Exploratory Psychometric Evaluation of HADS-Derived Anxiety- and Depression-Related Measures in Spanish University Students During a Context of Societal Uncertainty

1. Introduction

Emotional well-being is a fundamental component of mental health and plays a central role in how individuals perceive, interpret, and respond to everyday experiences and environmental challenges. Emotional responses are inherently adaptive, facilitating adjustment to changing circumstances, promoting learning, and supporting social functioning. Consequently, the presence of emotional reactions such as worry, tension, or uncertainty should not automatically be interpreted as indicators of psychopathology. Their clinical relevance depends on their intensity, persistence, associated functional impairment, and broader psychological context.

During the last few years, societies worldwide have experienced a succession of large-scale events, including the COVID-19 pandemic, geopolitical conflicts, economic instability, and increasing environmental concerns. Rather than representing isolated phenomena, these events have frequently been conceptualized as a polycrisis, in which multiple crises interact and reinforce one another, creating persistent uncertainty and cumulative psychosocial stress. Recent evidence indicates that prolonged exposure to these overlapping stressors is associated with poorer psychological well-being, particularly among young adults and socially vulnerable groups [1].

University students constitute one of the populations most likely to experience emotional difficulties during periods of sustained uncertainty. Beyond the challenges associated with higher education itself, this developmental stage involves important academic, occupational, financial, and interpersonal transitions that may increase vulnerability to psychological distress. Contemporary societal challenges may therefore interact with these developmental demands, influencing emotional well-being and increasing anxiety- and depression-related experiences. Previous studies conducted during and after the COVID-19 pandemic consistently documented elevated levels of psychological distress, anxiety, depressive symptoms, and emotional difficulties among university students across different countries [2,3,4,5]. Importantly, evidence suggests that the psychological consequences of prolonged uncertainty may persist beyond the acute phase of individual crises, reinforcing the need to continue monitoring student mental health in post-pandemic contexts.

Reliable assessment of emotional symptoms is therefore essential for both research and preventive mental health initiatives in university populations. Among the instruments most widely used for this purpose is the Hospital Anxiety and Depression Scale (HADS), originally developed by Zigmond and Snaith [6] to assess anxiety and depression in hospital settings while minimizing the influence of somatic symptoms associated with physical illness. Since its publication, the HADS has been extensively applied in both clinical and community samples and has demonstrated generally satisfactory psychometric properties in numerous languages, including Spanish [7,8,9].

Despite its widespread use, the psychometric structure of the HADS remains a matter of ongoing debate. Studies have reported one-, two-, and three-factor solutions depending on the characteristics of the population studied, the analytical methods employed, and the cultural context in which the instrument was administered [9,10,11]. Recent reviews have concluded that the dimensional structure of the HADS cannot be assumed to be invariant across populations and that the psychometric performance of individual items may vary according to the characteristics of the target sample [10]. These findings highlight the importance of evaluating measurement properties whenever the instrument is adapted, administered in substantially different populations, or modified with respect to its original format.

This consideration is particularly relevant when instruments developed for clinical settings are adapted for use in non-clinical university populations. Changes in response format, semantic interpretation, and contextual meaning may alter the functioning of individual items, potentially affecting the internal coherence of the resulting measures. Consequently, evidence supporting the original HADS cannot automatically be generalized to substantially modified versions of the instrument.

The present study adopts an explicitly exploratory psychometric perspective. Rather than attempting to validate a revised version of the HADS or establish clinical diagnostic thresholds, the study examines whether a set of HADS-derived items, adapted for administration to Spanish university students using a modified response format, demonstrates adequate internal coherence and a meaningful exploratory dimensional structure. Simultaneously, the study provides a descriptive overview of anxiety- and depression-related emotional experiences reported by university students during a period characterised by sustained societal uncertainty.

Accordingly, the study pursued two complementary objectives. The primary objective was to obtain preliminary psychometric evidence regarding the internal consistency and exploratory dimensional structure of two HADS-derived measures adapted for Spanish university students. The secondary objective was to describe anxiety- and depression-related emotional experiences in this population and to examine potential gender differences in these indicators. Given the exploratory nature of the study and the modifications introduced to the original instrument, the findings are intended to provide an initial foundation for future psychometric validation rather than evidence supporting the clinical use of the adapted measures.

