Depression Anxiety Stress Scales (DASS-21) in International Contexts

Abstract

The Depression Anxiety Stress Scales (DASS) is a tool used by psychologists to measure negative emotions like depression, anxiety, and stress. It provides individual scores for each emotion and an overall score for general mental health. The DASS is used worldwide in both general and clinical populations. In this chapter, the background of depression, anxiety, and stress is discussed along with the history of the scale’s development and validation. The DASS has been shown to be a reliable and valid measure of these negative emotions. This tool has been translated into several languages and has been tested across different cultures. The importance of measuring negative emotions is significant because it helps clinicians identify and treat mental health problems. The DASS is a useful tool for screening, diagnosing, and monitoring treatment progress for those experiencing such negative emotions.

Appendix 1 DASS-21

Please read each statement and circle a number 0, 1, 2 or 3 that indicates how much the statement applied to you the past week. There are no right or wrong answers. Do not spend too much time on any statement. The rating scale is as follows:

• 0 Did not apply to me at all – NEVER

• 1 Applied to me to some degree, or some of the time – SOMETIMES

• 2 Applied to me to a considerable degree, or a good part of time – OFTEN

• 3 Applied to me very much, or most of the time – ALMOST ALWAYS

1) I found it hard to wind down	0	1	2	3
2) I was aware of dryness of my mouth	0	1	2	3
3) I couldn’t seem to experience any positive feeling at all	0	1	2	3
4) I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion)	0	1	2	3
5) I found it difficult to work up the initiative to do things	0	1	2	3
6) I tended to over-react to situations	0	1	2	3
7) I experienced trembling (e.g., in the hands)	0	1	2	3
8) I felt that I was using a lot of nervous energy	0	1	2	3
9) I was worried about situations in which I might panic and make a fool of myself	0	1	2	3
10) I felt that I had nothing to look forward to	0	1	2	3
11) I found myself getting agitated	0	1	2	3
12) I found it difficult to relax	0	1	2	3
13) I felt down-hearted and blue	0	1	2	3
14) I was intolerant of anything that kept me from getting on with what I was doing	0	1	2	3
15) I felt I was close to panic	0	1	2	3
16) I was unable to become enthusiastic about anything	0	1	2	3
17) I felt I wasn’t worth much as a person	0	1	2	3
18) I felt that I was rather touchy	0	1	2	3
19) 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)	0	1	2	3
20) I felt scared without any good reason	0	1	2	3
21) I felt that life was meaningless	0	1	2	3

DASS-21 Scoring

The depression subscale comprises items 3, 5, 10, 13, 16, 17, and 21, the anxiety subscale contains items 2, 4, 7, 9, 15, 19, and 20, and the stress subscale includes items 1, 6, 8, 11, 12, 14, and 18. The scale uses a four-point Likert- type scale format, with responses ranging from 0 = Did not apply to me at all to 3 = Applied to me very much, or most of the time.

DASS-21 Scoring Interpretation

Interpretation	Depression	Anxiety	Stress
Normal	0–4	0–3	0–7
Mild	5–6	4–5	8–9
Moderate	7–10	6–7	10–12
Severe	11–13	8–9	13–16
Extremely Severe	14+	10+	17+

1. Note. This scoring interpretation is based on the DASS-21 subscales sum scores
2. Although, the scale developers recommended to multiply all scores by two to make scores comparable to 42 item version, which is not impacting on the results of statistical analyses and may be ignored by researchers