Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T05:12:06.225Z Has data issue: false hasContentIssue false

Depression Anxiety Stress Scale-10: A Brief Measure for Routine Psychotherapy Outcome and Progress Assessment

Published online by Cambridge University Press:  11 August 2021

W. Kim Halford*
Affiliation:
School of Psychology, University of Queensland, St. Lucia, Queensland, Australia
Aaron D.J. Frost
Affiliation:
Benchmark Psychology & Griffith University, Eight Mile Plains, Queensland, Australia
*
*Corresponding author: Kim Halford, Emeritus Professor of Clinical Psychology, School of Psychology, University of Queensland, St. Lucia, QLD 4072, Australia. Email: k.halford@psy.uq.edu.au
Get access

Abstract

Routine outcome measurement and progress monitoring is well established to enhance quality assurance in clinical psychology service delivery but is not widely used in routine care. A major barrier to more widespread implementation is the lack of public domain, brief, psychometrically sound outcome measures that easily integrate into clinical information systems. The current study assessed a brief 10-item version of the widely used Depression Anxiety Stress (DASS)-42 scale, which we called the Depression Anxiety Stress-10 (DASS-10) scale. In two clinical samples of adults (n = 1036, 445 men, 591 women; and n = 1084, 493 men, 591 women), the DASS-10 had a replicable two-level factor structure, which at the lower level had two factors assessing stress-anxiety and depression, which each loaded onto a superordinate psychological distress scale. The items in the distress score discriminated between a clinical sample (n = 376) and a community sample (n = 379) and were sensitive to clinical change. The measure has the potential to make routine outcome measurement and progress monitoring more cost-effective to implement than existing measures, particularly when integrated with practice management software to make administration, scoring, and use easy.