2. Materials and Methods

2.1. Study Design

An exploratory cross-sectional study was conducted using an online survey to examine anxiety- and depression-related emotional experiences among Spanish university students and to obtain preliminary psychometric evidence regarding two measures derived from the Hospital Anxiety and Depression Scale (HADS). Data were collected between April and May 2023.

Given the exploratory nature of the study and the modifications introduced to the original instrument, the research was not intended to validate a new diagnostic scale. Rather, it sought to examine the internal coherence and preliminary dimensional structure of HADS-derived measures adapted for use in a non-clinical university population.

2.2. Participants and Sampling Procedure

Participants were recruited using a non-probability snowball sampling strategy. The invitation to participate was disseminated electronically through university networks and social media platforms. Eligible participants were undergraduate students enrolled at Spanish universities who voluntarily agreed to complete the online questionnaire.

The final sample comprised 913 university students. Women represented 51.4% of the sample and men 48.6%. The mean age was 21.9 years (SD = 2.7).

Regarding living arrangements, 75.0% of participants lived with both parents, 11.4% lived with one parent, and approximately 7% lived with their partner. Concerning academic level, 32.4% were first-year students, 24.1% second-year students, 14.5% third-year students, and 29.0% fourth-year students. The mean academic grade obtained during the previous academic year was 7.2 out of 10 (SD = 1.1).

More than 97% of participants rated their overall health as good. Regarding emotional responses to the context of crisis and uncertainty, 51.3% reported no fear, whereas 46.2% reported experiencing fear.

2.3. Instrument Development

The questionnaire was developed from items derived from the Hospital Anxiety and Depression Scale (HADS) [6], a self-report instrument originally designed to assess anxiety and depression in hospital patients. The original HADS consists of 14 items equally distributed between anxiety and depression subscales and uses four ordered response categories.

For the purposes of the present study, the instrument was adapted for administration in a non-clinical university population. First, the original response format was replaced by a seven-point Likert scale ranging from 1 ("strongly disagree") to 7 ("strongly agree"). This modification was introduced to provide greater response variability and sensitivity when assessing emotional experiences in a community sample. Because this change altered the original measurement format, the resulting questionnaire should be regarded as an exploratory HADS-derived instrument rather than a revised version of the original HADS.

Second, the wording and conceptual allocation of the items were independently reviewed by specialists with expertise in psychology and psychological assessment to evaluate their semantic suitability for university students. The review focused on the clarity, conceptual relevance, and consistency of each item within its corresponding dimension. During this process, three items were identified as potentially problematic because their semantic content appeared more closely aligned with the opposite construct when interpreted within a non-clinical university context.

Specifically, the item "I am able to sit at ease and feel relaxed", originally assigned to the anxiety dimension, was considered conceptually closer to positive emotional functioning. Conversely, the items "I feel as if I am slowed down" and "I have lost interest in my appearance", originally included in the depression dimension, were considered to reflect emotional experiences that could overlap with anxiety-related manifestations in the study population.

Finally, a pilot study involving 30 university students was conducted to evaluate item comprehensibility, questionnaire length, response format, and administration procedures. Minor modifications to wording and question order were introduced following participants' feedback.

2.4. Procedure and Ethical Considerations

The questionnaire was administered online using an anonymous data collection platform. Before accessing the survey, participants received detailed information regarding the aims of the study, the voluntary nature of participation, the approximate completion time, confidentiality procedures, and their right to discontinue participation at any time without consequences.

Electronic informed consent was obtained from all participants before data collection commenced.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Project Review Board of Miguel Hernández University (Reference DPS.JGR.01.20; approval date: 21 May 2020).

2.5. Statistical Analysis

Statistical analyses were performed using IBM SPSS Statistics version 28.0 and SPAD version 5.0.

Descriptive statistics (means and standard deviations) were calculated for all anxiety- and depression-related items. Gender differences were examined by comparing mean scores for each item.

The internal consistency of the initial anxiety- and depression-related dimensions was evaluated using Cronbach's alpha coefficients. Corrected item-total correlations and changes in alpha following item deletion were examined to identify items showing limited contribution to internal consistency.

Given the exploratory objective of the study, the dimensional structure of each revised measure was examined separately using principal component analysis. Prior to extraction, sampling adequacy was evaluated using the Kaiser-Meyer-Olkin (KMO) index and Bartlett's test of sphericity. Components with eigenvalues greater than 1.0 were retained according to the Kaiser criterion, and factor loadings were inspected to evaluate the contribution of individual items to the extracted components.

