Psychometric Properties of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) in Patients with Hematologic Malignancies

Background/Objectives: Patients with hematologic malignancies undergo prolonged, intensive treatments involving frequent hospitalizations and experience debilitating side effects. Consequently, they are at increased risk of developing symptoms of depression, anxiety, and stress, which can undermine their quality of life. However, there is a scarcity of instruments validated for the simultaneous assessment of depression, anxiety, and stress within hematologic cancer populations. The aim of this study is to examine the construct validity, convergent and discriminant validity, and reliability of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) among hematologic cancer patients. Methods: We collected data from 452 hematologic cancer patients across three studies. Results: Confirmatory factor analyses indicated that the theoretical correlated three-factor model and bifactor model for DASS-42 and DASS-21 responses were sufficient to explain the underlying factor structure of the scales in hematologic cancer patients. However, the bifactor model for DASS-42 and DASS-21 fit better with the data compared to the theoretical correlated three-factor model. In addition, we found the correlated three-factor model and the bifactor structure to exhibit scalar measurement invariance across gender for DASS-42 and DASS-21. DASS-42 and DASS-21 subscales demonstrated weak to strong negative correlations with measures of psychological well-being (happiness, well-being, life satisfaction) and strong positive correlations with measures of similar constructs (depression, anxiety, and stress), thereby supporting their convergent and discriminant validity with theoretically and empirically expected correlations with external criteria. The reliability analyses demonstrated that both DASS-42 and DASS-21 subscales exhibited strong internal consistency and test-retest reliability when assessing symptoms of depression, anxiety, and stress among patients with hematologic malignancies. Moreover, the item-scale convergent and discriminant validity analyses demonstrated that items exhibited higher corrected item-total correlations with their intended subscales than with other subscales across the DASS-42 and DASS-21, providing evidence for the distinct measurement properties of each subscale. Conclusions: The findings suggest that the DASS-42 and DASS-21 are psychometrically robust instruments for use in Turkish hematologic cancer patients.