Depression, Anxiety, Stress Scale – 21 (DASS-21)
Depression and nervousness the most prevalent non-psychotic disorders that are increasingly causing public health concern. There is an escalating need for the measure to be used by clinicians in identifying individuals with mental health problems in the society. Further, there is a need for a clear definition of the relation between depression and anxiety and the rising controversies about the same.
The depression, anxiety, and stress scale (DASS) is a metric widely used to screen for symptoms of depression, anxiety, and stress in both community and clinical settings. DASS encompasses three subsets; the stress scale, which measures distress, tension, negativity, and anxiety scale, which asses autonomic stimulation, musculoskeletal reactions, situational nervousness; and the depression measure checks out for hopelessness, low self-esteem, and decreased levels of positive effect. DASS can be assessed in two forms the full 42 item version or the short half version consisting of 21 items. DASS-42 has 14 items in each subset, while DASS-21 has seven items in each subgroup.
The DASS 21 measures distress quantitively, explaining related causes, including depression, anxiety, and stress. The results yielded by DASS are usually slightly different from those gotten from DAS-42. It is, however, advantageous as it can be administered in less time, making it more suitable for a clinical setting. To compare DASS-21 with DASS normative data, the scores are multiplied by two. Different measurements are available to categorize the extent of emotional disturbance. The categories range from mild, moderate, severe to extreme.
Scholarly evidence for DASS setting in a clinical setting is available mostly in English-speaking countries, including Canada, the united states, England and Australia. Numerous studies in this area are proof of the validity, reliability, and psychometric efficiency of DASS-21. Various researchers have also explored the wide use of DASS-21 in both clinical and non-clinical settings while coming up with viable results and drawing sensible conclusions. This scale has also been used in diagnosing the lotus of emotional discomfort, exploring the extent of depression and anxiety symptoms.
DASS-21 was used in this research as is it helps clinicians identify the source of a patient’s emotional turbulence. It is useful in complementing other data gathered from clinical assessment and providing necessary knowledge into a person’s emotional quotient. DASS is useful in indicating a patient’s progress over a certain period and observation. With records of the patients’ moods over time, clinicians can make comparisons and relations deducing factors that could trigger emotional changes, getting more specific data on both positive and negative emotional triggers. More significantly, The DASS 21 is a self-reporting assessment, with no person’s restrictions to administer it and no associated costs. It is a public domain, and special permission from authorities is not necessary. Nevertheless, the analysis and interpretation of this calls for expertise in psychology and mental health professions.
As a self-report technique, respondents who agreed to participate in this research completed the questionnaires. It was completed before and after the project to evaluate respondents’ progress over a certain period. The BHC’s interpretation was conducted and explained to each participant pre-project initiation and post projection completion and CBT intervention. The process only encountered the limitation of a few uncooperative participants. Data collected from respondents was recorded on reliable database systems without exposing the identity of the participants. The data was also subjected to tests and peer review to ensure its validity. The data was secured from landing unauthorized hands through end-to-end encryption, and passcodes were availed to authorized parties only.
Body Mass Index (BMI)
Body Mass Index (BMI) is a useful and effective method to assess whether an individual’s weight falls in the range of overweight or obese. The Centers for Disease Control and Prevention identifies obesity in adults as having a BMI greater than 30.0 or more. BMI is calculated by taking an individual’s weight in Kilograms divided by the square of height in meters (Centers for Disease Control and Prevention, 2014; The Lancet, 2009). Adiposity has been associated with a higher risk of developing and being diagnosed with Type 2 diabetes and other diseases ranging from cardiovascular disease, hypertension to hypercholesterolemia (Castelnuovo et al., 2017). Adiposity not only increases the possibility of medical complications and comorbidities but is also associated with premature death (Fock & Khoo, 2013; The Lancet, 2009; National Institute of Health [NIH], n.d.). It is estimated that approximately 42.4% percent of adults in the United States twenty (20) years and older suffer from obesity (Leung et al., 2017; Moores, 2020). As a significant risk factor for diabetes and diabetes-related comorbidities, individuals with a high-level BMI in the obesity range also create higher health care expenditures than individuals with a lower BMI (Leung et al., 2017).
Body mass index is a scale used to measure weight will adjusting for height, calculated as weight in kilograms divided by the square height of an individual. It is a sensible indicator of body fats for all groups of people but should not be used in diagnosis as it measures excess weight rather than the amount of fat in the body. Nevertheless, various studies have indicated that BMI correlates to more direct body fat measures such as underwater weight.
This research sought to use BMI measure because it is simple and less costly. Compared to other methods, BMI relies on weight and weight, which require simple tools to measure. Weight and height measurement tools are easily available in both the community and clinical setting. It is thus easy for individuals to have their BMI frequently checked with little effort.
Various scholars have explored the relationship between BMI and fat and future body health, indicating that BMI can predict future morbidity and death. This makes BMI an objective measure for screening obesity and associated health perils.
More objectively, the widespread and longstanding use of BMI backs utility both in the community and clinical setting. Its usage has led to increased documentation and publication related to enabling clinicians to compare regions, various groups, and time.
When using BMI, its clinical limitations ought to be considered. BMI measures body weight in relation to height and not body fat. It does not define the relationship between body mass index and the amount of fat in the body. Also, BMI does not differentiate body fat from muscle and bone fat and does not indicate fat distribution amongst different groups. More significantly, a variety of factors including muscle mass, ethnicity, gender, and age are bound to influence the relationship between body fat and BMI; for instant, younger adults are likely to have less body fat than younger adults, females have more fat in their bodies than male counterparts with the same BMI, and athletic people may tend to have more BMI due to muscle build-up rather than fat.
The BMI scale is an individual’s weight in pounds divided by the square of height in feet and inches (American Heart Association, 2014). A high BMI may be an indicator of high body fatness. BMI was used to screen for weight categories that may lead to health problems; however, BMI is not diagnostic for individual health. The BMI scale categories are as follows: Underweight = <18.5 or under, Normal Weight = 18.5 – 24.9, Overweight = 25 – 29.9, Obesity = BMI of 30 > or greater (CDC, 2014). For BMI scale (see Appendix B). for a table of scale categories (CDC, 2014).
In this project, BMI scores were obtained from participant EMRs pre and post diabetes education self-management and CBT interventions. Primary care patients’ BMI are routinely assessed at in-take prior to all PCP visits. BMI scores are calculated and entered into the electronic medical records (EMR) by the primary care physicians’ nurses. The BHC was provided access to the EMR following the completion of the required EMR training. This access allowed the BHC to obtain the BMI from each participant in this project pre and post-educational self-management and CBT. There were no barriers associated with getting BMI for participants, and no expenditures were required.
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