These analyses were intended exclusively to provide preliminary evidence regarding the internal coherence and exploratory dimensionality of the adapted HADS-derived measures. Consequently, the findings should not be interpreted as evidence of full psychometric validation or structural confirmation of the original HADS.

3. Results

3.1. Sample Characteristics

The study included 913 university students enrolled at Spanish universities. The mean age of the participants was 21.9 years (SD = 2.7). Women represented 51.4% of the sample and men 48.6%.

Most participants lived with both parents (75.0%), whereas 11.4% lived with one parent and approximately 7% lived with their partner. Regarding academic level, 32.4% were first-year students, 24.1% second-year students, 14.5% third-year students, and 29.0% fourth-year students. The mean academic grade obtained during the previous academic year was 7.2 out of 10 (SD = 1.1). More than 97% of the participants rated their health as good. Regarding the context of crisis and uncertainty, 51.3% reported not feeling afraid, whereas 46.2% reported experiencing fear.

Table 1. Characteristics of the study sample (N = 913).

Variable	Result
Age, mean (SD)	21.9 (2.7)
Women	51.4%
Men	48.6%
Living with both parents	75.0%
Living with one parent	11.4%
Living with partner	≈7.0%
First academic year	32.4%
Second academic year	24.1%
Third academic year	14.5%
Fourth academic year	29.0%
Previous academic grade, mean (SD)	7.2 (1.1)
Self-rated good health	>97.0%
No fear of crisis/uncertainty	51.3%
Fear of crisis/uncertainty	46.2%

Note. Percentages may not total 100% because of missing responses or rounding.

Table 1. Characteristics of the study sample (N = 913).

Variable	Result
Age, mean (SD)	21.9 (2.7)
Women	51.4%
Men	48.6%
Living with both parents	75.0%
Living with one parent	11.4%
Living with partner	≈7.0%
First academic year	32.4%
Second academic year	24.1%
Third academic year	14.5%
Fourth academic year	29.0%
Previous academic grade, mean (SD)	7.2 (1.1)
Self-rated good health	>97.0%
No fear of crisis/uncertainty	51.3%
Fear of crisis/uncertainty	46.2%

Note. Percentages may not total 100% because of missing responses or rounding.

3.2. Descriptive Analysis of Anxiety- and Depression-Related Indicators

Participants generally reported preserved positive emotional functioning. Mean scores were highest for the items referring to the ability to laugh and appreciate the positive aspects of life (M = 5.1, SD = 1.7), enjoyment of leisure activities such as reading or watching television (M = 4.9, SD = 1.8), and the ability to remain calm and relaxed (M = 4.5, SD = 1.8).

In contrast, several anxiety-related indicators showed moderately elevated scores. Participants reported moderate levels of tension or nervousness (M = 4.4, SD = 1.9) and worries (M = 4.3, SD = 1.9).

Overall, the descriptive findings indicate that positive emotional functioning coexisted with moderate anxiety-related experiences within the study population.

The adapted questionnaire was designed exclusively for research purposes. Consequently, these scores should not be interpreted as indicators of psychiatric disorders or clinical prevalence.

Table 2. Descriptive statistics for selected anxiety- and depression-related indicators.

Item	M	SD
I am able to laugh and see the funny side of things	5.1	1.7
I am able to enjoy a good book or television/radio programme	4.9	1.8
I am able to sit at ease and feel relaxed	4.5	1.8
I feel tense and/or nervous	4.4	1.9
My head is full of worries	4.3	1.9

Table 2. Descriptive statistics for selected anxiety- and depression-related indicators.

Item	M	SD
I am able to laugh and see the funny side of things	5.1	1.7
I am able to enjoy a good book or television/radio programme	4.9	1.8
I am able to sit at ease and feel relaxed	4.5	1.8
I feel tense and/or nervous	4.4	1.9
My head is full of worries	4.3	1.9

3.3. Gender Differences

Women reported significantly higher scores than men on several anxiety-related indicators. Higher scores were observed for sudden feelings of fear or distress, feeling slowed down, unpleasant sensations of nervousness or discomfort in the stomach, tension or nervousness, and persistent worries.

Women also reported slightly lower scores on the ability to laugh and see the funny side of things and slightly higher scores on loss of interest in personal appearance.

