming response and
wide usage in Malaysia. The questionnaire is very simple to be administered to general population. Unlike certain
psychometric tests, by only using this questionnaire, researchers would be able to gauge 3 psychological domains. They are
levels of depression, anxiety and stress. Forty two items in this questionnaire are culturally free and that makes this test
feasible to adapt to any cultures.
At this juncture we have obtained the permission by the original author (Professor Dr. Peter Lovinbond, Professor of The
School of Psychology University of New South Wales Australia) to develop BM DASS-42. We have completed the translation
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process in accordance to guideline stipulated in US Census Bureau Guideline where 2 forward and 2 back translations were
done in parallel by 2 medical and 2 language experts. This method was done to ensure the translated version would be
grammatically sounded and the terms used were correct. At the same time, meanings and contents of original DASS were
well preserved.
We are yet to embark on the validation stage of BM DASS-42. The author decided to use medical students in this university
for validation purpose.
Objectives:
The ultimate aim of this study is to produce a well adapted Bahasa Malaysia version of DASS-42 that can be used in
Malaysian population.
MATERIALS AND METHODS:
Prior commencement of the translation work DASS-42 written approval from the original author (Peter Lovinbond) is
obtained. The process of translation, pre-test and validation of this project is summarized in figure 1. This research has
obtained an approval by The Ethics and Research committee Kulliyyah of Medicine International Islamic University Malaysia.
Original English DASS (Eo)
Translation into Bahasa by
medical expert BM1
Translation into Bahasa by
language expert BM2
Back translation into English
by medical expert (E1)
Back translation into English
by language expert E2
Translation Phase
Harmonized Bahasa Malaysia
version BM-H
Finalized BM version of DASS (BMDASS)
Subjects fulfilled inclusion
criteria
Reliability &
Validation Process
Subjects not fulfilled inclusion
criteria
Enrollment and
administration of BM-DASS
Analysis
Figure 1: Overview of the whole process of cross-cultural adaptation and the validation of the DASS
TRANSLATION PROCESS OF DASS
2 forward and 2 back translations were done in parallel by 4 bilingual independent translators. Two of them were
psychiatrists. This method is done to ensure the translated version is grammatically sounded and the terms used are correct.
At the same time meanings and contents of original DASS are well preserved.
The two forward and back translations were reconciled and sentence by sentence revision was done. Good translations were
reflected by production of 2 English back translations which almost similar to original English version. At the end of this
process we came to harmonized version of Bahasa Malaysia DASS-42.
VALIDATION STUDY
The finalized Bahasa Malaysia version (BM-DASS) will be tested for its reliability and validity. Reliability in this study is
determined by good Chronbach alpha values and validity is by good factor analysis of all 42 items.
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SELECTION OF RESPONDENTS
Study population of this study is all medical students but not all will be enrolled as the target number is 250 students.
Participants will be given a simple consent form and BM DASS-42 only. The subjects will be ensured of the confidentiality
of the questionnaire. They may also remain anonymous by not filling up the name.
Questionnaires
1)
2)
3)
Consent form.
DASS–42.
Hospital Anxiety and Depression Scale
The questionnaire is a self-administered questionnaire for the participants to answer. It shall take at the most 10 minutes to
complete.
Steps taken to ensure the accuracy of responses
During the course of Bahasa Malaysia DASS questionnaire administration, subject should be left without any interference
especially from facilitators of the project. If subjects raise any queries about the terminology, they should be explained as
minimal as possible to maintain the objective of this study and it should be recorded.
INCLUSION AND EXCLUSION CRITERIA
1)
Inclusion criteria:
a) Subjects must be proficient in Bahasa Malaysia.
2)
a)
Exclusion criteria:
Subjects who refused to give informed consent.
b) Subjects who have problem in understanding Bahasa Malaysia.
RESULTS
From the Total of 220 of the subjects, 3 incomplete then become 219.
