Differential Item Functioning of the Arabic Version of the Depression Anxiety Stress Scale-21 (DASS-21)

Symptoms of depression and anxiety are widespread, chronic, and recurrent; their recovery is poor. They are associated with decreased work productivity, dissatisfaction in social relations, low quality of life, and high risk of suicide [13]. Negative emotions play a major role in the development and continuation of substance use disorders (SUDs) [4]. Individuals turn to illicit drugs to achieve emotional-regulation i.e., to cope with depression, anxiety, anger and trauma; and cover up their poor social skills [5,6]. Evidence indicates that adolescents with both recent and chronic depression and anxiety are more likely to use illicit drugs in the future [7,8]. Correspondingly, use of illicit drugs in adolescence is associated with higher psychological distress and continued drug use in adulthood [9]. Furthermore, withdrawal symptoms, intensity and frequency of craving, failure of pharmacotherapy, and relapse increase during emotional distress, even during and after treatment [10,11]. Conversely, drop of negative emotions during treatment is associated with less use of drugs [12].