Overall, the observed pattern suggests greater self-reported emotional distress among women, particularly regarding anxiety-related experiences. These findings refer exclusively to self-reported emotional indicators and should not be interpreted as evidence of differences in the prevalence of psychiatric disorders.

Table 3. Gender differences in selected anxiety- and depression-related indicators.

Item	Women	Men
Sudden feelings of intense distress or fear	3.9	3.0
Feeling slowed down or clumsy	3.8	3.1
Nervous sensation in the stomach	3.6	3.0
Feeling tense and/or nervous	4.7	4.1
Head full of worries	4.6	4.1
Able to laugh and see the funny side of things	4.9	5.2
Lost interest in personal appearance	3.2	2.8

Table 3. Gender differences in selected anxiety- and depression-related indicators.

Item	Women	Men
Sudden feelings of intense distress or fear	3.9	3.0
Feeling slowed down or clumsy	3.8	3.1
Nervous sensation in the stomach	3.6	3.0
Feeling tense and/or nervous	4.7	4.1
Head full of worries	4.6	4.1
Able to laugh and see the funny side of things	4.9	5.2
Lost interest in personal appearance	3.2	2.8

3.4. Internal Consistency of the HADS-Derived Measures

The initial internal consistency analysis yielded a Cronbach's alpha coefficient of .700 for the anxiety-related dimension and .370 for the depression-related dimension.

Inspection of corrected item-total correlations revealed that three items contributed poorly to the internal coherence of their respective dimensions. Within the anxiety-related dimension, the item "I am able to sit at ease and feel relaxed" showed a negative corrected item-total correlation (−.498). Within the depression-related dimension, the items "I feel as if I am slowed down" and "I have lost interest in my appearance" also presented negative corrected item-total correlations (−.254 and −.210, respectively).

These empirical findings were consistent with the semantic inconsistencies previously identified during the expert review process.

Following the reassignment of these three items, internal consistency increased substantially. Cronbach's alpha reached .853 for the revised anxiety-related dimension and .798 for the revised depression-related dimension. Corrected item-total correlations became positive for all retained items, ranging from .377 to .721 for the anxiety-related dimension and from .478 to .691 for the depression-related dimension.

Table 4. Internal consistency of the HADS-derived dimensions before and after item reassignment.

Scale	Initial α	Revised α	Main modification
Anxiety-related dimension	.700	.853	Reallocation of I am able to sit at ease and feel relaxed
Depression-related dimension	.370	.798	Reallocation of I feel as if I am slowed down and I have lost interest in my appearance

Table 4. Internal consistency of the HADS-derived dimensions before and after item reassignment.

Scale	Initial α	Revised α	Main modification
Anxiety-related dimension	.700	.853	Reallocation of I am able to sit at ease and feel relaxed
Depression-related dimension	.370	.798	Reallocation of I feel as if I am slowed down and I have lost interest in my appearance

3.5. Exploratory Dimensional Structure

The Kaiser-Meyer-Olkin indices indicated adequate sampling adequacy for both revised dimensions (KMO = .888 for the anxiety-related dimension and KMO = .837 for the depression-related dimension). Bartlett's tests of sphericity were statistically significant for both analyses (p < .05), supporting the suitability of the correlation matrices for dimensional analysis.

For the anxiety-related dimension, the first component presented an eigenvalue of 4.019 and explained 50.24% of the total variance. For the depression-related dimension, the first component had an eigenvalue of 3.039 and explained 50.66% of the variance.

All retained items showed factor loadings greater than .40. Loadings ranged from .477 to .815 in the anxiety-related dimension and from .638 to .820 in the depression-related dimension.

Taken together, these findings provide preliminary evidence supporting the internal coherence and predominantly unidimensional structure of the revised HADS-derived measures under the exploratory analytical approach adopted in the present study.

Table 5. Exploratory dimensional characteristics of the revised HADS-derived measures.

Indicator	Anxiety-related dimension	Depression-related dimension
KMO	.888	.837
Bartlett's test	p < .05	p < .05
First component eigenvalue	4.019	3.039
Variance explained (%)	50.24	50.66
Factor loading range	.477–.815	.638–.820
Components retained	1	1

Table 5. Exploratory dimensional characteristics of the revised HADS-derived measures.

