DASS 21The Depression, Anxiety and Stress Scale - 21
What is the DASS 21 assessment and what does it test for?
The Depression, Anxiety and Stress Scale - 21, usually shortened to DASS 21, is a 3 dimensional self-administered questionnaire designed to measure the presence and severity of depression, anxiety and stress over the past week. It is the validated short-form version of the DASS 42. The DASS 21 can be used as a general psychological distress measure or broken down into it’s 3 sections for deeper symptom analysis.
When should the DASS 21 be used?
The DASS 21 has been validated to be used to determine the presence of negative emotional feelings within the categories of depression, anxiety and stress. Its validity is similar to other specific depression and anxiety questionnaires, however, the DASS 21 is able to give insight into the presence and impact of stress symptoms and potential environmental factors to the overall emotional status of the patient.
How is the DASS 21 scored?
The DASS 21 is a 3 part questionnaire with 7 questions to each part. The patient chooses the most appropriate answer to describe how they have felt over the past week. The minimum possible score is 0 and the maximum possible score is 56
Answer : Score
- Did not apply to me at all (NEVER): 0
- Applied to me to some degree or some of the time (SOMETIMES): 1
- Applied to me to a considerable degree, or a good part of time (OFTEN): 2
- Applied to me very much, or most of the time (ALMOST ALWAYS): 3
If you have previously completed a full DASS you may use the DASS-21 and double the scores for a reliable comparison.
The severity labels are used to describe the full range of scores in a population. ‘Mild’ means that a person is above the population mean but significantly under the level of someone seeking help, therefore, does not mean a mild level of disorder. General cut off points for severity markers are as follows:
- 0-9: Normal
- 10-13: Mild
- 14-20: Moderate
- 21-27: Severe
- 28+: Extremely Severe
- 0-7: Normal
- 8-9: Mild
- 10-14: Moderate
- 15-19: Severe
- 20+: Extremely Severe
- 0-14: Normal
- 15-18: Mild
- 19-25: Moderate
- 26-33: Severe
- 34+: Extremely Severe
Evidence and research supporting the DASS 21
The DASS 21 has been found to have high reliability (0.93) and produces similar validity to the full 42 question DASS, whilst being easier for patients to complete. It has been proven that the DASS 21 score can be doubled to provide similar results to the DASS 42.
While it can be said that the DASS is just a way of assessing general psychological distress, the DASS subsections contain variance that is specific to each scale thus may provide more insight than other generalised scales. The DASS is able to pick up on differentiating symptoms that relate to depression or anxiety rather than these factors getting lost in one tool.
The DASS 21 has been tested rigorously in large population trials worldwide and is widely accepted as a valid and reliable outcome measure and screening tool.
It is worth noting that when translated to other languages the validity and reliability may vary.
What questions does the DASS 21 ask?
Please read each statement and circle a number 0,1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.
- I found it hard to wind down
- I was aware of dryness of my mouth
- I couldn’t seem to experience any positive feeling at all
- I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)
- I found it difficult to work up the initiative to do things
- I tended to over-react to situations
- I experienced trembling (e.g. in the hands)
- I felt that I was using a lot of nervous energy
- I was worried about situations in which I might panic and make a fool of myself
- I felt that I had nothing to look forward to
- I found myself getting agitated
- I found it difficult to relax
- I felt down-hearted and blue
- I was intolerant of anything that kept me from getting on with what I was doing
- I felt I was close to panic
- I was unable to become enthusiastic about anything
- I felt I wasn’t worth much as a person
- I felt that I was rather touchy
- I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat)
- I felt scared without any good reason
- I felt that life was meaningless
- Sinclair SJ, Siefert CJ, Slavic-Mumford JM, et al (2012) Psychometric evaluation and normative data for the depression, anxiety and stress scales-21 (DASS-21) in a nonclinical sample of U.S. adults. Eval Health Prof. 35(3):259-799
- Lovibond PF and Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav. Res. Ther. 33(3):335-343.
- Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G (2012). The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J Clin Psychol. 68(12):1322-38.
- Henry JD and Crawford JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in large non-clinical sample. The British Psychological Society. 44:227-239
- Clara I, Cox B and Edna M (2001) Confirmatory factor analysis of the Depression-Anxiety-Stress Scales in depressed and anxious patients. Journal of psychopathology and behavioural assessment. 23(1):61-67
- Brown TA, Chorpita and Korotitsch W (1997) Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav. Res. Ther. 35(1)79-89