DASS-21 Overview

A Closer Look at Depression, Anxiety, and Stress Measurement

The Depression Anxiety Stress Scales (DASS-21) is a widely used self-report questionnaire designed to measure the severity of symptoms related to depression, anxiety, and stress. This instrument consists of 21 items, with seven items dedicated to each of the three constructs: depression, anxiety, and stress:

Depressive symptoms (items 2,4,7,9,15,19,20)—including, dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia and inertia
Anxiety (items 3,5,10,13,16,17,21)—autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect
Stress (items 1,6,8,11,12,14,18)—difficulty relaxing, nervous arousal, and being easily upset / agitated, irritable / over-reactive and impatient

DASS-21 Structure

21 items
4-point Likert scale
Respondents indicate how frequently (0 = “Did not apply to me at all”; 3 = “Applied to me very much or most of the time”) they have been bothered by the problems listed in each item (e.g. “I couldn’t seem to experience any positive feeling at all”)

Scoring the DASS-21

Sum the item responses for each subscale
Multiply the subscale score by 2 to derive the total score for that subscale

Identifying risk using the DASS-21

A patient may be at risk if they endorse item 21 of the DASS-21: “I felt that life was meaningless”. In this case, subsequent questions should be use to obtain more information about how the person is feeling—and whether feelings of meaninglessness are transient or reflect a more profound sense of hopelessness, contributing to suicidal ideation.

Summary of research evaluating the DASS-21

Application to diverse settings and cultural groups

The DASS-21 has been translated into multiple languages, making it accessible for use in various cultural contexts (Zanon et al., 2020). To-date, the instrument has demonstrated good reliability and validity across different populations, including Hispanic American, British, Australian, and Greek samples (Oei et al., 2013; Pezirkianidis et al., 2018; Kotoulas et al., 2021; Coker et al., 2018). Importantly, the three-factor structure consisting of subscales for Depression, Anxiety and Stress has been supported cross-culturally.

Researchers have also employed the DASS-21 with diverse occupational groups, including professionals during the COVID-19 pandemic, university students, military personnel, migrant construction workers, dentists, and nurses, highlighting its versatility as an assessment tool that can be used readily with different sections of the workforce (Sadek et al., 2021; Ferguson & Maynard, 2021; Al‐Rawi et al., 2022; Palaniappan et al., 2022).

Appropriateness with different age groups

The DASS-21 has been extensively studied for its applicability across various age groups. Research has shown that it is effective in assessing symptoms of depression, anxiety, and stress in adolescents (Szabó, 2009), young adults (Tearne et al., 2016), adults (Miller et al., 2006), and older individuals (Gomez et al., 2014).

Pros of using the DASS-21

The DASS-21 has several advantages and disadvantages that should be considered when deciding to use it in research or clinical settings.

One of the main advantages of the DASS-21 is its brevity and efficiency. With only 21 items, it can be completed relatively quickly by respondents, making it a convenient tool for large-scale studies or clinical assessments where time is limited. Additionally, the DASS-21 has been shown to have good reliability and validity in measuring symptoms of depression, anxiety, and stress, making it a robust instrument for assessing psychological distress.

Furthermore, the DASS-21 allows for the assessment of three distinct constructs (depression, anxiety, and stress) in a single questionnaire. This can provide a comprehensive overview of an individual’s mental health status and help differentiate between these three related but distinct constructs. The DASS-21 also provides standardised cutoff scores for each subscale, allowing for easy interpretation of results and comparison across different populations.

In summary:

Efficiency: The DASS-21 is a brief self-report questionnaire that can be completed relatively quickly by respondents, making it a convenient tool for large-scale studies or clinical assessments where time is limited.
Reliability and Validity: The DASS-21 has demonstrated good reliability and validity in measuring symptoms of depression, anxiety, and stress, making it a robust instrument for assessing psychological distress.
Comprehensive Assessment: The DASS-21 allows for the assessment of three distinct constructs – depression, anxiety, and stress – in a single questionnaire. This comprehensive approach provides a holistic view of an individual’s mental health status.
Standardised Cutoff Scores: The DASS-21 provides standardized cutoff scores for each subscale, allowing for easy interpretation of results and comparison across different populations.
Versatility: The DASS-21 has been successfully used across various age groups and cultural settings, indicating its versatility and applicability in diverse populations.

