The Depression Anxiety Stress Scale 8: Investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers

Abstract The Depression Anxiety Stress Scale 8-items (DASS-8) is a brief form of the DASS-21, which demonstrated adequate psychometrics relative to the parent scale in many studies. Aiming to determine an optimal cutoff score of the DASS-8, we recruited a convenient sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%). K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Based on score of 48 and 7 of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), receiver operator curve (ROC) analysis revealed an optimal cutoff point of 12.5 and 14.5 (area under the curve (AUC) = 0.85 & 0.92, p values = 0.001, 95% CI: 0.82–0.88 & 0.89 to 0.94, sensitivity = 0.81 & 0.78, specificity = 0.76 & 0.89, Youden index = 0.57 & 0.67, respectively). Decision modeling revealed that DASS-8 scores of 9.5 and 14.5 can predict low and high ZBI and UCLALS3 categories, respectively. Based on the median cutoff of the DASS-8 (14.5), the prevalence of high distress in this sample was 50.8%. In path analysis, the ZBI, UCLALS3, care dependency, receiving help with caregiving, predicted distress, especially in older female spouse caregivers. A DASS-8 score of 14.5 can detect mental distress symptomatology and reflect key mental problems such as burnout and loneliness in this vulnerable group. Further diagnostic workup may confirm psycho-pathogenicity. More investigations in other countries and conditions are needed to confirm the validity of this score.