{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:06:04Z","timestamp":1790672764785,"version":"4.1.0"},"reference-count":65,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Taishan Scholars Project","award":["Project No. tsqn202211130"],"award-info":[{"award-number":["Project No. tsqn202211130"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Depression, Anxiety, and Stress Scale-21 (DASS-21) is widely used to assess psychological symptoms among university students. However, its factor structure remains inconsistent, and few studies have employed advanced modeling approaches such as exploratory structural equation modeling (ESEM), particularly in cross-cultural contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The present study evaluated the factor structure of the DASS-21 by comparing five models: unidimensional, oblique three-factor, bifactor, three-factor ESEM, and bifactor ESEM. For the best-fitting model, internal consistency and measurement invariance across cultural, linguistic, and demographic groups were further examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using secondary data from an international mental health project, this cross-sectional study analyzed responses from 12,059 university students (\n                      <jats:italic>M<\/jats:italic>\n                      \u00a0=\u00a020.37 years,\n                      <jats:italic>SD<\/jats:italic>\n                      \u00a0=\u00a01.98; age range: 18\u201334; 36.6% men and 63.4% women) across ten distinct countries\/regions: Mainland China, Ghana, Hong Kong, India, Indonesia, Malaysia, Spain, Taiwan, Thailand, and Vietnam.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The three-factor ESEM model showed the best fit across the ten countries\/regions with acceptable fit indices, satisfactory internal consistency (McDonald\u2019s\n                      <jats:italic>\u03c9<\/jats:italic>\n                      \u00a0&gt;\u00a00.70), and acceptable internal structural validity evidence. Measurement invariance testing supported configural and metric invariance across all ten countries\/regions, whereas scalar invariance was not achieved, limiting direct cross-cultural comparisons. This pattern was also observed across the seven language groups. In contrast, scalar invariance was established across age, gender, data collection mode (online versus offline), and pandemic timing (onset versus post-COVID-19), further highlighting potential cultural and linguistic influences on DASS-21 responses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings support the DASS-21\u2019s robust internal structure and reliability across diverse student populations, while emphasizing caution in cross-cultural comparisons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21745","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:26:57Z","timestamp":1790670417000},"page":"e21745","source":"Crossref","is-referenced-by-count":0,"title":["A cross-sectional study examining the reliability and invariance of the Depression, Anxiety, and Stress Scale\u201321 (DASS-21) across ten countries\/regions"],"prefix":"10.7717","volume":"14","author":[{"given":"Xiu-Mei","family":"Chen","sequence":"first","affiliation":[{"name":"School of Information Engineering, Shandong Youth University of Political Science, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[{"name":"School of Culture and Communication, Shandong Youth Universtiy of Political Science, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iqbal","family":"Pramukti","sequence":"additional","affiliation":[{"name":"Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Kwasi","family":"Ahorsu","sequence":"additional","affiliation":[{"name":"Department of Special Education and Counselling, Education University of Hong Kong, Ting Kok, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha","family":"Kukreti","sequence":"additional","affiliation":[{"name":"Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Kang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Social Work, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Ying","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,  Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamolthip","family":"Ruckwongpatr","sequence":"additional","affiliation":[{"name":"Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Kuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dang","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pham le","family":"An","sequence":"additional","affiliation":[{"name":"Center of Family Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Nottingham Institute of Psychology, Nottingham Trent University, Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Chinese Academy of Education Big Data, Qufu Normal University, Qufu, Shandong, China"},{"name":"Faculty of Education, Qufu Normal University, Qufu, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Ying","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia"},{"name":"Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan"},{"name":"Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan"},{"name":"College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Malas","sequence":"additional","affiliation":[{"name":"Department of Psychology, Sociology and Social