Limitations of the DASS-21

The DASS-21 has several limitations that should be considered when utilising this instrument. One of the key limitations of the DASS-21 is that it is a self-report measure. Self-report instruments like the DASS-21 may be susceptible to response biases, such as social desirability or the individual’s current mood, which can impact the accuracy of the results (Crawford & Henry, 2003).

Another limitation of the DASS-21 is its generalisability across different populations. While the DASS-21 has been validated in various age groups and cultural settings, it may not be equally effective in all populations. For instance, the Chinese version of the DASS-21 has been validated in a young Chinese population, indicating potential limitations when used with other age groups or cultural backgrounds (Yan, 2022).

The DASS-21 may also miss male-specific expressions of depression. In the past 20 years, studies have shown that men may exhibit symptoms of depression that involve outward behaviours like anger, substance abuse, and engaging in risky activities. These manifestations of depression, as highlighted in various research studies (Brownhill et al., 2005; Heifner, 1997; Oliffe et al., 2012; Rabinowitz & Cochran, 2008), are not typically covered by existing diagnostic criteria for depression, which are often generic and gender-neutral. Male-specific depression tools, such as the Male Depression Risk Scale (Rice et al., 2013) have been shown to psychometrically out-perform generic depression screeners, such as the PHQ-9 (Rice et al., 2017), and the same is likely to hold true in comparison to the DASS-21.

Furthermore, the DASS-21 is primarily a screening tool and not a diagnostic instrument. It can help identify symptoms of depression, anxiety, and stress, but a comprehensive clinical evaluation is necessary for a formal diagnosis. This limitation underscores the importance of using the DASS-21 as part of a broader assessment rather than as a standalone diagnostic tool (Marfoh et al., 2023). If using the DASS-21 to infer the presence of a diagnosis, care should be taken to carefully match patient characteristics with norms/scores of an established research sample. For example, Guest and colleagues (2012) used the DASS-21 to investigate the prevalence of major depressive disorder (MDD) in adults who had experienced a motor vehicle crash (MVC) and were engaged in compensation. The DASS-21 scores used for detection included a total score of 32 for general psychological distress, a score of 10-12 for probable depression, and a score of 8 for probable anxiety disorder.

Additionally, the DASS-21 may lack the ability to consistently differentiate between major depressive disorder (MDD) and anxiety disorders in certain populations. This limitation can impact the specificity of the instrument in accurately capturing distinct mental health conditions (Andersson et al., 2023).

Finally, the brevity of the DASS-21, while advantageous in terms of efficiency, may also limit the depth of information provided. Opting for the DASS-21 over the full DASS may restrict the amount of clinical information available, potentially overlooking important nuances in mental health symptomatology (Balling et al., 2021).

While some studies have supported the use of the DASS-21 in adolescents, others have not. For example, Shaw and colleagues (2016) evaluated the DASS-21 in a sample of adolescents to determine the specificity of the subscales for anxiety, depression, and stress across different age groups. Data from 2,873 school students aged 12-18 in Australia were analysed using confirmatory factor analysis. The results indicated that a general mental health distress factor dominated the variation in the items, and the subscales lacked specificity across all age groups. The study concluded that while the DASS-21 can reliably measure general distress in adolescents, it fails to discriminate between the three states of depression, anxiety, and stress, and this lack of discrimination does not diminish with increasing age. The authors advised against using adult theoretical models and measures within adolescent populations.

In conclusion, while the DASS-21 is a valuable tool for assessing symptoms of depression, anxiety, and stress, it is essential to be mindful of its limitations related to self-report biases, generalisability, diagnostic capabilities, differentiation between mental health conditions, and the depth of information provided. Researchers and clinicians should consider these limitations when using the DASS-21 and supplement its findings with additional assessment measures for a comprehensive evaluation of mental health status.

Evaluating reliable change using the DASS-21: 3 possible methods

Most practitioners calculate score change by simply subtracting their client’s Time 1 score from their Time 2 score, across each subscale:

For example:

Baseline Depression score = 20

End-of-Treatment Depression score 5

Change in Depression = 15

But there is a problem with this approach. We don’t know whether the degree of change is statistically reliable—i.e. large enough to be a real indication of symptom improvement, and not simply an artefact of chance or measurement error.

There are two ways we can work out if the client’s change in score is statistically reliable:

**Find a research paper that supports a particular threshold, as being indicative of reliable change**

Using an Australian outpatient sample (N = 1000), consisting of patients attending a private CBT clinic, Ronk, Korman, Hooke and Page (2013) determined that a change of 6 points or 50% on the Depression subscale indicated a reliable degree of symptom improvement. If you are working with a specific client population, try to find a paper that has examined similar individuals.