Table 1: Socio-demographic data
Number
%
Total
Age
19-20
21-22
23-24
128
151
132
31.1
36.7
32.2
411
Race
Malays
Others
409
2
99.5
0.5
411
Gender
Male
Female
179
232
43.5
56.5
411
Overall Cronbach's Alpha was 0.95, Depressive domain 0.92, Anxiety domain 0.87 and Stress domain was 0.88
Table 2 With force
Domain
D3_ tidak dapat mengalami perasaan positif
D5_ tidak bergerak ke mana-mana
D10_ tidak mempunyai apa-apa untuk diharapkan
D13_ rasa sedih dan murung
D16_ hilang minat dalam segala hal
D17_ tidak begitu berharga
D21_ hidup ini sudah tidak bermakna
D24_ tidak dapat merasakan keseronokan
D26_ rasa duka dan tidak keruan
Depressive
.423
.403
.664
.429
.613
.680
.849
.587
.527
Anxiety
Stress
3
D31_ tidak bersemangat
D34_ diri saya langsung tidak berharga
D37_melihat tiada masa depan
D38_ rasa hidup ini tidak bermakna
D42_ sukar untuk mendapatkan semangat
A2_ mulut terasa kering
A4_ mengalami kesukaran bernafas
A7_ perasaan gementar
A9_ keadaan yang menjadikan saya amat risau
A15_ macam nak pengsan
A19_ banyak berpeluh
A20_ takut tanpa sebab
A23_ sukar menelan
A25_ sedar tindakbalas jantung
A28_ menjadi panik/cemas
A30_‘dihambat’ oleh tugas yang remeh
A36_ rasa amat takut
A40_ mungkin menjadi panik
A41_ rasa menggeletar
S1_ kesal/marah sebabkan perkara-perkara kecil
S6_ bertindak keterlaluan
S8_ sukar untuk relaks
S11_ mudah merasa kesal
S12_ menggunakan banyak tenaga
S14_ hilang kesabaran sekiranya saya dilambatkan
S18_ rasa mudah tersentuh
S22_ sukar ditenteramkan
S27_ mudah marah
S29_ sukar untuk bertenang setelah rasa kesal
S32_ sukar bersabar pada gangguan
S33_ keadaan yang terlalu gementar
S35_ hilang pertimbangan
S39_ saya semakin gelisah
.626
.804
.783
.860
.441
.410
.661
.603
.334*
.457
.409
.518
.613
.594
.571
.273*
.502
.294*
.571
.585
.630
.654
.515
.706
.625
.448
.642
.619
.712
.688
.573
.564
.733
.399
.318*
.548
.429
*Poor factor loading (<0.4
Scree Plot
14
12
10
8
6
Eigenvalue
4
2
0
1
4
7
10
13
16
19
22
25
28
31
34
37
40
Component Number
Correlation
Discussion
There are a few very important notions that author would like to make based on observation and results on validation studies
done in Malaysia. First, somatic items is best to heed for Asian population as this population has the tendency to exhibit
psychological ailment through somatic complaints. Nevertheless in the aspect of gauging psychological disabilities among
medical and surgical ill patients these items are not suitable as physical complaints may mask the underlying psychiatric
symptoms especially among chronic pain patients.
Artodo Bados: Using Cronbach’s the following values were obtained for the Depression, Anxiety and Stress scales,
respectively: .92, .84 and .91 for the DASS;
Thirdly non-somatic are well suit for medically ill patient such DASS.
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Weaknesses of this study We could not generalize the conclusion from this study to the Malaysia population as the
composition of rare did not represent the Malaysia population.
Conclusion
The BM version of DASS-42 has been translated with good quality and it is validated for this small group of students.
However to generalize it to Malaysian population, it needs more extensive studies in which we need to include public
Malaysian community.
Acknowledgement
We would like to thank to all the International Islamic University Malaysia, Kulliyyah of Medicine students for participating in
this study.
Conflicts of interest:
Here we declare there is no conflict of interest in this study.
REFERENCES
1) Ramli M, Ariff MF, Zaini Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the
Depression Anxiety and Stress Scales (DASS-21). ASEAN Journal of Psychiatry 2007;8 (2):82-89.
2) Ramli Musa, Salmiah Mohd Ali, Nurul Ain Musa. Validation and psychometric properties of Bahasa Malaysia
version of the Depression Anxiety and Stress Scales (DASS) among diabetic patients. 2008. Unpublished report.
3) Department of Statistics, State/District Data Bank, Malaysia; 2005.
4) Lovibond, P. F. (1998). Long-term stability of depression, anxiety, and stress syndromes. Journal of Abnormal
Psychology, 107(3), 520-526.
5) Lovibond, P. F., & Lovibond, S. H. (1995a). The structure of negative emotional states: Comparison of the
Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research
and Therapy, 33(3), 335-343.
6) Lovibond, S. H., & Lovibond, P. F. (1995b). Manual for the Depression Anxiety Stress Scales. Sydney, Australia:
Psychology Foundation.
7) Lovibond, P. F., & Rapee, R. M. (1993). The representation of feared outcomes. Behaviour Research and
Therapy, 31(6), 595-608.
8) Daza, Patricia; Novy, Diane M; Stanley, Melinda A; Averill, Patricia (2002). The Depression Anxiety Stress Scale21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology & Behavioral Assessment,
24(3), 195-205.
9) Novy, Diane M; Stanley, Melinda A; Averill, Patricia; Daza, Patricia (2001). Psychometric comparability of Englishand Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13(3), 347355.
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