Article Title

Rasch analysis supports the use of the depression, anxiety, and stress scales to measure mood in groups but not in individuals with chronic low back pain


Objective: Chronic pain is a common problem that is associated with mood disorders such as depression. The Depression, Anxiety, and Stress Scales (DASS-21) questionnaire is commonly used to help measure disordered mood. In this study, we used Rasch analysis to analyze the clinimetric properties of the DASS-21 in a chronic low back pain sample.

Study Design and Setting: A Rasch analysis was conducted on data collected as a part of a randomized hospital-based placebo-controlled trial. DASS-21 questionnaires were completed by the 154 enrolled participants.

Results: The DASS-21 subscales fit the Rasch model. No differential item functioning was detected for age, gender, pain severity, or disability. Reliability for individual use was supported for the depression subscale (Person Separation Index [PSI] = 0.86) but group use only for the anxiety (PSI = 0.74) and stress (PSI = 0.82) subscales. A DASS-21 aggregate score of “negative affect” lacked fit to the Rasch model (χ2 = 191.48, P < 0.001).

Conclusion: This is the first study that used Rasch analysis to demonstrate that the DASS-21 subscales demonstrate adequate measurement properties for research involving groups with chronic pain. Only the DASS-21 depression subscale demonstrated adequate reliability for use with individuals with chronic pain. The use of a single DASS-21 aggregate score as a measure of “negative affect” was not supported.


peer-reviewed, pain; mood, instrument, questionnaire, clinimetric, reliability

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