Psychometric Evaluation of Persian Version of Death Depression Scale in Iranian Patients with Acute Myocardial Infarction

  • Hamid Sharif Nia School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran.
  • Saeed Pahlevan Sharif School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran.
  • Rebecca H Lehto Associate Professor Michigan State University College of Nursing, Michigan, USA
  • Kelly A Allen Honorary Fellow. The Melbourne Graduate School of Education, The University of Melbourne. Melbourne, Australia
  • Amir Hossein Goudarzian Nursing, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
  • Ameneh Yaghoobzadeh Master in Geriatric Nursing, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohammad Ali Soleimani Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
Acute Myocardial Infarction, Death Depression, Persian version, Psychometric



Objective: The psychometric properties of a scale should be re-assessed routinely with different samples to ensure its generalizability. The present study aimed to determine the reliability and validity of the Persian Version of Death Depression Scale (DDS) in Iranian patients with Acute Myocardial Infarction (AMI).

Methods: The face validity, content validity and construct validity (i.e. factorial, convergent, and discriminant validity) of the DDS were assessed using a sample of 407 AMI patients. Confirmatory factor analysis was conducted using the ratio chi-square by degrees of freedom (χ2/df), the Goodness-of-fit index (GFI), Comparative Fit Index (CFI), Incremental Fit Index (IFI), Normed Fit Index (NFI), and Root Mean Square Error of Approximation (RMSEA). Convergent and discriminant validity were assessed using average variance extracted (AVE), maximum shared squared variance (MSV), and average shared square variance (ASV). Internal consistency, test–retest, and construct reliability (CR) were used to assess reliability of the Persian Version of DDS.

Results: Based on principle component analysis and consideration of conceptual meaning, a four-factor solution was selected, explaining 75.89% of the total variance. Goodness-of-fit indices (c2(98) = 583.646, p < .05, c2/df= 5.956, GFI = .856, CFI = .902, NFI = .885, IFI = .902, RMSEA (90% C.I.) = .110 (.102 - .119) in the final DDS structure demonstrated the adequacy of the four-domain structure of the DDS. Convergent and discriminant validity was used to assess the construct validity of the DDS. The reliability was greater than .70.

Conclusion: The DDS was found to be a valid and reliable assessment tool for death depression in Iranian patients with AMI.

Author Biographies

Rebecca H Lehto, Associate Professor Michigan State University College of Nursing, Michigan, USA

Michigan State University College of Nursing, Michigan, USA.

Kelly A Allen, Honorary Fellow. The Melbourne Graduate School of Education, The University of Melbourne. Melbourne, Australia

The Melbourne Graduate School of Education, The University of Melbourne. Melbourne, Australia.


Sharif Nia H, Ebadi A, Lehto RH, Peyrovi H. The experience of death anxiety in Iranian war veterans: a phenomenology study. Death Stud 2015; 39: 281-287.

Werlang R, Mendes JMR. Death over time: brief notes about death and dying in the West. Estud psicol (Campinas) 2014; 31: 437-449.

Sharif Nia H, Ebadi A, Lehto RH, Mousavi B, Peyrovi H, Chan YH. Reliability and validity of the persian version of templer death anxiety scale-extended in veterans of iran-iraq warfare. Iran J Psychiatry Behav Sci 2014 ; 8: 29-37.

Madnawat AS, Kachhawa PS. Age, gender, and living circumstances: Discriminating older adults on death anxiety. Death Stud 2007; 31: 763-769.

Abdel-Khalek AM. Death, anxiety, and depression. OMEGA 1997; 35: 219-229.

Abdel-Khalek AM. Death, anxiety, and depression: A comparison between Egyptian, Kuwaiti, and Lebanese undergraduates. OMEGA 2002; 45: 277-287.

Tomer A, Eliason G. Toward a comprehensive model of death anxiety. Death Stud 1996; 20: 343-365.

Yeganeh khah MR, Abedini A, Akbari H, Ziyayi Nezhad MT. [Comparison of Different Methods of Education on Reducing the Anxiety of Patients with Myocardial Infarction (persian)]. Iran Journal of Nursing 2012; 24: 36-44.

