Depression, Anxiety, Stress, Scale (DASS - 21)
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First Name
Last Name
Date
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Day
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Date
Dass 21
Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you "
over the past week"
. There are no right or wrong answers. Do not spend too much time on any statement.
The rating scale is as follows:
0 Did not apply to me at all 1 Applied to me to some degree, or some of the time 2 Applied to me to a considerable degree, or a good part of time 3 Applied to me very much, or most of the time
(1) I found it hard to wind down
*
0
1
2
3
(2) I was aware of dryness of my mouth
*
0
1
2
3
(3) I couldn't seem to experience any positive feeling at all
*
0
1
2
3
(4) I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)
*
0
1
2
3
(5) I found it difficult to work up the initiative to do things
*
0
1
2
3
(6) I tended to over-react to situations
*
0
1
2
3
(7) I experienced trembling (eg, in the hands)
*
0
1
2
3
(8) I felt that I was using a lot of nervous energy
*
0
1
2
3
(9) I was worried about situations in which I might panic and make a fool of myself
*
0
1
2
3
(10) I felt that I had nothing to look forward to
*
0
1
2
3
(11) I found myself getting agitated
*
0
1
2
3
(12) I found it difficult to relax
*
0
1
2
3
(13) I felt down-hearted and blue
*
0
1
2
3
(14) I was intolerant of anything that kept me from getting on with what I was doing
*
0
1
2
3
(15) I felt I was close to panic
*
0
1
2
3
(16) I was unable to become enthusiastic about anything
*
0
1
2
3
(17) I felt I wasn't worth much as a person
*
0
1
2
3
(18) I felt that I was rather touchy
*
0
1
2
3
(19) I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)
*
0
1
2
3
(20) I felt scared without any good reason
*
0
1
2
3
(21) I felt that life was meaningless
*
0
1
2
3
Depression (Admin use only)
Anxiety (Admin use only)
Stress (Admin use only)
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