Type
Standard Paper
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Berle, D, Starcevic, V, Milicevic, D, Moses, K, Hannan, A, Sammut, P and Brakoulias, V (2010). The factor structure of the Kessler-10 questionnaire in a treatment-seeking sample. The Journal of Nervous and Mental Disease, 198, 660664. doi:10.1097/NMD.0b013e3181ef1f16.CrossRefGoogle Scholar
Boswell, JF, Kraus, DR, Miller, SD and Lambert, MJ (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25, 619. doi:10.1080/10503307.2013.817696.CrossRefGoogle ScholarPubMed
Brooks, RT, Beard, J and Steel, Z (2006). Factor structure and interpretation of the K10. Psychological Assessment, 18, 6270. doi:10.1037/1040-3590.18.1.62.CrossRefGoogle ScholarPubMed
Cuipers, P, van Straten, A, Andersson, G and van Oppen, P (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76, 909922. doi:10.1037/a0013075.CrossRefGoogle Scholar
Evans, C, Connell, J, Barkham, M and Margison, F (2002). Towards a standardized brief outcome measure: Psychometric properties and utility of the CORE-OM. British Journal of Psychiatry, 180, 5160. doi:10.1192/bjp.180.1.51.CrossRefGoogle Scholar
Funk, J and Rogge, R (2007). Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the Couples Satisfaction Index. Journal of Family Psychology, 21, 572583. doi:10.1037/0893-3200.21.4.572.CrossRefGoogle ScholarPubMed
Halford, WK and Pepping, CA (2019). What every therapist needs to know about couple therapy. Behaviour Change, 36, 121142. doi:10.1017/bec.2019.12.CrossRefGoogle Scholar
Halford, WK, Bernoth-Doolan, S and Eadie, K (2002). Schemata as moderators of clinical effectiveness of a comprehensive cognitive behavioural program for patients with depression or anxiety disorders. Behavior Modification, 26, 571593. doi:10.1177/014544502236651.CrossRefGoogle ScholarPubMed
Halford, WK, Farrugia, C, Lizzio, A and Wilson, KL (2010). Relationship aggression, violence and self-regulation in Australian newlywed couples. Australian Journal of Psychology, 62, 8292. doi:10.1080/00049530902804169.CrossRefGoogle Scholar
Halford, WK, Rahimullah, R, Wilson, KL, Occhipinti, S, Busby, D and Larson, J (2017). Four year effects of couple relationship education on low and high satisfaction couples: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 85, 495507. doi:10.1037/ccp0000181.CrossRefGoogle ScholarPubMed
Hatfield, D, McCullough, L, Frantz, SH and Krieger, K (2010). Do we know when our clients get worse? An investigation of therapists’ ability to detect negative client change. Clinical Psychology and Psychotherapy, 17, 2532. doi:10.1002/cpp.656.Google ScholarPubMed
Ionita, G and Fitzpatrick, M (2014). Bringing science to clinical practice: A Canadian survey of psychological practice and usage of progress monitoring measures. Canadian Psychology, 55, 187196. doi:10.1037/a0037355.CrossRefGoogle Scholar
World Health Organ ization, (2017). Depression and other common mental disorders: Global health estimates. Geneva: World Health Organization. Retrieved from: https://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/Google Scholar
Jacobson, NS and Truax, P (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219. doi:10.1037//0022-006x.59.1.12.CrossRefGoogle ScholarPubMed
Jensen-Doss, A, Haimes, EMB, Smith, AM, Lyon, AR, Lewis, CC, Stanick, CF and Hawley, KM (2018). Monitoring treatment progress and providing feedback is viewed favourably but rarely used in practice. Administration and Policy in Mental Health and Mental Health Services Research, 45, 4861. doi:10.1007/210488-016-0763-0.CrossRefGoogle Scholar
Jorm, AF, Patten, SB, Brugha, TS and Motjabati, R (2017). Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry, 16, 9099.CrossRefGoogle ScholarPubMed
Kessler, RC, Andrews, G, Colpe, LJ and Hiripi, E (2002). Short screening scales to monitor population prevalence and trends in non-specific psychological distress. Psychological Medicine, 32, 959976. doi:10.1017/SO0033291702006074.CrossRefGoogle ScholarPubMed
Kraus, DR, Seligman, DA and Jordan, JR (2005). Validation of a behavioral health treatment outcome and assessment tool designed for naturalistic settings: The Treatment Outcome Package. Journal of Clinical Psychology, 61, 285314. doi:10.1002/JCLP20084.CrossRefGoogle ScholarPubMed
Lace, JW, Greif, TR, McGrath, A, Grant, AF, Merz, ZC, Teague, CL and Handal, J (2019). Investigating the factor structure of the K10 and identifying cutoff scores denoting nonspecific psychological distress and the need for treatment. Mental Health and Prevention, 13, 100106. doi:10.1016/j.mhp.2019.01.008.CrossRefGoogle Scholar
Lambert, MJ (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice. Washington D.C.: American Psychological Association.CrossRefGoogle Scholar
Lambert, MJ (2015). Progress feedback and the UQ system: The past and the future. Psychotherapy, 52, 381390. doi:10.1037/pst0000027.CrossRefGoogle Scholar
Lambert, MJ (2017). Maximizing psychotherapy outcome beyond evidence-based medicine. Psychotherapy and Psychosomatics, 86, 8089. doi:10.1159/000455170.CrossRefGoogle ScholarPubMed
Lambert, MJ, Whiplle, JL and Kleinstäuber, M (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55, 520537. doi:10.1037/pst0000167.CrossRefGoogle ScholarPubMed
Lovibond, SH and Lovibond, PF (1995) Manual for the Depression, Anxiety, Stress Scale. Sydney: Psychology Foundation, University of New South Wales.Google Scholar
Miller, SD, Duncan, BL, Brown, J, Sparks, JA and Claud, DA (2003). The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 91100.Google Scholar
Miller, SD, Duncan, BL, Brown, J, Sparks, JA and Chalk, MB (2006). Using formal client feedback to improve retention and outcome: Making ongoing, real-time assessment feasible. Journal of Brief Therapy, 5, 522.Google Scholar
O'Donovan, A, Halford, WK and Walters, B (2011). Toward best practice of clinical psychology supervision. Australian Psychologist, 46, 101112. doi:10.1111/j.1742-9544.2011.00033.x.CrossRefGoogle Scholar
Oei, TPS, Sawang, S, Goh, YW and Mukhtar, F (2013). Using the Depression Anxiety, Stress Scale 21 (DASS-21) across cultures. International Journal of Psychotherapy, 48, 10181029. doi:10.1080/00207594.2012.755535.Google ScholarPubMed
Overington, L and Ionita, G (2012). Progress monitoring measures: A brief guide. Canadian Psychology, 53, 8292. doi:10.1037/a0028017.CrossRefGoogle Scholar
Probst, T, Klienstauber, M, Lambert, MJ, Tritt, K, Pieh, C, Loew, TH, … Delgadillo, J (2020). Why are some cases not on track? An item analysis of the assessment for signal cases during inpatient psychotherapy. Clinical Psychology and Psychotherapy, 27, 559566. doi:10.1002/cpp.2441.CrossRefGoogle Scholar
Rickwood, DJ, Marzer, KR, Telford, NR, Parker, AG, Tanti, CJ and McGorry, PD (2015). Changes in psychological distress and psychosocial functioning in young people accessing headspace centers for mental health problems. Medical Journal of Australia, 202, 537542. doi:10.5694/mja14.01696.CrossRefGoogle Scholar
Rubin, RM, Hurford, MO, Hadley, T, Matlin, S, Weaver, S and Evans, AC (2016) Synchronizing watches: The challenge of aligning implementation science and public systems. Administration and Policy in Mental Health and Mental Health Services Research, 43, 10231028. doi:10.1007/s10488-016-0759-9.CrossRefGoogle ScholarPubMed
Sunderland, M, Mahoney, A and Andrews, G (2012). Investigating the factor structure of the Kessler psychological distress scale in community and clinical samples of the Australian population. Journal of Psychopathology and Behavioral Assessment, 34, 253259. doi:10.1007/s10862-012-9276-7.CrossRefGoogle Scholar
Swift, JK and Greenberg, RP (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547559. doi:10.1037/a0028226.CrossRefGoogle ScholarPubMed
Walfish, S, McAlister, B, O'Donnell, P and Lambert, MJ (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110, 639644. doi:10.2466/02.07.17.PR0.110.2.639-644.CrossRefGoogle ScholarPubMed
Wang, K, Shi, H-S, Geng, F-L, Zou, L-Q, Tan, S-P, Wang, Y, … Chan, RCK (2016). Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China. Psychological Assessment, 28, e88e100. doi:10.1037/pas0000207.CrossRefGoogle ScholarPubMed