Thomas Gaziano KSR, Fred Paccaud, Sue Horton, Vivek Chaturvedi. Cardiovascular Disease: Washington (DC): World Bank; 2006.

Basam Pour SS. The effect of education on anxiety before and after open heart surgery. Journal of Payesh 2004; 3: 139-144.

Taghipour B, Sharif Nia H, Soleimani MA, Afshar MH, Far SS. [Comparison of the clinical symptoms of myocardial infarction in the middle-aged and elderly (persian)]. J Kermanshah Univ Med Sci 2014; 18.

Dunderdale K, Thompson DR, Miles JNV, Beer SF, Furze G. Quality-of-life measurement in chronic heart failure: do we take account of the patient perspective? Eur J Heart Fail 2005; 7: 572-582.

Fried EI, Nesse RM. Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential. BMC Med 2015; 13: 72.

Meneses R, Almeida M, Abecasis J, Arroja I, Carvalho A, Aleixo A. Depression in patients with myocardial infarction. Rev Port Cardiol 2007; 26: 1143-1165.

Celano CM, Huffman JC. Depression and Cardiac Disease: A Review. Cardiol Rev 2011; 19: 130-142.

Serrano CV Jr, Setani KT, Sakamoto E, Andrei AM, Fraguas R. Association between depression and development of coronary artery disease: pathophysiologic and diagnostic implications. Vasc Health Risk Manag 2011; 7: 159-164.

Schrader G, Cheok F, Hordacre AL, Guiver N. Predictors of depression three months after cardiac hospitalization. Psychosom Med 2004; 66: 514-520.

L Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F,, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 2008; 118: 1768-1775.

Williams RB. Depression After Heart Attack: Why Should I Be Concerned About Depression After a Heart Attack? Circulation 2011; 123: e639-640.

Sharif Nia H, Pahlevan Sharif S, Lehto RH, Boyle C, Yaghoobzadeh A, Kaveh O, Goudarzian AH. Development and psychometric evaluation of a Persian version of the Death Depression Scale-Revised: a cross-cultural adaptation for patients with advanced cancer. Jpn J Clin Oncol 2017; 47: 713-719.

Tomas-Sabado J, GOMEZ-BENITO J. The Spanish form of the death depression scale. Percept Mot Skills 2003; 96: 49-53.

Abdel-Khalek AM. Death, anxiety, and depression in Lebanese undergraduates. OMEGA 1998; 37: 289-302.

Templer DI, Lavoie M, Chalgujian H, Thomas‐Dobson S. The measurement of death depression. J Clin Psychol 1990; 46: 834-839.

Dadfar M, Lester D. Cronbach's α reliability, concurrent validity, and factorial structure of the Death Depression Scale in an Iranian hospital staff sample. Int J Nurs Sci 2017; 4: 135-141.

Birks Y, Roebuck A, Thompson DR. A validation study of the Cardiac Depression Scale (CDS) in a UK population. Br J Health Psychol 2004; 9: 15-24.

Gholizadeh L, Salamonson Y, Davidson PM, Parvan K, Frost SA, Chang S, et al. Cross‐cultural validation of the Cardiac Depression Scale in Iran. Br J Clin Psychol 2010; 49: 517-528.

Kellar SP, Kelvin EA. Munro's statistical methods for health care research. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.

Westland JC. Lower bounds on sample size in structural equation modeling. Electron Commer Res Appl 2010; 9: 476-487.

Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample Size Requirements for Structural Equation Models: An Evaluation of Power, Bias, and Solution Propriety. Educ Psychol Meas 2013; 76: 913-934.

World Health Organization. Process of translation and adaptation of instruments 2009.

Templer DI, Harville M, Hutton S, Underwood R, Tomeo M, Russell M, et al. Death depression scale-revised. OMEGA 2002; 44: 105-112.

Hajizadeh E, Asghari M. [Statistical methods and analyses in health and biosciences a research methodological approach (Persian)]. Tehran: Jahade Daneshgahi Publications; 2011.

Maasoumi R, Lamyian M, Montazeri A, Azin SA, Aguilar-Vafaie ME, Hajizadeh E. The sexual quality of life-female (SQOL-F) questionnaire: translation and psychometric properties of the Iranian version. Reprod Health 2013; 10: 25-31.

