Depression Anxiety Stress Scales (DASS-21)
The Depression Anxiety Stress Scales are a questionnaire that measures how much depression, anxiety and stress a person felt over the past week. The DASS-21 is the short form: 21 statements, seven for each state, each rated from 0 to 3.
At a first visit, a psychologist asks a new client to fill in the DASS-21. Her stress score comes out high and her depression score low, so the next questions are about tension and sleep rather than mood.
A DASS-21 score isn't a diagnosis, and the questionnaire has no question about suicide. Its authors built it on the view that everyday distress and a clinical problem differ in degree. They say its scores have no direct bearing on diagnostic categories, and ask that a trained professional read them after talking with the person. None of its statements asks about suicide, so its authors expect a clinician to ask about that separately. If low mood, anxiety or stress has been heavy for weeks, a doctor or psychologist can assess it.
If you or someone you know is having a difficult time, free support is available.
In an emergency, call your local emergency number.
The three scales
Each scale has seven statements in the DASS-21 and fourteen in the full DASS. The authors describe what each one covers.
| Scale | What it covers | Its statements in the DASS-21 |
|---|---|---|
| Depression | Low mood, hopelessness, feeling life isn't worth much, running oneself down, loss of interest and pleasure, and trouble getting started | 3, 5, 10, 13, 16, 17 and 21 |
| Anxiety | The body's alarm, such as a racing heart, trembling or a dry mouth, along with fear of panicking in certain situations and the feeling of being anxious | 2, 4, 7, 9, 15, 19 and 20 |
| Stress | Steady tension: trouble relaxing, being keyed up, being easily upset or agitated, irritability and impatience | 1, 6, 8, 11, 12, 14 and 18 |
How it shows
At work
Depression can show as tasks that take a huge push to start and bring little satisfaction when done. Anxiety can show as a racing heart before a meeting, or avoiding a presentation for fear of panicking in it. Stress can show as snapping at a colleague over a small delay, and staying wound up long after work.
In close relationships
Low mood can look like pulling away from people who used to matter. Anxiety can keep someone out of crowded places or long drives. Stress can show as impatience and overreacting at home, often toward the people closest.
In ourselves
We can notice which of the three is loudest: a flatness that won't lift, a body that keeps sounding the alarm, or a mind that can't wind down. In a hard week many of us feel some of each.
How it differs from similar ideas
Major depression
Major depression is a diagnosis made in an interview: low mood or loss of interest nearly every day for at least two weeks, along with other symptoms such as trouble sleeping, changes in appetite or tiredness. The DASS depression scale measures how much of the core feeling was there last week. It leaves out sleep and appetite, so a clinician asks about those separately.
Generalized anxiety
Generalized anxiety is mostly worry about many things at once. The DASS anxiety scale is mostly about the body's alarm and the fear of panic. Tension and trouble relaxing are on the DASS stress scale instead.
Neuroticism
Neuroticism is a lasting trait: how often and how strongly a person feels upset, anxious or low across years. The DASS asks about a single week. Even so, in Lovibond's follow-up, each scale was best predicted by the same scale measured 3 to 8 years earlier.
What it doesn’t mean
Its stress scale doesn't count stressful events. The stress scale asks how tense, irritable and keyed up a person has felt. It doesn't ask what happened to them. Someone with a hard week can score low on it, and someone with an easy week can score high.
High scores on all three don't mean three separate problems. The three scales overlap a good deal. In Henry and Crawford's study, part of every DASS-21 score reflected a general distress shared by all three, and each scale added something of its own on top.
What the research shows
The four studies below test whether the DASS scales measure separate things, how they compare with Beck's inventories, and how steady the scores are over years. Each asked people to answer once or twice, so none shows what causes the three states.
Its scales kept depression and anxiety further apart than Beck's inventories
In 1995, Peter and Syd Lovibond gave the full DASS, the Beck Depression Inventory and the Beck Anxiety Inventory to 717 people who were not patients.
