Depression Anxiety Stress Scales – 21-Item

What it measures?

• Three self-report subscales assess the emotional states of depression, anxiety and stress.
• Depression subscale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia and inertia.
• The anxiety subscale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect.
• The stress subscale assesses difficulty relaxing, nervous arousal, and being easily upset / agitated, irritable / over-reactive and impatient.

Who is it for?

Adults and adolescents aged 17 years +

Instrument Quality

• The DASS-21 has well-established psychometric properties and is among the most common instruments used to assess symptoms of depression, anxiety and stress (Ronke et al., 2013).

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 instructions

• Sum the item responses for each subscale
• Multiply the subscale score by 2

Score Interpretation

What higher scores mean?

• More severe symptoms of depression, anxiety and stress over the past week. Greater likelihood of meeting criteria for a DSM-5 depressive- or anxiety- disorder. Optimal cut-off scores will vary across settings and populations. As general guidelines, cut-off scores have been provided for each of the three subscales indicating 'normal', 'mild', 'moderate', 'severe', and 'extremely severe' symptoms.

Identifying risk

A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.

Instrument developers

• Lovibond, S.H. & Lovibond, P.F. (1995).  Manual for the Depression Anxiety Stress Scales. (2nd. Ed.)  Sydney: Psychology Foundation

Refrences

Crawford, J. R., Garthwaite, P. H., Lawrie, C. J., Henry, J. D., MacDonald, M. A., Sutherland, J., & Sinha, P. (2009). A convenient method of obtaining percentile norms and accompanying interval estimates for self‐report mood scales (DASS, DASS‐21, HADS, PANAS, and sAD). British Journal of Clinical Psychology, 48(2), 163-180 Crawford, J., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self‐report mood scales (BAI, BDI, CRSD, CES‐D, DASS, DASS‐21, STAI‐X, STAI‐Y, SRDS, and SRAS). Australian Psychologist, 46(1), 3-14 Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British journal of clinical psychology, 44(2), 227-239. Ronk, F. R., Korman, J. R., Hooke, G. R., & Page, A. C. (2013). Assessing clinical significance of treatment outcomes using the DASS-21. Psychological assessment, 25(4), 1103 Sinclair, S. J., Siefert, C. J., Slavin-Mulford, J. M., Stein, M. B., Renna, M., & Blais, M. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of US adults. Evaluation & the health professions, 35(3), 259-279