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Depression Anxiety Stress Scales (DASS) Manual

General description of the scales

The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The DASS was constructed not merely as another set of scales to measure conventionally defined emotional states, but to further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states usually described as depression, anxiety and stress. The DASS should thus meet the requirements of both researchers and scientist-professional clinicians.

Each of the three DASS scales contains 14 items, divided into subscales of 2-5 items with similar content. The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The Stress scale is sensitive to levels of chronic non-specific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Subjects are asked to use 4-point severity/frequency scales to rate the extent to which they have experienced each state over the past week. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items.

In addition to the basic 42-item questionnaire, a short version, the DASS21, is available with 7 items per scale. Note also that an earlier version of the DASS scales was referred to as the Self-Analysis Questionnaire (SAQ).

As the scales of the DASS have been shown to have high internal consistency and to yield meaningful discriminations in a variety of settings, the scales should meet the needs of both researchers and clinicians who wish to measure current state or change in state over time (e.g., in the course of treatment) on the three dimensions of depression, anxiety and stress.

Characteristics of high scorers on each DASS scale

Depression scale

  • self-disparaging
  • dispirited, gloomy, blue
  • convinced that life has no meaning or value
  • pessimistic about the future
  • unable to experience enjoyment or satisfaction
  • unable to become interested or involved
  • slow, lacking in initiative

Anxiety scale

  • apprehensive, panicky
  • trembly, shaky
  • aware of dryness of the mouth, breathing difficulties, pounding of the heart, sweatiness of the palms
  • worried about performance and possible loss of control

Stress scale

  • over-aroused, tense
  • unable to relax
  • touchy, easily upset
  • irritable
  • easily startled
  • nervy, jumpy, fidgety
  • intolerant of interruption or delay

The DASS in research

The DASS may be administered either in groups or individually for research purposes. The capacity to discriminate between the three related states of depression, anxiety and stress should be useful to researchers concerned with the nature, aetiology and mechanisms of emotional disturbance.

As the essential development of the DASS was carried out with non-clinical samples, it is suitable for screening normal adolescents and adults. Given the necessary language proficiency, there seems no compelling case against use of the scales for comparative purposes with children as young as 12 years. It must be borne in mind, however, that the lower age limit of the development samples was 17 years.

Clinical use of the DASS

The principal value of the DASS in a clinical setting is to clarify the locus of emotional disturbance, as part of the broader task of clinical assessment. The essential function of the DASS is to assess the severity of the core symptoms of depression, anxiety and stress. It must be recognised that clinically depressed, anxious or stressed persons may well manifest additional symptoms that tend to be common to two or all three of the conditions, such as sleep, appetite, and sexual disturbances. These disturbances will be elicited by clinical examination, or by the use of general symptom check lists as required.

The DASS may be administered and scored by non-psychologists, but decisions based on particular score profiles should be made only by experienced clinicians who have carried out an appropriate clinical examination. It should be noted also that none of the DASS items refers to suicidal tendencies because items relating to such tendencies were found not to load on any scale. The experienced clinician will recognise the need to determine the risk of suicide in seriously disturbed persons.

The DASS and diagnosis

The DASS is based on a dimensional rather than a categorical conception of psychological disorder. The assumption on which the DASS development was based (and which was confirmed by the research data) is that the differences between the depression, the anxiety, and the stress experienced by normal subjects and the clinically disturbed, are essentially differences of degree. The DASS therefore has no direct implications for the allocation of patients to discrete diagnostic categories postulated in classificatory systems such as the DSM and ICD. However, recommended cutoffs for conventional severity labels (normal, moderate, severe) are given in the DASS Manual.

 

 

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