The DASS anxiety scale correlated 0.81 with Beck's anxiety inventory, and the DASS depression scale 0.74 with Beck's depression inventory. In factor analyses, the DASS items separated into their scales more cleanly than Beck's did. Several items on Beck's depression inventory, such as weight loss, poor sleep and irritability, didn't set depression apart from the other states.
Doesn’t show how well it works with patients, since no one in this study was a patient.
The short form held up with patients as well as the long one
In 1998, Martin Antony and colleagues gave both versions to 49 volunteers and to patients diagnosed with panic disorder (67), obsessive-compulsive disorder (54), social phobia (74), specific phobia (17) and major depression (46).
Both versions told apart depression, the body's arousal, and tension. Each scale's statements hung together well and its scores agreed with other measures, at levels rated acceptable to excellent. Each group's average scores pointed the expected way.
Doesn’t show how well a single score picks out who has a disorder. The study compared group averages, and some groups were small.
In 1,794 UK adults, the three scales sat on top of general distress
In 2005, Julie Henry and John Crawford gave the DASS-21 to 1,794 adults, broadly representative of the UK's general adult population.
The model that fit best had one general factor of psychological distress, plus separate factors for depression, anxiety and stress. A model in which the stress scale only measured negative mood in general fit worse. They also published norms, so a score can be compared with the general adult population.
Doesn’t show anything about people in treatment, and each person answered only once.
Each scale predicted the same scale 3 to 8 years later
Peter Lovibond gave the DASS to 3,540 people, and again, 3 to 8 years later, to 882 of them.
At the second time, each scale was best predicted by the same scale at the first. Adding the other two scales didn't improve the prediction. He read this as a sign of vulnerabilities specific to each state, on top of a general tendency toward distress.
Doesn’t show why the states last. The 882 people who answered twice may also differ from those who didn't.
Is the DASS-21 free to use?
The questionnaire and its scoring key are in the public domain, and its authors let anyone download and copy them without asking. The authors also ask that it not be given on websites open to the public, and that its scores go to a trained professional and are not shown to the person who answered. That's why this library explains it and doesn't run it.
How is the DASS-21 scored?
Each statement is rated from 0, did not apply to me at all, to 3, applied to me very much or most of the time. The seven answers for each scale are added and then doubled, giving a score from 0 to 42 for depression, anxiety and stress. The manual names score ranges on each scale, from normal to extremely severe. Those names compare a score with the general population. They don't diagnose.
Can the DASS-21 diagnose depression or anxiety?
Its authors say it has no direct bearing on diagnostic categories. A diagnosis needs an interview that covers what the DASS leaves out, such as sleep, appetite, how long it has lasted and what else could explain it.
What's the difference between the DASS-21 and the DASS-42?
The DASS-42 is the full questionnaire, with 14 statements for each state. The DASS-21 takes seven of each. The authors say the full version gives somewhat more reliable scores and more detail on symptoms, and the short form takes half the time.
Where the idea comes from
Syd and Peter Lovibond, psychologists at the University of New South Wales in Sydney, set out to measure depression and anxiety separately. An early version was called the Self-Analysis Questionnaire. Alongside the two states they measured a third, stress: trouble relaxing, nervous tension, irritability and impatience.
Their manual sets out the 42-statement DASS and its 21-statement short form. Its second edition came out in 1995, the same year as their paper comparing the DASS with Beck's inventories. They placed the questionnaire in the public domain.
The question it adds
Talk about strain often lumps it all together as stress. The DASS asks which state it is: low mood, the body's alarm, or tension that won't settle. Each can be high while the others are low.
Syd and Peter Lovibond, University of New South Wales, 1995 (Manual for the Depression Anxiety Stress Scales, which holds both the 42-item DASS and the 21-item short form)
Questions to carry
- Over the past week, which was loudest: flatness, fear in the body, or tension that wouldn't settle?
- When I tell people I'm stressed, which of the three do I mean?
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