Work Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"10.7717\/peerj.21745\/ref-1","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/j.jad.2025.04.099","article-title":"Validating the Depression Anxiety Stress Scales (DASS-21) across Germany, Ghana, India, and New Zealand using Rasch methodology","volume":"383","author":"Adu","year":"2025","journal-title":"Journal of Affective Disorders"},{"key":"10.7717\/peerj.21745\/ref-2","doi-asserted-by":"publisher","first-page":"104511","DOI":"10.1016\/j.actpsy.2024.104511","article-title":"The second language trait emotional intelligence (L2-TEI) scale and its relation to language engagement","volume":"250","author":"Alamer","year":"2024","journal-title":"Acta Psychologica"},{"issue":"5","key":"10.7717\/peerj.21745\/ref-3","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1017\/S0272263121000863","article-title":"Exploratory structural equation modeling in second language research: an applied example using the dualistic model of passion","volume":"44","author":"Alamer","year":"2022","journal-title":"Studies in Second Language Acquisition"},{"issue":"2\u20133","key":"10.7717\/peerj.21745\/ref-4","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1111\/jpm.12363","article-title":"Factor structure and validity of the depression, anxiety and stress scale-21 in Swedish translation","volume":"24","author":"Alfonsson","year":"2017","journal-title":"Journal of Psychiatric and Mental Health Nursing"},{"key":"10.7717\/peerj.21745\/ref-5","doi-asserted-by":"publisher","first-page":"9534110","DOI":"10.1155\/2024\/9534110","article-title":"A cross-sectional network analysis study applied to the depression anxiety stress scale-21 (DASS-21): a new factor revealed","volume":"2024","author":"Alvarenga","year":"2024","journal-title":"Mental Illness"},{"issue":"8","key":"10.7717\/peerj.21745\/ref-6","doi-asserted-by":"publisher","first-page":"3243","DOI":"10.1002\/pits.23214","article-title":"Screening psychological symptoms in Filipino university students during the COVID-19 pandemic: translation and structural validation of the Filipino version of the DASS-21","volume":"61","author":"Aruta","year":"2024","journal-title":"Psychology in the Schools"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-7","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1080\/10705510903008204","article-title":"Exploratory structural equation modeling","volume":"16","author":"Asparouhov","year":"2009","journal-title":"Structural Equation Modeling: A Multidisciplinary Journal"},{"issue":"6","key":"10.7717\/peerj.21745\/ref-8","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1002\/ijop.12671","article-title":"Psychometric properties and measurement invariance of Depression, Anxiety and Stress Scales (DASS-21) across cultures","volume":"55","author":"Bibi","year":"2020","journal-title":"International Journal of Psychology"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-9","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/10944281211056520","article-title":"The quick and the careless: the construct validity of page time as a measure of insufficient effort responding to surveys","volume":"26","author":"Bowling","year":"2023","journal-title":"Organizational Research Methods"},{"key":"10.7717\/peerj.21745\/ref-10","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1177\/0049124192021002005","article-title":"Alternative ways of assessing model fit","volume":"21","author":"Browne","year":"1992","journal-title":"Sociological Methods & Research"},{"issue":"1","key":"10.7717\/peerj.21745\/ref-11","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1186\/s40359-025-03742-5","article-title":"Dimensionality, reliability, invariance, and item analysis of the Depression, Anxiety, and Stress Scale-21 (DASS-21) in Honduran and Colombian university students","volume":"13","author":"Castillo-D\u00edaz","year":"2025","journal-title":"BMC Psychology"},{"key":"10.7717\/peerj.21745\/ref-12","first-page":"616","article-title":"Religious, spiritual, and cultural aspects of psychiatric ethics in Hinduism","volume-title":"The Oxford handbook of psychiatric ethics","author":"Chaturvedi","year":"2015"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-13","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1080\/10705510701301834","article-title":"Sensitivity of goodness of fit indexes to lack of measurement invariance","volume":"14","author":"Chen","year":"2007","journal-title":"Structural Equation Modeling: A Multidisciplinary Journal"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-14","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1037\/0021-843X.100.3.316","article-title":"Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications","volume":"100","author":"Clark","year":"1991","journal-title":"Journal of Abnormal Psychology"},{"issue":"1","key":"10.7717\/peerj.21745\/ref-15","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12955-021-01853-2","article-title":"French cross-cultural adaptation and validation of the Quality of Life-Alzheimer\u2019s Disease scale in Nursing Homes (QOL-AD NH)","volume":"19","author":"Cousi","year":"2021","journal-title":"Health and Quality of Life Outcomes"},{"key":"10.7717\/peerj.21745\/ref-16","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1002\/gps.5329","article-title":"Cross-cultural comparison of symptom