Use change expressed in standard deviation units

Find the mean and standard deviation of a research sample matching the characteristics of your client. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change (i.e. change that is both statistically reliable, and which moves the patient out of a disordered range/into a normative range).

Calculate the reliable change index (RCI) developed by Jacobson & Truax (1991)

Using the formula of Jacobson & Truax requires a few research statistics. We need to locate the Mean, Standard Deviation, and Reliability for the Depression subscale, in research that examined a similar sample of patients to our client population.

Ronk and colleagues (2013) obtained the following mean and standard deviation values:

Mean = 13.32

SD = 11.11

Lovibond & Lovibond (1995) reported an alpha-coefficient reliability of 0.96.

With our statistics in hand, the RCI can be calculated in the following steps:

Time 1 score = 20

Time 2 score = 5

Clinical mean = 13.32

Clinical sd = 11.11 Reliability = 0.96

Standard Error of Measurement (SEM) = 11.11 * SQR ( 1 – 0.96)

= 11.11 * SQR(0.04)

= 2.222

Standard Error of Difference (SED) = SQR[ 2 * (SEM^2 ]

= SQR[ 2 * 2.222 ]

= SQR[ 4.444]
= 2.11

RC = (5 – 20) / 2.11

= -7.1

Because -7.1 is greater — in an absolute sense—than 1.96 so we say that RC = true

And because the direction of improvement on the DASS-21 Depression subscale is a decrease AND RC = true…

We have reliable improvement.

We could then go ahead and apply these same calculations to the Anxiety and Stress subscales, using appropriate research statistics.

Conclusion

In conclusion, the DASS-21 is a valuable tool for assessing symptoms of depression, anxiety, and stress due to its brevity, reliability, and validity. It offers a comprehensive assessment of psychological distress in a single questionnaire. However, researchers and clinicians should be aware of its limitations, such as reliance on self-report and the need for further evaluation for diagnostic purposes. Overall, the DASS-21 can be a useful instrument when used appropriately and in conjunction with other assessment methods.

References:

Kyriazos, T. A. (2018). Can the Depression Anxiety Stress Scales Short Be Shorter? Factor Structure and Measurement Invariance of DASS-21 and DASS-9 in a Greek, Non-Clinical Sample. Psychology, 09(05), 1095-1127. https://doi.org/10.4236/psych.2018.95069

Vaughan, C., et al. (2020). Mental Health Measurement in a Post COVID-19 World: Psychometric Properties and Invariance of the DASS-21 in Athletes and Non-athletes. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.590559

Ali, A., et al. (2021). The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142

, T. (2022). Admirable Effort for an Ambitious Goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229

Ali, A., et al. (2021). Impact of COVID‐19 on Psychological Distress Among SME Owners in Ghana: Partial Least Square–Structural Equation Modeling (PLS‐SEM) Approach. Journal of Community Psychology, 50(3), 1282-1314. https://doi.org/10.1002/jcop.22716

Th’Ng, J., et al. (2021). A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 18(21), 11228. https://doi.org/10.3390/ijerph182111228

Balling, C., et al. (2021). The Impact of Personality and Lifestyle Change on Distress During the COVID-19 Pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525

Ali, A., et al. (2021). The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post-COVID-19 World. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142

Khosravani, V., et al. (2018). Difficulties in Emotion Regulation and Symptom Dimensions in Patients with Obsessive-Compulsive Disorder. Current Psychology, 39(5), 1578-1588. https://doi.org/10.1007/s12144-018-9859-x

Ali, A., Alameri, R., Hendawy, A., Al‐Amer, R., Shahrour, G., Ali, E., … & Hassan, B. (2022). Psychometric evaluation of the depression anxiety stress scale 8-items (dass-8)/dass-12/dass-21 among family caregivers of patients with dementia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1012311