Indicator	Anxiety-related dimension	Depression-related dimension
KMO	.888	.837
Bartlett's test	p < .05	p < .05
First component eigenvalue	4.019	3.039
Variance explained (%)	50.24	50.66
Factor loading range	.477–.815	.638–.820
Components retained	1	1

4. Discussion

The present study examined anxiety- and depression-related symptoms among Spanish university students in a context characterized by perceived crisis and uncertainty and explored the preliminary psychometric properties of two scales derived from the HADS.

The first major finding is that participants did not show a generalized pattern of negative emotional functioning. Positive indicators, including the ability to laugh, enjoy leisure activities, and experience positive emotions, were generally above the midpoint of the response scale. At the same time, some anxiety-related experiences, particularly tension, nervousness, and worry, were moderately present. The present findings are also consistent with recent evidence from Spanish universities indicating that emotional well-being remains a priority in higher education and that preventive interventions should be incorporated into university mental health policies [13].

This pattern is relevant because emotional responses to uncertainty should not necessarily be equated with psychopathology. Worry, nervousness, and tension may constitute understandable responses to unpredictable or potentially threatening circumstances. Their clinical significance depends on their severity, persistence, associated impairment, and broader clinical context.

The findings are consistent with the increasing recognition that young adults may be exposed to cumulative psychological stress resulting from overlapping crises. Kałwak et al. [1], for example, found that young adults exposed to the contemporary polycrisis reported greater stress and poorer mental health in several domains, with particularly adverse outcomes among disadvantaged groups. Although the present study did not measure polycrisis exposure directly and did not assess causal associations between crises and mental health, it supports the relevance of examining emotional responses in young university populations within broader contexts of uncertainty.

The present results should also be considered alongside evidence from the COVID-19 period. Research in Spain documented substantial psychological impact during the initial stage of the pandemic [2], while research involving university students internationally identified considerable psychological effects associated with disruption and uncertainty [4,5]. The present study was conducted in 2023, after the acute phase of the COVID-19 pandemic. Therefore, its findings should not be interpreted as a direct assessment of pandemic-related psychopathology. Rather, they describe emotional indicators in a post-acute context in which students continued to experience broader forms of social and global uncertainty.

A second relevant finding concerns gender. Women reported higher levels of several anxiety-related experiences, including tension, worry, gastrointestinal nervousness, and intense fear or distress. This pattern is consistent with evidence from different crisis contexts indicating that women may report greater anxiety-related and emotional symptoms than men. It is also consistent with recent longitudinal evidence from Spanish universities showing that anxiety and depression remain important mental health concerns throughout university life and emphasizing the protective role of family support, positive peer relationships, and early preventive strategies [14]. However, the present findings should be interpreted as differences in self-reported symptoms and not as evidence of differences in psychiatric diagnoses.

The principal methodological contribution of the study concerns the exploratory adaptation of HADS-derived items.

The initial internal consistency of the anxiety dimension was acceptable (α = .70), whereas the depression dimension showed poor internal consistency (α = .37). Item-level analysis identified three items that were poorly aligned with their respective dimensions. Importantly, these empirical findings were consistent with the semantic concerns identified during expert review.

The reassignment of these three items produced a substantial increase in internal consistency, reaching α = .853 for the anxiety-related dimension and α = .798 for the depression-related dimension. Corrected item-total correlations were also positive for all retained items.

This finding illustrates the importance of considering both content and empirical evidence when adapting established instruments to new populations. The meaning and functioning of individual items may vary according to the characteristics of the target population and the context in which the questionnaire is administered.

The findings also contribute to the broader psychometric discussion concerning HADS. Although the original instrument was designed around two subscales, previous research has identified variability in its latent structure [9,10]. A recent systematic examination of the HADS structure emphasized that different analytical approaches can yield different solutions, while recent research in Spanish-speaking populations has also identified general and specific dimensions of emotional distress [11].

In this context, the identification of items whose empirical behavior differs from their original allocation is not necessarily surprising. Nevertheless, the present results should not be interpreted as evidence that the original HADS structure is invalid. Rather, they suggest that substantial adaptation to a university population may require reconsideration of the semantic and psychometric functioning of individual items.

A particularly important issue concerns the revised depression-related dimension. Several retained items are positively worded, including “I feel cheerful”, “I look forward to things with enjoyment”, and “I am able to enjoy a good book or television/radio program”. Therefore, higher scores on these items may represent preserved positive emotional functioning or fewer depressive symptoms rather than greater depressive symptomatology.

