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, Cassibba R, Cavazos-Arroyo J, Daemi F, Díaz-Guerra DD, Džida M, Eidelsburger M, Fernández-Berrocal P, Fernández-Castillo E, Fonseca-Pedrero E, Frackowiak T, Freire T, Gavrilov-Jerković V, Gjoneska B, Guerrero-Alcedo J, Hillekens J, Höfer S, Hossain MJ, Iqbal N, Jámbori S, Joshanloo M, Lipovčan LK, Kavčič T, Kowal M, Taseva MK, Kuan SI, Lazić M, Mahmud T, Manrique-Millones D, Misiak M, Musso P, Obradović V, Ortuño-Sierra J, Orzea I, Özaslan A, Park J, Pašić M, Valickienė RP, Puente-Díaz R, Puerta-Sierra L, Dimitrovska GR, Roberts SC, Ronauli PT, Savahl S, Serapinas D, Sorokowska A, Sorokowski P, Sulejmanović D, Sultana MS, Szél E, Šakan D, Tilga H, Tomašević A, Tong KK, Unanue W, Unanue J, van Egmond M, Yıldırım M, Yuen SM, Kocjan GZ, Zamarian L & Zotović-Kostić M (2026) Depression and anxiety symptoms in adolescents across 30 countries: Cross-national measurement invariance and relationships with subjective well-being. Journal of Affective Disorders, p. 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.

Journal
Journal of Affective Disorders