Psychometric evaluation of the 21-item Depression, Anxiety and Stress Scale (DASS-21) among Afghans

Neyazi, A, Rahimi, BA, Mohammadi, AQ, Satapathy, P, Shikhulislamy, Y, Qaderi, F, Qarizada, BS, Afzali, H, Neyazi, M and Griffiths, MD ORCID: https://orcid.org/0000-0001-8880-6524, 2025. Psychometric evaluation of the 21-item Depression, Anxiety and Stress Scale (DASS-21) among Afghans. BMC Psychiatry, 25: 1186. ISSN 1471-244X

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Abstract

Background
Depression, anxiety, and stress are psychological mood states that have close relationships. Moreover, they are influenced by situational factors such as living in conflict zones (e.g., Afghanistan). The World Health Organization’s assessment suggests that a significant proportion, specifically one-tenth, of the population residing in areas of conflict endure varying degrees of mental health disorders, ranging from moderate to severe. The most used psychometric instrument to assess these mood states is the 21-item Depression, Anxiety and Stress Scale (DASS-21). However, the scale has not been validated in Dari, the most spoken language in Afghanistan.

Methods
A cross-sectional investigation was undertaken between June and September of 2023 across various locales within Afghanistan, aiming to assess the psychometric attributes of the Dari iteration of the DASS-21. The sample comprised 1318 participants (69% females) with mean age of 32 years.

Results
The total scale demonstrated excellent internal consistency (Cronbach’s α = 0.94), with strong reliability for the depression (α = 0.860), anxiety (α = 0.832), and stress (α = 0.883) subscales. Test–retest reliability was high for all subscales (ICC range: 0.784–0.916). Significant positive correlations were observed between DASS-21 subscales and scores on the 20-item Center for Epidemiologic Studies Depression Scale (CES-D-20) and the 28-item General Health Questionnaire (GHQ-28), supporting convergent validity.

Conclusions
The findings provide strong evidence that the Dari version of the DASS-21 is a psychometrically sound instrument for assessing depression, anxiety, and stress among Dari-speaking Afghan adults. The scale demonstrated excellent internal consistency, good test–retest reliability, and strong convergent validity, supporting its use in research and public health contexts for screening psychological distress. However, given the non-clinical and predominantly female sample, further studies in clinical populations and more diverse sociocultural groups are recommended to confirm its generalizability and diagnostic utility.

Item Type:	Journal article
Publication Title:	BMC Psychiatry
Creators:	Neyazi, A., Rahimi, B.A., Mohammadi, A.Q., Satapathy, P., Shikhulislamy, Y., Qaderi, F., Qarizada, B.S., Afzali, H., Neyazi, M. and Griffiths, M.D.
Publisher:	Springer Science and Business Media LLC
Date:	December 2025
Volume:	25
ISSN:	1471-244X
Identifiers:	Number Type 10.1186/s12888-025-07613-6 DOI 2552001 Other
Rights:	© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Divisions:	Schools > School of Social Sciences
Record created by:	Melissa Cornwell
Date Added:	09 Jan 2026 15:07
Last Modified:	09 Jan 2026 15:07
URI:	https://irep.ntu.ac.uk/id/eprint/55011

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