DASS 21

Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDOB
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please read each statement and fill in the circle 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.

Rows	Did not apply to me	Applied to me to some degree or some of the time	Applied to me a considerable degree or a good part of time	Applied to me very much or most of the time
I find it difficult to wind down
I was aware of dryness of my mouth
I couldn’t seem to experience any positive feeling at all
I experience breathing difficulty (e.g. rapid breathing without physical exertion)
I found it difficult to work up the initiative to do things
I tended to over-react to situations
I experienced trembling, e.g. in the hands
I felt that I was using a lot of nervous energy
I was worried of situations in which I might panic and make a fool of myself
I feel like I have nothing to look forward to
I found myself getting agitated
I found it difficult to relax
I felt down-hearted and blue
I was intolerant of anything that kept kept me from getting on with what I was doing
I felt I was close to panic
I was unable to become enthusiastic about anything
I felt I wasn’t worth much as a person
I felt that I was rather touchy
I was aware of the action of my heart in the absence of any physical exertion; eg. sense of heart racing or skipping a beat
I felt scared without any good reason
I felt that life was meaningless