Depression, Anxiety, and Stress Scale (DASS)

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.

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 SCORES ON EACH DASS SCALE

A- 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 

B- 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.

C- 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, etiology 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 recognized 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 recognize 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.

REFERENCES

PUBLICATIONS THAT FOCUS ON THE DASS ITSELF

Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation.

Lovibond, P.F. & 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. Behaviour Research and Therapy, 33, 335-43.

Brown, T.A., Korotitsch, W., Chorpita, B.F. & Barlow, D.H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79-89.

Antony, M.M., Bieling, P.J., Cox, B.J., Enns, M.W. & Swinson, R.P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176-81.

Crawford, J.R. & Henry, J.D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111-31.

PUBLICATIONS THAT CITE THE DASS

Aluoja A, Shlik J, Vasar V, et al. Development and psychometric properties of the Emotional State Questionnaire, a self-report questionnaire for depression and anxiety NORD J PSYCHIAT 53 (6): 443-449 1999 

Andrew MJ, Baker RA, Kneebone AC, et al. Mood state as a predictor of neuropsychological deficits following cardiac surgery J PSYCHOSOM RES 48 (6): 537-546 JUN 2000 

Andrew MJ, Baker RA, Kneebone AC, et al. Neuropsychological dysfunction after minimally invasive direct coronary artery bypass grafting ANN THORAC SURG 66 (5): 1611-1617 NOV 1998 

Anstey KJ, Lord SR, Williams P Strength in the lower limbs, visual contrast sensitivity, and simple reaction time predict cognition in older women PSYCHOL AGING 12 (1): 137-144 MAR 1997 

Antony MM Assessment and treatment of social phobia CAN J PSYCHIAT 42 (8): 826-834 OCT 1997 

Antony MM, Bieling PJ, Cox BJ, et al. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample PSYCHOL ASSESSMENT 10 (2): 176-181 JUN 1998 

Baker RA, Andrew MJ, Schrader G, et al. Preoperative depression and mortality in coronary artery bypass surgery: Preliminary findings AUST NZ J SURG 71 (3): 139-142 MAR 2001 

Barrett P, Shortt A, Healy L Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families? J CHILD PSYCHOL PSYC 43 (5): 597-607 JUL 2002 

Barrett P, Turner C, Rombouts S, et al. Reciprocal skills training in the treatment of externalising behaviour disorders in childhood: A preliminary investigation BEHAV CHANGE 17 (4): 221-234 2000 

Bieling PJ, Antony MM, Swinson RP The State-Trait Anxiety Inventory, Trait version: structure and content re-examined BEHAV RES THER 36 (7-8): 777-788 JUL-AUG 1998 

Bieling PJ, Rowa K, Antony MM, et al. Factor structure of the illness intrusiveness rating scale in patients diagnosed with anxiety disorders J PSYCHOPATHOL BEHAV 23 (4): 223-230 DEC 2001 

Bor W, Sanders MR, Markie-Dadds C The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties J ABNORM CHILD PSYCH 30 (6): 571-587 DEC 2002 

Brown, T.A., Barlow, D.H. & Liebowitz, M.R. (1994). The empirical basis of generalized anxiety disorder. AMER J PSYCHIAT, 151, 1272-1280.

Brown TA, Chorpita BF, Barlow DH Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal J ABNORM PSYCHOL 107 (2): 179-192 MAY 1998

Brown TA, Chorpita BF, Korotitsch W, et al. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples BEHAV RES THER 35 (1): 79-89 JAN 1997 

Burroughs JE, Rindfleisch A Materialism and well-being: A conflicting values perspective J CONSUM RES 29 (3): 348-370 DEC 2002 

Burt CDB, Strongman KT, Costanzo CL Memorial distortions and homesickness following relocation AUST J PSYCHOL 50 (2): 106-113 AUG 1998 

Carstairs JR, Shores EA The Macquarie University Neuropsychological Normative Study (MUNNS): Rationale and methodology AUST PSYCHOL 35 (1): 36-40 MAR 2000 

Chan CKY, Lovibond PF Expectancy bias in trait anxiety J ABNORM PSYCHOL 105 (4): 637-647 NOV 1996 

