Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain

Amira Mohammed Ali, Rana Ali Alameri, Tiffany Brooks, Tazeen Saeed Ali, Nashwa Ibrahim, Haitham Khatatbeh, Annamaria Pakai, Abdulmajeed A. Alkhamees, Saeed A. Al-Dossary

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Aim: Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. Design: This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13–71 years). Methods: Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. Results: Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. Conclusion: CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. Implications for patient care: At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Original languageEnglish
Pages (from-to)8054-8062
Number of pages9
JournalJournal of Clinical Nursing
Issue number23-24
Publication statusPublished - Dec 2023


  • chronic pelvic pain
  • cut-off score*/cut-off point*
  • pain severity/polypharmacy/the intake of any medication/analgesics/pain medication
  • psychological distress/psychiatric comorbidity
  • receiver operator curve (ROC)/decision trees/K-means clustering
  • sexual abuse/sexual assault/post-traumatic stress
  • short form of the Depression Anxiety Stress Scale 21/Depression Anxiety Stress Scale 8-items


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