Assessment of Mental Health in Healthcare Personnel: A Review of DASS, MBI, and Zung Scales

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Abstract
Background/Objectives: Healthcare professionals face high occupational stress, emotional burden, and demanding conditions that increase the risk of burnout, depression, and anxiety, with recent post-pandemic evidence indicating a high and rising global prevalence. Early identification of distress is therefore essential. This review compared three widely used instruments—the Depression, Anxiety and Stress Scales (DASS), the Maslach Burnout Inventory (MBI), and the Zung Self-Rating Depression Scale (SDS)—selected because they jointly cover depression, anxiety, stress, and burnout, unlike unidimensional tools (PHQ-9, GAD-7, PSS, CBI) that would need combining for comparable coverage. Methods: A narrative integrative review searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for peer-reviewed articles (English/Croatian) published up to December 2025 (final search: 26 June 2026). Two reviewers independently screened records, resolving disagreements by consensus; quality was appraised narratively. Of 55 records, 35 were included. Results: The DASS showed a replicated three-factor structure and strong reliability, with shortened forms (DASS-8, DASS-12) enabling rapid screening at reduced domain coverage. The MBI remained the most widely used burnout measure but was limited by its emotional-exhaustion focus, proprietary licensing, and scoring heterogeneity. The Zung SDS offered a brief depression screen, though dated wording and context-dependent cut-offs favor initial-screen use. Notably, much evidence is derived from non-healthcare populations—the principal limitation. Conclusions: The instruments appear complementary rather than interchangeable; their combined use is proposed—as a reasonable suggestion from the literature, not an empirically demonstrated finding—as a multidimensional approach, contingent on context, objective, and appropriate cultural validation.

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