networks in late-life major depressive disorder: Yoruba Africans and the Spanish population","volume":"35","author":"de\u00a0laTorre Luque","year":"2020","journal-title":"International Journal of Geriatric Psychiatry"},{"issue":"7","key":"10.7717\/peerj.21745\/ref-17","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1177\/07067437231183747","article-title":"University student mental health: an important window of opportunity for prevention and early intervention","volume":"68","author":"Duffy","year":"2023","journal-title":"The Canadian Journal of Psychiatry"},{"issue":"5","key":"10.7717\/peerj.21745\/ref-18","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1007\/s10566-024-09795-8","article-title":"Systematic review of the psychometric evidence supporting use of the Depression Anxiety Stress Scales, Short Form (DASS-21) with youth","volume":"53","author":"Dwight","year":"2024","journal-title":"Child & Youth Care Forum"},{"key":"10.7717\/peerj.21745\/ref-19","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/002224378101800104","article-title":"Evaluating structural equation models with unobservable variables and measurement error","volume":"18","author":"Fornell","year":"1981","journal-title":"Journal of Marketing Research"},{"issue":"6","key":"10.7717\/peerj.21745\/ref-20","doi-asserted-by":"publisher","first-page":"e0233998","DOI":"10.1371\/journal.pone.0233998","article-title":"Confirmatory factor analysis and exploratory structural equation modelling of the factor structure of the Depression Anxiety and Stress Scales-21","volume":"15","author":"Gomez","year":"2020","journal-title":"PLOS ONE"},{"key":"10.7717\/peerj.21745\/ref-21","article-title":"Healthy minds study among colleges and universities","author":"Healthy Minds\u00a0Network","year":"2022"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-22","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/j.1556-6678.2007.tb00456.x","article-title":"Mental health and career development of college students","volume":"85","author":"Hinkelman","year":"2007","journal-title":"Journal of Counseling & Development"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-23","doi-asserted-by":"publisher","first-page":"e0299229","DOI":"10.1371\/journal.pone.0299229","article-title":"Are anxiety, depression, and stress distinguishable in Italian adolescents? An examination through the Depression Anxiety Stress Scales-21","volume":"19","author":"Iannattone","year":"2024","journal-title":"PLOS ONE"},{"issue":"4","key":"10.7717\/peerj.21745\/ref-24","doi-asserted-by":"crossref","first-page":"205","DOI":"10.23916\/0020200536840","article-title":"The depression anxiety stress scales (DASS-21); an Indonesian validation Measure of the depression anxiety stress","volume":"5","author":"Ifdil","year":"2022","journal-title":"COUNS EDU: The International Journal of Counseling and Education"},{"key":"10.7717\/peerj.21745\/ref-25","doi-asserted-by":"publisher","first-page":"899246","DOI":"10.3389\/fpsyg.2022.899246","article-title":"The depression anxiety stress scale-21 in Chinese hospital workers: reliability, latent structure, and measurement invariance across genders","volume":"13","author":"Jiang","year":"2022","journal-title":"Frontiers in Psychology"},{"issue":"12","key":"10.7717\/peerj.21745\/ref-26","doi-asserted-by":"publisher","first-page":"6045","DOI":"10.1007\/s12144-019-00540-2","article-title":"Can adolescents differentiate between depression, anxiety and stress? Testing competing models of the Depression Anxiety Stress Scales (DASS-21)","volume":"40","author":"Jovanovi\u0107","year":"2021","journal-title":"Current Psychology"},{"key":"10.7717\/peerj.21745\/ref-27","volume-title":"Principles and practice of structural equation modeling","author":"Kline","year":"2023"},{"key":"10.7717\/peerj.21745\/ref-28","doi-asserted-by":"publisher","first-page":"39","DOI":"10.22916\/jcpc.2023.40.39","article-title":"Confucian affect (Qing) as the foundation for mutual care and moral elevation","volume":"40","author":"Li","year":"2023","journal-title":"Journal of Confucian Philosophy and Culture"},{"key":"10.7717\/peerj.21745\/ref-29","doi-asserted-by":"publisher","first-page":"444","DOI":"10.3389\/fpsyg.2015.00444","article-title":"The role of language in emotion: predictions from psychological constructionism","volume":"6","author":"Lindquist","year":"2015","journal-title":"Frontiers in Psychology"},{"key":"10.7717\/peerj.21745\/ref-30","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1057\/s41599-024-03686-y","article-title":"Depression, anxiety, and student satisfaction with university life among college students: a cross-lagged study","volume":"11","author":"Liu","year":"2024","journal-title":"Humanities and Social Sciences Communications"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-31","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-u","article-title":"The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behaviour Research and Therapy"},{"key":"10.7717\/peerj.21745\/ref-32","volume-title":"Manual for the depression anxiety stress scales","author":"Lovibond","year":"1995","edition":"2"},{"key":"10.7717\/peerj.21745\/ref-33","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.3389\/fpsyg.2018.02064","article-title":"Measurement invariance of the Depression Anxiety Stress Scales-21 