Ali, A., Alkhamees, A., Hori, H., & Kim, Y. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post-covid-19 world.. https://doi.org/10.20944/preprints202109.0014.v1 Ali, A., Alkhamees, A., Hori, H., Kim, Y., & Kunugi, H. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post covid-19 world. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142 Andersson, P., Jamshidi, E., Ekman, C., Tedroff, K., Björkander, J., Sjögren, M., … & Boström, A. (2023). Anorexia nervosa with comorbid severe depression. Journal of Ect, 39(4), 227-234. https://doi.org/10.1097/yct.0000000000000922 Balling, C., Napolitano, S., Lane, S., & Samuel, D. (2021). The impact of personality and lifestyle change on distress during the covid-19 pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525 Crawford, J. and Henry, J. (2003). The depression anxiety stress scales (dass): normative data and latent structure in a large non‐clinical sample. British Journal of Clinical Psychology, 42(2), 111-131. https://doi.org/10.1348/014466503321903544 Gomez, R., Summers, M., Summers, A., Wolf, A., & Summers, J. (2014). Depression anxiety stress scales-21. Assessment, 21(4), 418-426. https://doi.org/10.1177/1073191113514106 Husain, W., Othman, A., Othman, N., Mohamad, W., & Zakaria, M. (2018). Determining the internal and external reliability of depression, anxiety and stress scales (dass-21) in assessing psychological symptoms among patients with tinnitus. Neuroquantology, 16(12). https://doi.org/10.14704/nq.2018.16.12.1876 Le, M., Tran, T., Holton, S., Huong, N., Wolfe, R., & Fisher, J. (2017). Reliability, convergent validity and factor structure of the dass-21 in a sample of vietnamese adolescents. Plos One, 12(7), e0180557. https://doi.org/10.1371/journal.pone.0180557 Lu, S., Hu, S., Guan, Y., Xiao, J., Cai, D., Gao, Z., … & Margraf, J. (2018). Measurement invariance of the depression anxiety stress scales-21 across gender in a sample of chinese university students. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02064Marfoh, K., Okyere, E., Kushigbor, P., & Acheampong, F. (2023). Validation of depression, anxiety and stress scale (dass-21) among healthcare workers during the outbreak of delta variant of sars-cov-2 in ghana. F1000research, 12, 229. https://doi.org/10.12688/f1000research.130447.1 Miller, R., Pallant, J., & Negri, L. (2006). Anxiety and stress in the postpartum: is there more to postnatal distress than depression?. BMC Psychiatry, 6(1). https://doi.org/10.1186/1471-244x-6-12 Shaw, T., Campbell, M., Runions, K., & Zubrick, S. (2016). Properties of the dass‐21 in an australian community adolescent population. Journal of Clinical Psychology, 73(7), 879-892. https://doi.org/10.1002/jclp.22376Susanti, H., Sonko, I., & Chung, M. (2022). Translation and validation of the depression anxiety stress scales for menopausal women in indonesia. Climacteric, 25(5), 483-489. https://doi.org/10.1080/13697137.2022.2052839 Szabó, M. (2009). The short version of the depression anxiety stress scales (dass‐21): factor structure in a young adolescent sample. Journal of Adolescence, 33(1), 1-8. https://doi.org/10.1016/j.adolescence.2009.05.014 Tearne, J., Robinson, M., Jacoby, P., Allen, K., Cunningham, N., Li, J., … & McLean, N. (2016). Older maternal age is associated with depression, anxiety, and stress symptoms in young adult female offspring.. Journal of Abnormal Psychology, 125(1), 1-10. https://doi.org/10.1037/abn0000119 Yan, T. (2022). Admirable effort for an ambitious goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229 Ali, A., Alameri, R., Hendawy, A., Al‐Amer, R., Shahrour, G., Ali, E., … & Hassan, B. (2022). Psychometric evaluation of the depression anxiety stress scale 8-items (dass-8)/dass-12/dass-21 among family caregivers of patients with dementia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1012311 Ali, A., Alkhamees, A., Hori, H., & Kim, Y. