Psychometric Validation of the Depression, Anxiety and Stress Scale (DASS-21) in Portuguese Youth Transitioning to...

Background/Objectives: The transition to higher education is a critical phase of human development that makes adolescents and young adults particularly vulnerable to mental health problems, such as depression, anxiety, and stress. This study aimed to evaluate the psychometric properties of the Portuguese version of the Depression, Anxiety and Stress Scale-21 Items (DASS-21) among first-year undergraduate nursing students. Methods: A methodological study was conducted with 225 undergraduate nursing students, aged 17 to 18 years, from a higher education institution in central Portugal. Data were collected using the Google Forms platform. Confirmatory factor analysis was conducted to test three competing models: a single-factor model, a three-factor correlated model, and a second-order factor model. Reliability was assessed using composite reliability, and validity was evaluated using average variance extracted and the Fornell-Larcker criterion for discriminant validity. Results: Factor analyses revealed that the three-factor correlated model fit the data best overall, showing superior fit indices compared to the competing models (χ²/df = 2.37; CFI = 0.90; and RMSEA = 0.08; TLI = 0.88 and SRMR = 0.04). Composite reliability was high across all tested models, ranging from 0.84 to 0.94. The analysis of score distributions by category revealed a high prevalence of severe or extremely severe symptoms of anxiety, stress, and, to a lesser extent, depression. A statistically significant association was found between higher symptom severity and prior familiarity with mental illness. Conclusions: The DASS-21 proved to be a valid and reliable instrument for assessing psychological distress in higher education students. These findings underscore the urgent need for mental health programs in higher education institutions that focus on early detection and intervention, particularly for students initiating their studies and those with a history of mental health problems.