For this reason, the revised measure should not be interpreted as a conventional depression scale without an explicit scoring direction. This issue should be addressed in future research by determining whether the construct is better conceptualized as depressive symptomatology, positive emotional functioning, or the absence of depressive symptoms.

The exploratory factorial results provide additional preliminary support for the revised scales. KMO values were high and the first component accounted for approximately half of the variance in each dimension. Factor loadings were generally moderate to high.

However, these findings must be interpreted within the methodological limitations of the analytical procedure. Principal component analysis is primarily a data-reduction procedure rather than a common-factor model, and the Kaiser criterion may overestimate the number of retained components in some circumstances. The current results therefore constitute exploratory evidence rather than definitive evidence of structural validity.

This limitation is particularly important in light of current psychometric research. The literature increasingly emphasizes the need to evaluate multiple measurement properties, including content validity, structural validity, internal consistency, reliability, and relationships with external variables [12]. Consequently, the present results should be viewed as an initial step rather than a final validation.

The study nevertheless has practical implications. Brief measures of emotional symptoms may be useful for monitoring university students during periods of uncertainty and for identifying students who report greater levels of distress. Such assessment may contribute to preventive mental health initiatives and facilitate the identification of students who could benefit from further evaluation.

However, screening instruments should not replace clinical assessment and should not be used independently to establish psychiatric diagnoses. This distinction is particularly important for the current instrument because the revised scales do not have established clinical cut-off points or demonstrated criterion validity.

4.1. Limitations

Several limitations should be considered when interpreting the findings of this study.

First, participants were recruited through a non-probability snowball sampling procedure. Although the sample size was large, this approach limits the representativeness of the sample and, consequently, the generalizability of the findings to the broader population of Spanish university students.

Second, the cross-sectional design precludes any causal inference. The study describes emotional experiences reported during a specific period characterized by societal uncertainty but cannot determine whether these experiences were directly attributable to that context or to other individual or environmental factors.

Third, all data were obtained through self-report measures. As with any self-administered questionnaire, responses may have been influenced by recall bias, individual differences in response style, or social desirability.

Fourth, the questionnaire was derived from the original Hospital Anxiety and Depression Scale but incorporated substantial modifications, including a seven-point Likert response format and the reassignment of three items between dimensions. Consequently, the adapted measures cannot be considered equivalent to the original HADS, and the present findings should be interpreted as preliminary psychometric evidence rather than a formal validation of a revised instrument.

Fifth, the psychometric evaluation was intentionally exploratory. Although internal consistency and exploratory dimensional analyses yielded encouraging results, additional measurement properties-including test-retest reliability, convergent validity, discriminant validity, criterion validity, responsiveness, and measurement invariance-were not examined.

Finally, the exploratory dimensional analyses were based on principal component analysis. Future studies should replicate these findings using confirmatory factor analysis or other contemporary psychometric approaches in independent and more representative samples before the adapted measures are considered suitable for research or clinical applications.

5. Conclusions

This study provides preliminary evidence regarding the psychometric performance of two HADS-derived measures adapted for use in a non-clinical population of Spanish university students. The revised anxiety- and depression-related dimensions demonstrated satisfactory internal consistency and coherent exploratory dimensional structures after the reassignment of three semantically inconsistent items.

From a descriptive perspective, participants generally reported preserved positive emotional functioning, although moderate levels of tension, nervousness, and worry were observed. Women reported higher scores than men on several anxiety-related indicators, consistent with previous research describing greater self-reported emotional distress among female university students.

The principal contribution of this study lies in demonstrating that the psychometric behaviour of HADS-derived items may change when the instrument is substantially modified and administered to populations that differ from those for which it was originally developed. These findings reinforce the importance of evaluating measurement properties whenever established psychological instruments are adapted to new contexts or target populations.

Because the adapted questionnaire differs substantially from the original HADS, the revised measures should be regarded as exploratory research instruments rather than validated diagnostic tools. Future research should replicate these findings in larger and more representative samples while examining additional sources of psychometric evidence, including structural validity, measurement invariance, temporal stability, and relationships with external measures of anxiety, depression, and psychological well-being.

Despite these limitations, the present study contributes to the growing literature on mental health assessment among university students and provides an initial foundation for the development of psychometrically sound instruments capable of monitoring emotional well-being during periods of sustained societal uncertainty.