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TRANSLATION_ VALIDATION AND PSYCHOMETRIC PROPERTIES

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					Original Paper

Psychometric properties of Bahasa Malaysia version of the Depressive Anxiety and Stress Scales 42-item (DASS-42)

Ramli M1, Mohd Ariff F2, Nora MZ1, Rosnani S3 Aidil Faszrul AR1,

1Kulliyyah of Medicine, International Islamic University Malaysia, Bandar Indera Mahkota, 25200 Kuantan, Pahang,
Malaysia.

2Faculty   of Medicine, University of Technology MARA, 40450 Shah Alam, Selangor, Malaysia,

3Kulliyyah   of Nursing, International Islamic University Malaysia, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.

Dr. Ramli Musa, M.D., M.Med.(Psych)
Dr. Mohd Ariff Fadzil, MBBS, MPH
Dr. Nora Mat Zin, M.D., M.Med.(Psych)
Rosnani Sarkarsi, SN, B.N.S.
Aidil Faszrul Abdul Rahim, B.Sc.Hons(Biotechnology)

Correspondence:
Dr. Ramli Musa
M.D.(UKM) M.Med(Psych)(UKM)
Department of Psychiatry, Kulliyyah of Medicine,
International Islamic University Malaysia,
Jalan Hospital, 25150 Kuantan, Pahang MALAYSIA
Tel: (+609) 5716400, Fax: (+609) 5133 615, H/P: (+6012) 2485 076
ramlidr@yahoo.com @ drramli@iiu.edu.my

                                                            Abstract

Background: The Depressive Anxiety and Stress Scale (DASS) had been widely used to measure psychological parameters
in many studies. It is suitable to be used among clinical and non-clinical populations. The Bahasa Malaysia version of DASS
21-item had been translated and validated among Malaysians in earlier efforts. Objectives: To analyse and establish the
psychometric properties of Bahasa Malaysia version of the DASS 42-item (BM DASS-42) among medical students. Methods:
Dual forward and backward translations of original English DASS-42 were completed. Construct validity of the DASS-42 was
established by looking at its exploratory factor analysis. Results: Reliability of DASS-42 revealed excellent Cronbach’s alpha
values of 0.94, 0.90 and 0.87 for depressive, anxiety and stress domains respectively. Construct validity yielded 90.5% or 38
items out of 42 items had good factor loadings of o.4 and more. Conclusions: The BM DASS-42 had admirable psychometric
properties among the tested population. Hence it is reliable and validated tool to measure depressive, anxiety and stress
levels.

Extensive study to generalize it to Malaysian population.

Keywords: Depressive, anxiety, stress, Bahasa Malaysia, validation.

                                                       INTRODUCTION

The Depression Anxiety Stress Scales (DASS) has been translated in various languages. It also has been broadly used
across the globe as a research tool to measure psychological aspects. This is due to the fact that it’s convenient and practical
to administer. By a single administration the researchers can gauge 3 main psychological domains. it will . The original
version of DASS is 42-item. DASS 21-item is a modified and shorter version. The DASS-21 has been translated into Bahasa
Malaysia (BM) and this BM version also has been validated in the previous project (Ramli M, Ariff MF, Zaini Z) [1]. The whole
project report has been published in the ASEAN Journal of Psychiatry 2007.

Ever since the validation and publication of this effort, Bahasa Malaysia DASS-21 has received overwhelming response and
wide usage in Malaysia. The questionnaire is very simple to be administered to general population. Unlike certain
psychometric tests, by only using this questionnaire, researchers would be able to gauge 3 psychological domains. They are
levels of depression, anxiety and stress. Forty two items in this questionnaire are culturally free and that makes this test
feasible to adapt to any cultures.

At this juncture we have obtained the permission by the original author (Professor Dr. Peter Lovinbond, Professor of The
School of Psychology University of New South Wales Australia) to develop BM DASS-42. We have completed the translation



                                                                                                                              1
process in accordance to guideline stipulated in US Census Bureau Guideline where 2 forward and 2 back translations were
done in parallel by 2 medical and 2 language experts. This method was done to ensure the translated version would be
grammatically sounded and the terms used were correct. At the same time, meanings and contents of original DASS were
well preserved.

We are yet to embark on the validation stage of BM DASS-42. The author decided to use medical students in this university
for validation purpose.

Objectives:

The ultimate aim of this study is to produce a well adapted Bahasa Malaysia version of DASS-42 that can be used in
Malaysian population.