across gender in a sample of Chinese university students","volume":"9","author":"Lu","year":"2018","journal-title":"Frontiers in Psychology"},{"issue":"5","key":"10.7717\/peerj.21745\/ref-34","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1037\/met0000624","article-title":"The dire disregard of measurement invariance testing in psychological science","volume":"30","author":"Maassen","year":"2025","journal-title":"Psychological Methods"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-35","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1111\/bmsp.12336","article-title":"When and how to use set-exploratory structural equation modelling to test structural models: a tutorial using the R package lavaan","volume":"77","author":"Marsh","year":"2024","journal-title":"British Journal of Mathematical and Statistical Psychology"},{"issue":"4","key":"10.7717\/peerj.21745\/ref-36","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1177\/0734282911406657","article-title":"Methodological measurement fruitfulness of exploratory structural equation modeling (ESEM): new approaches to key substantive issues in motivation and engagement","volume":"29","author":"Marsh","year":"2011","journal-title":"Journal of Psychoeducational Assessment"},{"key":"10.7717\/peerj.21745\/ref-37","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1146\/annurev-clinpsy-032813-153700","article-title":"Exploratory structural equation modeling: an integration of the best features of exploratory and confirmatory factor analysis","volume":"10","author":"Marsh","year":"2014","journal-title":"Annual Review of Clinical Psychology"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-38","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1027\/1015-5759\/a000218","article-title":"Factorial invariance of the DASS-21 among adolescents in four countries","volume":"31","author":"Mellor","year":"2014","journal-title":"European Journal of Psychological Assessment"},{"key":"10.7717\/peerj.21745\/ref-39","article-title":"Exploratory structural equation modeling","volume-title":"Handbook of structural equation modeling","author":"Morin","year":"2023","edition":"2"},{"key":"10.7717\/peerj.21745\/ref-40","volume-title":"Psychometric properties of a Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21)","author":"Moussa","year":"2001"},{"key":"10.7717\/peerj.21745\/ref-41","article-title":"A Thai translation of DASS","author":"NCHECR Thai\u00a0translation","year":"2007"},{"issue":"6","key":"10.7717\/peerj.21745\/ref-42","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1080\/00207594.2012.755535","article-title":"Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures","volume":"48","author":"Oei","year":"2013","journal-title":"International Journal of Psychology"},{"key":"10.7717\/peerj.21745\/ref-43","doi-asserted-by":"publisher","first-page":"106244","DOI":"10.1016\/j.neubiorev.2025.106244","article-title":"Prevalence of mental disorder symptoms among university students: an umbrella review","volume":"175","author":"Paiva","year":"2025","journal-title":"Neuroscience and Biobehavioral Reviews"},{"issue":"3","key":"10.7717\/peerj.21745\/ref-44","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1023\/A:1016014818163","article-title":"The Depression Anxiety Stress Scale-21: Spanish translation and validation with a Hispanic sample","volume":"24","author":"Patricia","year":"2002","journal-title":"Journal of Psychopathology and Behavioral Assessment"},{"issue":"9","key":"10.7717\/peerj.21745\/ref-45","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1002\/jclp.20696","article-title":"Depression Anxiety Stress Scale: is it valid for children and adolescents?","volume":"66","author":"Patrick","year":"2010","journal-title":"Journal of Clinical Psychology"},{"key":"10.7717\/peerj.21745\/ref-46","doi-asserted-by":"publisher","DOI":"10.1007\/s10943-025-02354-y","article-title":"Buddhist practices and mental health outcomes in Thailand","author":"Pholphirul","year":"2025","journal-title":"Journal of Religion & Health"},{"key":"10.7717\/peerj.21745\/ref-47","article-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2025"},{"key":"10.7717\/peerj.21745\/ref-48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9707\/2307-0919.1080","article-title":"Somatization vs. psychologization of emotional distress: a paradigmatic example for cultural psychopathology","volume":"10","author":"Ryder","year":"2002","journal-title":"Online Readings in Psychology and Culture"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-49","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1037\/0021-843X.117.2.300","article-title":"The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?","volume":"117","author":"Ryder","year":"2008","journal-title":"Journal of Abnormal Psychology"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-50","doi-asserted-by":"publisher","DOI":"10.1177\/21582440221096123","article-title":"Severity and correlates of the symptoms of depression, anxiety, and stress in a nationally representative sample of Turkish secondary boarding school Counselors","volume":"12","author":"\u015eahin","year":"2022","journal-title":"SAGE Open"},{"issue":"1","key":"10.7717\/peerj.21745\/ref-51","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.bodyim.2011.10.002","article-title":"Analysis