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post-covid-19 world.. https://doi.org/10.20944/preprints202109.0014.v1 Ali, A., Alkhamees, A., Hori, H., Kim, Y., & Kunugi, H. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post covid-19 world. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142 Andersson, P., Jamshidi, E., Ekman, C., Tedroff, K., Björkander, J., Sjögren, M., … & Boström, A. (2023). Anorexia nervosa with comorbid severe depression. Journal of Ect, 39(4), 227-234. https://doi.org/10.1097/yct.0000000000000922 Balling, C., Napolitano, S., Lane, S., & Samuel, D. (2021). The impact of personality and lifestyle change on distress during the covid-19 pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525 Crawford, J. and Henry, J. (2003). The depression anxiety stress scales (dass): normative data and latent structure in a large non‐clinical sample. British Journal of Clinical Psychology, 42(2), 111-131. https://doi.org/10.1348/014466503321903544 Gomez, R., Summers, M., Summers, A., Wolf, A., & Summers, J. (2014). Depression anxiety stress scales-21. Assessment, 21(4), 418-426. https://doi.org/10.1177/1073191113514106 Husain, W., Othman, A., Othman, N., Mohamad, W., & Zakaria, M. (2018). Determining the internal and external reliability of depression, anxiety and stress scales (dass-21) in assessing psychological symptoms among patients with tinnitus. Neuroquantology, 16(12). https://doi.org/10.14704/nq.2018.16.12.1876 Le, M., Tran, T., Holton, S., Huong, N., Wolfe, R., & Fisher, J. (2017). Reliability, convergent validity and factor structure of the dass-21 in a sample of vietnamese adolescents. Plos One, 12(7), e0180557. https://doi.org/10.1371/journal.pone.0180557 Lu, S., Hu, S., Guan, Y., Xiao, J., Cai, D., Gao, Z., … & Margraf, J. (2018). Measurement invariance of the depression anxiety stress scales-21 across gender in a sample of chinese university students. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02064 Marfoh, K., Okyere, E., Kushigbor, P., & Acheampong, F. (2023). Validation of depression, anxiety and stress scale (dass-21) among healthcare workers during the outbreak of delta variant of sars-cov-2 in ghana. F1000research, 12, 229. https://doi.org/10.12688/f1000research.130447.1 Miller, R., Pallant, J., & Negri, L. (2006). Anxiety and stress in the postpartum: is there more to postnatal distress than depression?. BMC Psychiatry, 6(1). https://doi.org/10.1186/1471-244x-6-12 Shaw, T., Campbell, M., Runions, K., & Zubrick, S. (2016). Properties of the dass‐21 in an australian community adolescent population. Journal of Clinical Psychology, 73(7), 879-892. https://doi.org/10.1002/jclp.22376Susanti, H., Sonko, I., & Chung, M. (2022). Translation and validation of the depression anxiety stress scales for menopausal women in indonesia. Climacteric, 25(5), 483-489. https://doi.org/10.1080/13697137.2022.2052839 Szabó, M. (2009). The short version of the depression anxiety stress scales (dass‐21): factor structure in a young adolescent sample. Journal of Adolescence, 33(1), 1-8. https://doi.org/10.1016/j.adolescence.2009.05.014 Tearne, J., Robinson, M., Jacoby, P., Allen, K., Cunningham, N., Li, J., … & McLean, N. (2016). Older maternal age is associated with depression, anxiety, and stress symptoms in young adult female offspring.. Journal of Abnormal Psychology, 125(1), 1-10. https://doi.org/10.1037/abn0000119 Yan, T. (2022). Admirable effort for an ambitious goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229