                                                 MATERIALS AND METHODS:

Prior commencement of the translation work DASS-42 written approval from the original author (Peter Lovinbond) is
obtained. The process of translation, pre-test and validation of this project is summarized in figure 1. This research has
obtained an approval by The Ethics and Research committee Kulliyyah of Medicine International Islamic University Malaysia.

                                                     Original English DASS (Eo)


                                Translation into Bahasa by                  Translation into Bahasa by
                                   medical expert BM1                         language expert BM2


                               Back translation into English                Back translation into English
                                 by medical expert (E1)                       by language expert E2
   Translation Phase

                                                     Harmonized Bahasa Malaysia
                                                           version BM-H


                                                   Finalized BM version of DASS (BM-
                                                                 DASS)


                               Subjects fulfilled inclusion               Subjects not fulfilled inclusion
                                        criteria                                     criteria

      Reliability &
   Validation Process               Enrollment and
                               administration of BM-DASS


                                        Analysis

                   Figure 1: Overview of the whole process of cross-cultural adaptation and the validation of the DASS


TRANSLATION PROCESS OF DASS
2 forward and 2 back translations were done in parallel by 4 bilingual independent translators. Two of them were
psychiatrists. This method is done to ensure the translated version is grammatically sounded and the terms used are correct.
At the same time meanings and contents of original DASS are well preserved.

The two forward and back translations were reconciled and sentence by sentence revision was done. Good translations were
reflected by production of 2 English back translations which almost similar to original English version. At the end of this
process we came to harmonized version of Bahasa Malaysia DASS-42.

VALIDATION STUDY
The finalized Bahasa Malaysia version (BM-DASS) will be tested for its reliability and validity. Reliability in this study is
determined by good Chronbach alpha values and validity is by good factor analysis of all 42 items.



                                                                                                                           2
SELECTION OF RESPONDENTS

Study population of this study is all medical students but not all will be enrolled as the target number is 250 students.
Participants will be given a simple consent form and BM DASS-42 only. The subjects will be ensured of the confidentiality
of the questionnaire. They may also remain anonymous by not filling up the name.

Questionnaires
                 1)   Consent form.
                 2)   DASS–42.
                 3)   Hospital Anxiety and Depression Scale

The questionnaire is a self-administered questionnaire for the participants to answer. It shall take at the most 10 minutes to
complete.

Steps taken to ensure the accuracy of responses
During the course of Bahasa Malaysia DASS questionnaire administration, subject should be left without any interference
especially from facilitators of the project. If subjects raise any queries about the terminology, they should be explained as
minimal as possible to maintain the objective of this study and it should be recorded.

INCLUSION AND EXCLUSION CRITERIA

                 1)   Inclusion criteria:
                      a) Subjects must be proficient in Bahasa Malaysia.

                 2)   Exclusion criteria:
                 a)   Subjects who refused to give informed consent.
                           b) Subjects who have problem in understanding Bahasa Malaysia.

                                                           RESULTS

From the Total of 220 of the subjects, 3 incomplete then become 219.

Table 1: Socio-demographic data
                                                  Number                 %               Total

Age
  19-20                                              128                31.1              411
  21-22                                              151                36.7
  23-24                                              132                32.2

Race
  Malays                                             409                99.5              411
  Others                                              2                 0.5

Gender
  Male                                               179                43.5              411
  Female                                             232                56.5

Overall Cronbach's Alpha was 0.95, Depressive domain 0.92, Anxiety domain 0.87 and Stress domain was 0.88

Table 2 With force
                                                                         Domain
                                                           Depressive    Anxiety     Stress
 D3_ tidak dapat mengalami perasaan positif                  .423
 D5_ tidak bergerak ke mana-mana                             .403
 D10_ tidak mempunyai apa-apa untuk diharapkan               .664
 D13_ rasa sedih dan murung                                  .429
 D16_ hilang minat dalam segala hal                          .613
 D17_ tidak begitu berharga                                  .680
 D21_ hidup ini sudah tidak bermakna                         .849
 D24_ tidak dapat merasakan keseronokan                      .587
 D26_ rasa duka dan tidak keruan                             .527




