Depression and anxiety symptoms in adolescents across 30 countries: Cross-national measurement invariance and relationships with subjective well-being

Citation

Jovanović V, Adams S, Aritio-Solana R, Aryanto CB, Avsec A, Bakhshi A, Baldassarre M, Bender M, Berjot S, Zambrano SB, Brajša-Žganec A, Broche-Pérez Y, Buzea C, Cabello R & Roberts SC (2026) Depression and anxiety symptoms in adolescents across 30 countries: Cross-national measurement invariance and relationships with subjective well-being. Journal of Affective Disorders, Art. No.: 121693. https://doi.org/10.1016/j.jad.2026.121693

Abstract
Cross-cultural empirical evidence on the validity of measures of depression and anxiety symptoms in adolescents is scarce and inconclusive. The present study investigated the cross-national measurement invariance and convergent validity evidence of the Depression and Anxiety scales of the Depression Anxiety and Stress Scales (DASS-21). We sampled 16,802 adolescents (58.1% female) aged 14–19 years across 30 countries from five continents. Both exact and approximate measurement invariance were tested. The results provided evidence for the exploratory structural equation model (ESEM) as the best representation of the data in most countries. Full scalar invariance was not supported when tested across all countries, but only among two Southern Asian countries (Bangladesh, India), two Northern European countries (Estonia, Lithuania), the six former republics of Yugoslavia, and European and American countries grouped by UN subregions. Results of the alignment method supported the approximate invariance of the ESEM model across 29 countries. Associations between Depression and Anxiety ESEM factors and life satisfaction, positive affect, and negative affect conformed to the theoretical expectations in most countries. Our findings indicate that the Depression and Anxiety scales of the DASS-21 have potential for use in cross-national research on adolescent internalizing symptoms, but we highlight issues of using it outside of Western (European, North American) settings.

Keywords
Depression; Anxiety; Culture; Adolescence; Measurement invariance; Exploratory structural equation modeling

Notes
Additional authors: Rosalinda Cassibba, Judith Cavazos-Arroyo, Fatemeh Daemi, Diego D. Díaz-Guerra, Marija Džida, Mona Eidelsburger, Pablo Fernández Berrocal, Evelyn Fernández-Castillo, Eduardo Fonseca-Pedrero, Tomasz Frackowiak, Teresa Freire, Vesna Gavrilov-Jerković, Biljana Gjoneska, Jesús Guerrero-Alcedo, Jessie Hillekens, Stefan Höfer, Md Jamil Hossain, Naved Iqbal, Szilvia Jámbori, Mohsen Joshanloo, Ljiljana Kaliterna Lipovčan, Tina Kavčič, Marta Kowal, Marija Krstevska Taseva, Sok Ian Kuan, Milica Lazić, Tareq Mahmud, Denisse Manrique-Millones, Michal Misiak, Pasquale Musso, Vojana Obradović, Javier Ortuño-Sierra, Ioana Orzea, Ahmet Özaslan, Joonha Park, Marija Pašić, Rasa Pilkauskaitė Valickienė, Rogelio Puente-Díaz, Lizbeth Puerta-Sierra, Gordana Ristevska Dimitrovska Puji Tania Ronauli, Shazly Savahl, Danielius Serapinas, Agnieszka Sorokowska, Piotr Sorokowski, Dijana Sulejmanović, Mst Sadia Sultana, Erzsébet Szél, Dušana Šakan, Henri Tilga, Aleksandar Tomašević, Kwok Kit Tong, Wenceslao Unanue, Jesús Unanue, Marieke van Egmond, Murat Yıldırım, Sze Man Yuen, Gaja Zager Kocjan, Laura Zamarian, Marija Zotović-Kostić

Journal
Journal of Affective Disorders