Colton D, Covert RW. Designing and constructing instruments for social research and evaluation: John Wiley & Sons; 2007.

Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 2006; 119: 166.e7-16.

Lawshe C. A qualitative approach to content validity. Pers Psychol 1975; 25: 563-575.

Jay Lynn S, Surya Das L, HALLQUIST MN, WILLIAMS JC. Mindfulness, acceptance, and hypnosis: Cognitive and clinical perspectives. Int J Clin Exp Hypn 2006; 54: 143-166.

Baumgartner H, Homburg C. Applications of structural equation modeling in marketing and consumer research: A review. International journal of Research in Marketing 1996; 13: 139-161.

Cattell RB. The scree test for the number of factors. Multivariate Behav Res 1966; 1: 245-76.

Cattell RB, Jaspers J. A general plasmode (No. 30-10-5-2) for factor analytic exercises and research. Multivariate Behavioral Research Monographs 1967; 67: 211.

Jolliffe I. Principal Component Analysis. New York: Springer; 1986.

Jolliffe IT. Discarding variables in a principal component analysis. I: Artificial data. Appl Stat 1972: 160-173.

Soleimani MA, Yaghoobzadeh A, Bahrami N, Sharif SP, Sharif Nia H. Psychometric evaluation of the Persian version of the Templer's Death Anxiety Scale in cancer patients. Death Stud 2016; 40: 547-557.

Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 1981; 18: 39-50.

Hair JF, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Upper Saddle River, NJ: Prentice Hall; 2010.

Sb J, Gudaganavar N. Effect of varying sample size in estimation of reliability coefficients of internal consistency.

Grove S, Burns N. The Practice of Nursing Research: Conduct, Critique, & Utilization. Philadelphia: Saunders; 2005.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174.

Pahlevan Sharif S, Mahdavian V. [Structural Equation Modeling by the Use of AMOS (Persian)]. Tehran: Fazel; 2015.

Rajabi GR, Begdeli Z, Naderi Z. Psychometric Properties of the Persian Version of Death Depression Scale Among Nurses. Death studies. Death Stud 2015; 39: 342-346.

Aghazadeh SE, Mohammadzadeh A, Rezaie A. [Validation of Death Depression Scale among Tabriz universities students in 2012 (persian)]. J Res Behave Sci 2014; 12: 433-442.

Cohen AB, Pierce Jr JD, Chambers J, Meade R, Gorvine BJ, Koenig HG. Intrinsic and extrinsic religiosity, belief in the afterlife, death anxiety, and life satisfaction in young Catholics and Protestants. J Res Pers 2005; 39: 307-324.

Brown A. An Examination of the Relationship Between Death Anxiety, Optimism, Depression, and Anxiety: Texas Tech University; 2011.

Chan WCH, Epstein I, Reese D, Chan CLW. Family predictors of psychosocial outcomes among Hong Kong Chinese cancer patients in palliative care: living and dying with the “support paradox”. Soc Work Health Care 2009; 48: 519-532.

de Figueiredo JM. Depression and demoralization: phenomenologic differences and research perspectives. Compr Psychiatry 1993; 34: 308-311.

Tomás-Sábado J, Limonero JT, Templer DI, Gómez-Benito J. The Death Depression Scale-Revised. Preliminary empirical validation of the Spanish form. OMEGA 2005; 50: 43-52.

Munro BH. Statistical Methods for Health Care Research: Lippincott Williams & Wilkins; 2005.

Jiang W. Business Partnerships and Organizational Performance: The Role of Resources and Capabilities: Springer Berlin Heidelberg; 2014.

Harrington D. Confirmatory Factor Analysis: Oxford University Press, USA; 2008.

Vinzi VE, Chin WW, Henseler J, Wang H. Handbook of Partial Least Squares: Concepts, Methods and Applications: Springer; 2010.

How to Cite
Sharif Nia H, Pahlevan Sharif S, Lehto RH, Allen KA, Goudarzian AH, Yaghoobzadeh A, Soleimani MA. Psychometric Evaluation of Persian Version of Death Depression Scale in Iranian Patients with Acute Myocardial Infarction. Iran J Psychiatry. 12(3):172-181.
Original Article(s)