Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 30:8:116-122.
doi: 10.5116/ijme.58ba.7d8b.

Measurement invariance of the Depression Anxiety Stress Scales-21 across medical student genders

Peyman Jafari  1 , Farnoosh Nozari  2 , Forooghosadat Ahrari  2 , Zahra Bagheri  1
Affiliations

Measurement invariance of the Depression Anxiety Stress Scales-21 across medical student genders

Peyman Jafari et al. Int J Med Educ. .

Abstract

Objectives: This study aimed to assess whether male and female Iranian medical students perceived the meaning of the items in the Depression Anxiety Stress Scales-21 consistently.

Methods: A convenience sample of 783 preclinical medical students from the first to sixth semester was invited to this cross-sectional study. Of the 477 respondents, 238 were male and 239 were female. All participants completed the Persian version of the Depression Anxiety Stress Scales-21. The graded response model was used to assess measurement invariance of the instrument across the gender groups. Categorical confirmatory factor analysis was used to evaluate the construct validity of the measure. Moreover, internal consistency was assessed via Cronbach's Alpha.

Results: Statistically significant differential item functioning was flagged for just item 6 in the depression subscales (c2=6.5, df=1, p=0.011). However, removing or retaining the item 6 in the stress subscale did not change our findings significantly, when we compared stress scores across two genders. The results of categorical confirmatory factor analysis supported the fit of the three-factor model of Depression Anxiety Stress Scales-21. Moreover, Cronbach's alpha was greater than 0.7 in depression, anxiety and stress subscales.

Conclusions: This study revealed that Depression Anxiety Stress Scales-21 is an invariant measure across male and female medical students. Hence, this reliable and valid instrument can be used for meaningful comparison of distress scores between medical student genders. Gender comparisons of medical students' psychological profiles provide a better insight into gender influences on the outcome of medical education and medical practice.

Keywords: dass-21; iran; measurement invariance; medical students.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nedjat S, Majdzadeh R, Rashidian A. Graduate entry to medicine in Iran. BMC Med Educ. 2008;8:47. doi: 10.1186/1472-6920-8-47. - DOI - PMC - PubMed
    1. Koochaki GM, Charkazi A, Hasanzadeh A, Saedani M, Qorbani M, Marjani A. Prevalence of stress among Iranian medical students: a questionnaire survey. East Mediterr Health J. 2011;17:593–598. - PubMed
    1. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81:354–373. - PubMed
    1. Hope V, Henderson M. Medical student depression, anxiety and distress outside North America: a systematic review. Med Educ. 2014;48:963–979. doi: 10.1111/medu.12512. - DOI - PubMed
    1. Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ. 1998;32:456–464. doi: 10.1046/j.1365-2923.1998.00234.x. - DOI - PubMed