of the factor structure of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in Spanish secondary-school students through exploratory structural equation modeling","volume":"9","author":"S\u00e1nchez-Carracedo","year":"2012","journal-title":"Body Image"},{"issue":"11","key":"10.7717\/peerj.21745\/ref-52","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1037\/pas0000440","article-title":"Testing measurement invariance of the Depression, Anxiety, and Stress Scales (DASS-21) across four countries","volume":"29","author":"Scholten","year":"2017","journal-title":"Psychological Assessment"},{"key":"10.7717\/peerj.21745\/ref-53","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.jad.2024.09.116","article-title":"Exploring the impact of depression, anxiety, stress, academic engagement, and dropout intention on medical students\u2019 academic performance: a prospective study","volume":"368","author":"Sinval","year":"2025","journal-title":"Journal of Affective Disorders"},{"key":"10.7717\/peerj.21745\/ref-54","doi-asserted-by":"publisher","first-page":"101641","DOI":"10.1016\/j.bodyim.2023.101641","article-title":"A guide to exploratory structural equation modeling (ESEM) and bifactor-ESEM in body image research","volume":"47","author":"Swami","year":"2023","journal-title":"Body Image"},{"key":"10.7717\/peerj.21745\/ref-55","doi-asserted-by":"publisher","first-page":"1524680","DOI":"10.3389\/fpsyg.2025.1524680","article-title":"Cultural diversity in beliefs regarding mental illness: comparison of Indonesian Muslims, Indonesian Christians, and Japanese non-religions","volume":"16","author":"Tanaka","year":"2025","journal-title":"Frontiers in Psychology"},{"key":"10.7717\/peerj.21745\/ref-56","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-244X-13-24","article-title":"Validation of the Depression Anxiety Stress Scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women","volume":"13","author":"Tran","year":"2013","journal-title":"BMC Psychiatry"},{"key":"10.7717\/peerj.21745\/ref-57","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1177\/14680173241312749","article-title":"Ubuntu philosophy, values, and principles: an opportunity to do social work differently","volume":"25","author":"Udah","year":"2025","journal-title":"Journal of Social Work"},{"key":"10.7717\/peerj.21745\/ref-58","article-title":"Statement on the fifteenth meeting of the IHR(2005) Emergency Committee on the COVID-19 pandemic","author":"World Health\u00a0Organization","year":"2023"},{"issue":"4","key":"10.7717\/peerj.21745\/ref-59","doi-asserted-by":"publisher","first-page":"e12362","DOI":"10.1037\/h0101782","article-title":"A systematic review and meta-analytic factor analysis of the depression anxiety stress scales","volume":"27","author":"Yeung","year":"2020","journal-title":"Clinical Psychology: Science and Practice"},{"key":"10.7717\/peerj.21745\/ref-60","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12144-022-03710-x","article-title":"Using a bifactor exploratory structural equation modeling framework to examine the factor structure of the Depression Anxiety and Stress Scales-21","volume":"5","author":"Y\u0131lmaz\u00a0Ko\u011far","year":"2022","journal-title":"Current Psychology"},{"issue":"6","key":"10.7717\/peerj.21745\/ref-61","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1177\/1073191119887449","article-title":"Examining the dimensionality, reliability, and invariance of the Depression, Anxiety, and Stress Scale\u201321 (DASS-21) across eight countries","volume":"28","author":"Zanon","year":"2021","journal-title":"Assessment"},{"issue":"2","key":"10.7717\/peerj.21745\/ref-62","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1080\/15305058.2025.2489359","article-title":"Psychometric properties of the depression, anxiety, and stress scale\u201321 (DASS-21) across nine countries\/regions","volume":"25","author":"Zanon","year":"2025","journal-title":"International Journal of Testing"},{"key":"10.7717\/peerj.21745\/ref-63","doi-asserted-by":"publisher","first-page":"2934","DOI":"10.1186\/s12889-024-20123-6","article-title":"Application of DASS-21 in Chinese students: invariance testing and network analysis","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Public Health"},{"key":"10.7717\/peerj.21745\/ref-64","doi-asserted-by":"publisher","first-page":"104626","DOI":"10.1016\/j.actpsy.2024.104626","article-title":"Psychometric evaluation of DASS versions among Spanish and Chinese teachers using exploratory structural equation modeling (ESEM)","volume":"251","author":"Zhou","year":"2024","journal-title":"Acta Psychologica"},{"key":"10.7717\/peerj.21745\/ref-65","article-title":"A Chinese Translation of the DASS (simplified characters)","author":"Zuo","year":"2008"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/21745.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21745.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21745.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21745.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:27:02Z","timestamp":1790670422000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/21745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":65,"alternative-id":["10.7717\/peerj.21745"],"URL":"https:\/\/doi.org\/10.7717\/peerj.21745","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"e21745"}}