CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE DEPRESSION ANXIETY    STRESS  SCALE—21 IN NON–NATIVE ENGLISH SPEAKING PARTICIPANTS IN BRUNEI.

Urime Demiri-Shaipi^1,2*, David Koh^1,3, Mas Rina Wati Abdul Hamid¹, Khadizah H. Abdul - Mumin¹

¹Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku LinkGadong, BE1410 Negara Brunei Darussalam.

²University “Mother Teresa”, Mirçe Acev N. 4, 1000 Skopje, R. of North Macedonia.

³Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2#10-01, 117549 Singapore.

ABSTRACT

Introduction: The English version of the Depression Anxiety Stress Scales - 21 (DASS-21) lacks assessment of comprehensibility and validity when used in Asian populations whose first language is not English. This study aims to evaluate comprehensibility, validity, and reliability of the English version of DASS-21 among non – native English speaking university students in Brunei.    Methods: The study comprises three stages. First Comprehensibility of the English DASS-21 was tested in 15 university students in Brunei who were studying English. English and Malay synonyms were added in parentheses following those DASS-21 English words that were unfamiliar to the participants. Next, reliability and temporal stability of the adapted DASS-21 were tested with 39 participants selected by purposive sampling. Reliability statistics, factor analysis, and convergent/discriminant validity were tested with 204 university students. Results: The adapted English DASS-21 in the Brunei context, demonstrated good Cronbach’s alpha (ranges of alphas = 0.70 - 0.78), good temporal stability and convergent/discriminant validity.  Three factors were detected, however, most of the stress items split between anxiety and depression construct. Conclusion: The triangulation of data from interscale correlations and convergent/discriminant validity indicated that the three scales of the adapted English version of DASS-21 contain variance that is specific to each scale. However, the stress scale should be used with caution when used for outcome assessment. We recommend cross-cultural adaptation of the English version of DASS-21 before its use in Asians countries, where English is not a first language.

Keywords: Asia, Anxiety, Depression, Patient health questionnaire (DASS-21), Reproducibility of results, Validation study.

Corresponding author: Urime Demiri-Shaipi, PhD, University “Mother Teresa”, Mirçe Acev N. 4, 1000 Skopje, R of North Macedonia.

Telephone: (+389) 71 535320

E-mail: urimedsh@hotmail.com

Brunei Int Med J. 2020;16:1-8