The development of the DASS-6 for in-person and telehealth settings: A community-driven empirical approach

Abstract

Brief, reliable instruments are critical for mental health care providers to efficiently capture psychometrically sound and clinically useful information during in-person and telehealth service provision. This study used data from 949 community clinic patients with primary anxiety and depressive disorders. We developed a shortened (6-item) form of the English and Spanish versions of the 21-item Depression, Anxiety, and Stress Scales (DASS) for in-person, telehealth, and hybrid mental health services using moderated nonlinear factor analysis, designed to maintain maximum reliability across the clinical range of mental health treatment-seekers. Results indicate minimal loss in local reliability in reducing the DASS to 6 items (DASS-6), with reliability exceeding 0.85 throughout the relevant clinical range of distress. Moreover, likely clinical distress is a minimum total score of 8. Test-retest with an independent sample that included in person and telehealth administration was in the good-to-excellent range for each subscale. The DASS-6 is an efficient tool for assessing depression, anxiety, and stress in both in-person and telehealth settings.