The DASS is a 21- or 42-item measure designed to assess the fundamental symptoms of depression, anxiety and tension/stress.
42 or 21
5-10 minutes
Adult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Daniel Chellette, SPT, Jarod Hill, SPT, Emily Kemp, SPT, Claire McCormick, SPT, Anne McLean, SPT, Stacie Morris, SPT, Morgan Mowery, SPT, Matt Rossman, SPT, Elizabeth Schuppert, SPT, Justin Zych, SPT, and Rebecca Schuck, SPT.
(From the DASS Website)
Patients with low back pain (LBP):
(Haggman et al, 2004)
An initial evaluation should consist of two questions to screen for depression in LBP
1. “During the past month, have you often been bothered by feeling down, depressed or hopeless?”
2. “During the past month, have you been bothered by little interest or pleasure in doing things?” Positive responses to these questions should recommend that the clinician needs to pay close attention to the progress and effectiveness of the interventions given. If progress seems stunted by depressive symptoms administering the DASS - 21 is then used as a follow - up. If a patient scores in the severe to extremely severe categories (21 - 42), the clinician should consider a psychological referral. DASS - 21 can also be used if someone with a negative response to the 2 question screen is failing to respond to an intervention or if other clinical signs of depression are observed (insomnia, fatigue, weight change)
Patients Diagnosed with Chronic Fatigue Syndrome (CFS) at the Fatigue Service at the Royal Free Hospital in London, UK (>18 y/o):
(Lovibond et al, 1995), (Maher-Edwards et al, 2010)
Metacognitions (or negative beliefs about one’s own thoughts concerning uncontrollability, cognitive confidence, and beliefs about the need to control thoughts) can be used independently of negative emotions to predict symptom severity. As a result, it may be a better use of time and resources to implement questionnaires that assess metacognitions, rather than simply depressive state or negative affect. Thus, the 30-Item Metacognitions Questionnaire may be a better predictor of CFS severity than implementation of the DASS
Undergraduate students from 2 Public Universities Receiving Partial Credit for Taking Survey:
(Osman et al, 2012)
Results may be skewed/influenced since students received extra credit for completing the survey
484 Adolescents with Depression, Anxiety and Stress:
(Szabo et al, 2010)
Originally designed for adults, the DASS contains a number of expressions and words that may not be familiar to adolescents. The results of the series of Confirmatory Factor Analyses in this study indicate that while the constructs of Depression and Anxiety are similar between adults and 11,15 year old adolescents, the validity of the Tension/Stress construct, as measured by the adult DASS - 21, is questionable in this age group. It is possible that this specific emotional state is still emerging during early adolescence. The DASS - 21 needs to be used in young adolescent samples with caution, and it is perhaps best seen as a measure of Anxiety and Depression until further evidence for the construct validity of the Tension/Stress scale becomes available. Because of its demonstrated association with worry and GAD in adults (Brown et al., 1997; Szabo ? & Lovibond, 2000), an ability to delineate the lowest age group at which the tension/stress syndrome is experienced by young people would make an important contribution towards a better understanding of the development of worry and its disorders in youth (Tracey et al, 1997)
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Patients Diagnosed with Chronic Fatigue Syndrome:
(Lovibond et al, 1995; n = 717 people who were administered the Beck Depression Inventory and the Beck Anxiety Inventory)
Adults Referred for Psychotherapy with Symptoms of Depression:
(Ruwaard et al, 2012; n = 1500 total adult participants with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burn out (n = 470); mean age = 40 years)
Patients Presenting for Assessment and Treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders:
(Brown et al, 1997; n = 437 patients presenting for assessment and treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders; average age = 36.1 years (10.55) and range = 18 - 65 years; 63.6% were women)
**Calculated from SD, using Cronbach's alpha for ICC
Adults Referred for Psychotherapy with Symptoms of Depression:
(Ruwaard et al, 2012)
Patients Presenting for Assessment and Treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders:
(Brown et al, 1997)
Depression, Anxiety and Stress as Predictors of Postconcussion - Like Symptoms:
(Edmed et al, 2012; n = 71 nonclinical undergraduate students from Queensland University of Technology; mean age = 24.27 (8.93); age range = 17 – 54 years )
Patients Presenting for Assessment and Treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders:
(Brown et al, 1997)
Patients Presenting for Assessment and Treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders:
(Brown et al, 1997)
Undergraduate Students with no History of Head Injury of Neurological Impairment:
(Edmed et al, 2012)
Patients Diagnosed with Chronic Fatigue Syndrome:
(Lovibond et al, 1995)
Undergraduate students:
(Osman et al, 2012; n = 887 undergraduate students, 363 men; age range = 18 – 35 years; mean age = 19.46 (2.71))
Adults Referred for Psychotherapy with Symptoms of Depression:
(Ruwaard et al, 2012)
Adolescents with Depression, Anxiety and Stress:
(Szabo et al, 2010; n = 484 high school students; mean age = 13.62 years; age range = 11.83 – 15.67 years; 52% were boys)
Depression, Anxiety and Stress:
(Edmed et al, 2012)
(Osman et al, 2012)
Patients Presenting for Assessment and Treatment at the Phobia and Anxiety Disorders Clinic, Center for Stress and Anxiety Disorders:
(Brown et al, 1997)
Study with First Year Psychology Students at the University of New South Wales:
(Lovibond et al, 1995)
DASS - Anxiety:
DASS - Depression:
DASS - Stress:
Adolescents with Depression, Anxiety and Stress:
(Szabo et al, 2010)
Acquired Brain Injury Patients with Elevated Psychological Distress:
(Arundine et al, 2012; n = 17 chronic acquired brain injury (ABI) patients with elevated psychological distress; mean age = 42.94 (11.23); 9 males; years of education = 12.71 (1.57); years post injury = 9.65 (8.35))
Individuals with chronic Pain, Psychology Clinic Patients with Similar Overall Levels of Depression, Anxiety and a General Population Sample:
(Taylor et al, 2005)
Chronic Pain sample:
Psychology Clinic sample:
General Population sample:
Depression and Anxiety with SCI:
(Mitchell et al, 2008)
Acquired Brain Injury Patients with Elevated Psychological Distress Tested Pretreatment, Posttreatment, and 6 months Posttreatment:
(Arundine et al, 2012)
Patients with Low Back Pain:
(Pengel et al, 2007; n = 259 people with subacute low back pain lasting greater than 6 weeks and less than 3 months)
Allen, J. and Annells, M. (2009). "A literature review of the application of the Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder Checklist to community nursing cohorts." J Clin Nurs 18(7): 949-959.
Arundine, A., Bradbury, C. L., et al. (2012). "Cognitive behavior therapy after acquired brain injury: maintenance of therapeutic benefits at 6 months posttreatment." J Head Trauma Rehabil 27(2): 104-112.
Brown, T. A., Chorpita, B. F., et al. (1997). "Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples." Behav Res Ther 35(1): 79-89.
Edmed, S. and Sullivan, K. (2012). "Depression, anxiety, and stress as predictors of postconcussion-like symptoms in a non-clinical sample." Psychiatry Res 200(1): 41-45.
Haggman, S., Maher, C. G., et al. (2004). "Screening for symptoms of depression by physical therapists managing low back pain." Phys Ther 84(12): 1157-1166.
Lovibond, P. F. and Lovibond, S. H. (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.
Lovibond, S. and Lovibond, P. F. (1996). Manual for the depression anxiety stress scales, Psychology Foundation of Australia. Maher-Edwards, L., Fernie, B. A., et al. (2011). "Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome." J Psychosom Res 70(4): 311-317.
Mitchell, M. C., Burns, N. R., et al. (2008). "Screening for depression and anxiety in spinal cord injury with DASS-21." Spinal Cord 46(8): 547-551.
Osman, A., Wong, J. L., et al. (2012). "The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates." J Clin Psychol 68(12): 1322-1338.
Pengel, L. H., Refshauge, K. M., et al. (2007). "Physiotherapist-directed exercise, advice, or both for subacute low back pain: a randomized trial." Ann Intern Med 146(11): 787-796.
Ruwaard, J., Lange, A., et al. (2012). "The effectiveness of online cognitive behavioral treatment in routine clinical practice." PLoS One 7(7): e40089.
Szabo, M. (2010). "The short version of the Depression Anxiety Stress Scales (DASS-21): factor structure in a young adolescent sample." J Adolesc 33(1): 1-8.
Taylor, R., Lovibond, P. F., et al. (2005). "The utility of somatic items in the assessment of depression in patients with chronic pain: a comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in chronic pain and clinical and community samples." Clin J Pain 21(1): 91-100.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.