, T. (2022). Admirable Effort for an Ambitious Goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229

Balling, C., et al. (2021). The Impact of Personality and Lifestyle Change on Distress During the COVID-19 Pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525

Ali, A., et al. (2021). The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post-COVID-19 World. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142

References: Ali, A., Alameri, R., Hendawy, A., Al‐Amer, R., Shahrour, G., Ali, E., … & Hassan, B. (2022). Psychometric evaluation of the depression anxiety stress scale 8-items (dass-8)/dass-12/dass-21 among family caregivers of patients with dementia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1012311 Ali, A., Alkhamees, A., Hori, H., & Kim, Y. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post-covid-19 world.. https://doi.org/10.20944/preprints202109.0014.v1 Ali, A., Alkhamees, A., Hori, H., Kim, Y., & Kunugi, H. (2021). The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post covid-19 world. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142 Andersson, P., Jamshidi, E., Ekman, C., Tedroff, K., Björkander, J., Sjögren, M., … & Boström, A. (2023). Anorexia nervosa with comorbid severe depression. Journal of Ect, 39(4), 227-234. https://doi.org/10.1097/yct.0000000000000922 Balling, C., Napolitano, S., Lane, S., & Samuel, D. (2021). The impact of personality and lifestyle change on distress during the covid-19 pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525 Crawford, J. and Henry, J. (2003). The depression anxiety stress scales (dass): normative data and latent structure in a large non‐clinical sample. British Journal of Clinical Psychology, 42(2), 111-131. https://doi.org/10.1348/014466503321903544 Gomez, R., Summers, M., Summers, A., Wolf, A., & Summers, J. (2014). Depression anxiety stress scales-21. Assessment, 21(4), 418-426. https://doi.org/10.1177/1073191113514106 Husain, W., Othman, A., Othman, N., Mohamad, W., & Zakaria, M. (2018). Determining the internal and external reliability of depression, anxiety and stress scales (dass-21) in assessing psychological symptoms among patients with tinnitus. Neuroquantology, 16(12). https://doi.org/10.14704/nq.2018.16.12.1876 Le, M., Tran, T., Holton, S., Huong, N., Wolfe, R., & Fisher, J. (2017). Reliability, convergent validity and factor structure of the dass-21 in a sample of vietnamese adolescents. Plos One, 12(7), e0180557. https://doi.org/10.1371/journal.pone.0180557 Lu, S., Hu, S., Guan, Y., Xiao, J., Cai, D., Gao, Z., … & Margraf, J. (2018). Measurement invariance of the depression anxiety stress scales-21 across gender in a sample of chinese university students. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02064 Marfoh, K., Okyere, E., Kushigbor, P., & Acheampong, F. (2023). Validation of depression, anxiety and stress scale (dass-21) among healthcare workers during the outbreak of delta variant of sars-cov-2 in ghana. F1000research, 12, 229. https://doi.org/10.12688/f1000research.130447.1 Miller, R., Pallant, J., & Negri, L. (2006). Anxiety and stress in the postpartum: is there more to postnatal distress than depression?. BMC Psychiatry, 6(1). https://doi.org/10.1186/1471-244x-6-12 Shaw, T., Campbell, M., Runions, K., & Zubrick, S. (2016). Properties of the dass‐21 in an australian community adolescent population. Journal of Clinical Psychology, 73(7), 879-892. https://doi.org/10.1002/jclp.22376Susanti, H., Sonko, I., & Chung, M. (2022). Translation and validation of the depression anxiety stress scales for menopausal women in indonesia. Climacteric, 25(5), 483-489. https://doi.org/10.1080/13697137.2022.2052839 Szabó, M. (2009). The short version of the depression anxiety stress scales (dass‐21): factor structure in a young adolescent sample. Journal of Adolescence, 33(1), 1-8. https://doi.org/10.1016/j.adolescence.2009.05.014 Tearne, J., Robinson, M., Jacoby, P., Allen, K., Cunningham, N., Li, J., … & McLean, N. (2016). Older maternal age is associated with depression, anxiety, and stress symptoms in young adult female offspring.. Journal of Abnormal Psychology, 125(1), 1-10. https://doi.org/10.1037/abn0000119 Yan, T. (2022). Admirable effort for an ambitious goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229

, T. (2022). Admirable Effort for an Ambitious Goal. International Psychogeriatrics, 34(8), 679-681. https://doi.org/10.1017/s1041610222000229

Balling, C., et al. (2021). The Impact of Personality and Lifestyle Change on Distress During the COVID-19 Pandemic. Collabra Psychology, 7(1). https://doi.org/10.1525/collabra.19525

Ali, A., et al. (2021). The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post-COVID-19 World. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142

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A Closer Look at Depression, Anxiety, and Stress Measurement

DASS-21 Structure

Scoring the DASS-21

Identifying risk using the DASS-21

Summary of research evaluating the DASS-21

Application to diverse settings and cultural groups

Appropriateness with different age groups

Pros of using the DASS-21

Limitations of the DASS-21

Evaluating reliable change using the DASS-21: 3 possible methods

**Find a research paper that supports a particular threshold, as being indicative of reliable change**

Use change expressed in standard deviation units

Calculate the reliable change index (RCI) developed by Jacobson & Truax (1991)

Conclusion

References:

Read more posts

Why You Don’t Trust PROMs (and Don’t Want Them in Your Life—but Should)

Legal and Ethical Considerations in Using the PHQ-9

Depression Screening Tools: A Comparative Analysis

Subscribe to our newsletter and get the latest Measurely updates

A Closer Look at Depression, Anxiety, and Stress Measurement

DASS-21 Structure

Scoring the DASS-21

Identifying risk using the DASS-21

Summary of research evaluating the DASS-21

Application to diverse settings and cultural groups

Appropriateness with different age groups

Pros of using the DASS-21

Limitations of the DASS-21

Evaluating reliable change using the DASS-21: 3 possible methods

Find a research paper that supports a particular threshold, as being indicative of reliable change

Use change expressed in standard deviation units

Calculate the reliable change index (RCI) developed by Jacobson & Truax (1991)

Conclusion

References:

Share

Read more posts

Why You Don’t Trust PROMs (and Don’t Want Them in Your Life—but Should)

Legal and Ethical Considerations in Using the PHQ-9

Depression Screening Tools: A Comparative Analysis

Subscribe to our newsletter and get the latest Measurely updates

**Find a research paper that supports a particular threshold, as being indicative of reliable change**