                                                                                                                            3
              D31_ tidak bersemangat                                         .626
              D34_ diri saya langsung tidak berharga                         .804
              D37_melihat tiada masa depan                                   .783
              D38_ rasa hidup ini tidak bermakna                             .860
              D42_ sukar untuk mendapatkan semangat                          .441
              A2_ mulut terasa kering                                                     .410
              A4_ mengalami kesukaran bernafas                                            .661
              A7_ perasaan gementar                                                       .603
              A9_ keadaan yang menjadikan saya amat risau                                .334*        .630
              A15_ macam nak pengsan                                                      .457
              A19_ banyak berpeluh                                                        .409
              A20_ takut tanpa sebab                                                      .518
              A23_ sukar menelan                                                          .613
              A25_ sedar tindakbalas jantung                                              .594
              A28_ menjadi panik/cemas                                                    .571
              A30_‘dihambat’ oleh tugas yang remeh                                       .273*        .654
              A36_ rasa amat takut                                                        .502
              A40_ mungkin menjadi panik                                                 .294*        .515
              A41_ rasa menggeletar                                                       .571
              S1_ kesal/marah sebabkan perkara-perkara kecil                                           .706
              S6_ bertindak keterlaluan                                                                .625
              S8_ sukar untuk relaks                                                                   .448
              S11_ mudah merasa kesal                                                                  .642
              S12_ menggunakan banyak tenaga                                                           .619
              S14_ hilang kesabaran sekiranya saya dilambatkan                                         .712
              S18_ rasa mudah tersentuh                                                                .688
              S22_ sukar ditenteramkan                                                                 .573
              S27_ mudah marah                                                                         .564
              S29_ sukar untuk bertenang setelah rasa kesal                                            .733
              S32_ sukar bersabar pada gangguan                                                        .399
              S33_ keadaan yang terlalu gementar                                          .585        .318*
              S35_ hilang pertimbangan                                                                 .548
              S39_ saya semakin gelisah                                                                .429
             *Poor factor loading (<0.4

                           Scree Plot
                      14


                      12


                      10


                       8


                       6


                       4
Eigenvalue




                       2

                       0
                           1   4   7      10   13   16   19   22   25   28    31    34   37      40


                           Component Number



                                                                        Correlation
             Discussion

             There are a few very important notions that author would like to make based on observation and results on validation studies
             done in Malaysia. First, somatic items is best to heed for Asian population as this population has the tendency to exhibit
             psychological ailment through somatic complaints. Nevertheless in the aspect of gauging psychological disabilities among
             medical and surgical ill patients these items are not suitable as physical complaints may mask the underlying psychiatric
             symptoms especially among chronic pain patients.

             Artodo Bados: Using Cronbach’s the following values were obtained for the Depression, Anxiety and Stress scales,
             respectively: .92, .84 and .91 for the DASS;


             Thirdly non-somatic are well suit for medically ill patient such DASS.




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Weaknesses of this study We could not generalize the conclusion from this study to the Malaysia population as the
composition of rare did not represent the Malaysia population.

Conclusion

The BM version of DASS-42 has been translated with good quality and it is validated for this small group of students.
However to generalize it to Malaysian population, it needs more extensive studies in which we need to include public
Malaysian community.

Acknowledgement

We would like to thank to all the International Islamic University Malaysia, Kulliyyah of Medicine students for participating in
this study.

Conflicts of interest:

Here we declare there is no conflict of interest in this study.

                                                          REFERENCES

       1) Ramli M, Ariff MF, Zaini Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the
       Depression Anxiety and Stress Scales (DASS-21). ASEAN Journal of Psychiatry 2007;8 (2):82-89.

       2) Ramli Musa, Salmiah Mohd Ali, Nurul Ain Musa. Validation and psychometric properties of Bahasa Malaysia
       version of the Depression Anxiety and Stress Scales (DASS) among diabetic patients. 2008. Unpublished report.

       3) Department of Statistics, State/District Data Bank, Malaysia; 2005.

       4) Lovibond, P. F. (1998). Long-term stability of depression, anxiety, and stress syndromes. Journal of Abnormal
       Psychology, 107(3), 520-526.

       5) Lovibond, P. F., & Lovibond, S. H. (1995a). The structure of negative emotional states: Comparison of the
       Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research
       and Therapy, 33(3), 335-343.

       6) Lovibond, S. H., & Lovibond, P. F. (1995b). Manual for the Depression Anxiety Stress Scales. Sydney, Australia:
       Psychology Foundation.

       7) Lovibond, P. F., & Rapee, R. M. (1993). The representation of feared outcomes. Behaviour Research and
       Therapy, 31(6), 595-608.

       8) Daza, Patricia; Novy, Diane M; Stanley, Melinda A; Averill, Patricia (2002). The Depression Anxiety Stress Scale-
       21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology & Behavioral Assessment,
       24(3), 195-205.

       9) Novy, Diane M; Stanley, Melinda A; Averill, Patricia; Daza, Patricia (2001). Psychometric comparability of English-
       and Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13(3), 347-
       355.




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