Validation of Depression, Anxiety and Stress Scale (DASS-21) among healthcare workers during the outbreak of delta variant of SARS-CoV-2 in Ghana

Background: Today COVID-19 is having a dire effect on the mental and physical health of the general population. Although the long-term psychological effects of COVID-19 remain unknown, studies have shown increasing depression, anxiety and stress among healthcare workers. The aim of the study was to examine the psychometric properties and validation of the Depression, Anxiety, and Stress Scale (DASS-21) and evaluate the level of depression, anxiety, and stress among healthcare workers in a tertiary hospital during the SARS-CoV-2 delta variant outbreak. Methods: Using an online questionnaire, we conducted a cross-sectional study on 1201 healthcare workers in a tertiary hospital. The validation of DASS-21 was performed by examining the factorial structure (construct validity) using confirmatory factor analysis (CFA), internal consistency (reliability), convergent validity, discriminate validity and measurement invariance. Results: Cronbach's Alpha was acceptable for depression (0.88), anxiety (0.81), and stress (0.86). CFA provides support for the three-factor oblique model with the following fit indexes: (Chi-Square χ2/ (degrees of freedom) = 1628.5/(186), p < 0.001), comparative fit index (CFI = 0.923), Tucker-Lewis index (TLI = 0.901), standardized root mean square residual (SRMR = 0.0452) and root mean square error of approximation (RMSEA = 0.07). DASS-21 achieved both configural and metric invariance. Conclusions: Our results indicate that DASS-21 is a reliable and valid self-reporting screening tool for depression, anxiety and stress among healthcare workers. This tool is also invariant across sex, doctors, nurses, and non-clinical healthcare workers. Thus DASS-21 is an essential screening tool to identify healthcare workers at a higher risk of developing work-related mental health disorders.