Cheng SK, Chong GH, Wong CW Chinese frost multidimensional perfectionism scale: A validation and prediction of self-esteem and psychological distress J CLIN PSYCHOL 55 (9): 1051-1061 SEP 1999 

Chorpita BF The tripartite model and dimensions of anxiety and depression: An examination of structure in a large school sample J ABNORM CHILD PSYCH 30 (2): 177-190 APR 2002 

Chorpita BF, Barlow DH The development of anxiety: The role of control in the early environment PSYCHOL BULL 124 (1): 3-21 JUL 1998 

Chorpita BF, Daleiden EL Tripartite dimensions of emotion in a child clinical sample: Measurement strategies and implications for clinical utility J CONSULT CLIN PSYCH 70 (5): 1150-1160 OCT 2002 

Chorpita BF, Daleiden EL, Moffitt C, et al. Assessment of tripartite factors of emotion in children and adolescents I: Structural validity and normative data of an affect and arousal scale J PSYCHOPATHOL BEHAV 22 (2): 141-160 JUN 2000

Clara IP, Cox BJ, Enns MW Confirmatory factor analysis of the Depression-Anxiety-Stress Scales in depressed and anxious patients J PSYCHOPATHOL BEHAV 23 (1): 61-67 MAR 2001 

Connell S, Sanders MR, MarkieDadds C Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas BEHAV MODIF 21 (4): 379-408 OCT 1997 

Dadds MR, Holland DE, Laurens KR, et al. Early intervention and prevention of anxiety disorders in children: Results at 2-year follow-up J CONSULT CLIN PSYCH 67 (1): 145-150 FEB 1999 

Dammeyer MM, Nunez N Anxiety and depression among law students: Current knowledge and future directions LAW HUMAN BEHAV 23 (1): 55-73 FEB 1999 

Daza P, Novy DM, Stanley MA, et al. The Depression Anxiety Stress Scale-21: Spanish translation and validation with a Hispanic sample J PSYCHOPATHOL BEHAV 24 (3): 195-205 SEP 2002 

de Beurs, Edwin; Van Dyck, Richard; Marquenie, Loes A; Lange, Alfred; Blonk, Roland W. B. The DASS: A questionnaire for the measurement of depression, anxiety, and stress. [Dutch]. Gedragstherapie. Vol 34(1) Mar 2001, 35-53. Bohn Stafleu Van Loghum bv, Netherlands

Devilly GJ The psychological effects of a lifestyle management course on war veterans and their spouses J CLIN PSYCHOL 58 (9): 1119-1134 SEP 2002 

Devilly GJ, Borkovec TD Psychometric properties of the credibility/expectancy questionnaire J BEHAV THER EXP PSY 31 (2): 73-86 JUN 2000 

Dingle G Career versus motherhood? A case study describing a cognitive-existential approach to the dilemma BEHAV CHANGE 19 (1): 2-11 2002 

Eccleston L, Sorbello L The RUSH program - Real understanding of self-help: A suicide and self-harm prevention initiative within a prison setting AUST PSYCHOL 37 (3): 237-244 NOV 2002 

Einstein DA, Lovibond PF, Gaston JE Relationship between perfectionism and emotional symptoms in an adolescent sample AUST J PSYCHOL 52 (2): 89-93 AUG 2000

Fox TL, Barrett PM, Shortt AL Sibling relationships of anxious children: A preliminary investigation J CLIN CHILD ADOLESC 31 (3): 375-383 SEP 2002 

Grant AM, Franklin J, Langford P The self-reflection and insight scale: A new measure of private self-consciousness SOC BEHAV PERSONAL 30 (8): 821-835 2002 

Green HJ, Pakenham KI, Headley BC, et al. Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial BJU INT 90 (4): 427-432 SEP 2002 

Green HJ, Pakenham KI, Headley BC, et al. Coping and health-related quality of life in men with prostate cancer randomly assigned to hormonal medication or close monitoring PSYCHO-ONCOL 11 (5): 401-414 SEP-OCT 2002 

Gutierrez PM, Osman A, Barrios FX, et al. Development of the reasons for living inventory for young adults J CLIN PSYCHOL 58 (4): 339-357 APR 2002 

Harris LM, Robinson J, Menzies RG Evidence for fear of restriction and fear of suffocation as components of claustrophobia BEHAV RES THER 37 (2): 155-159 FEB 1999 

Harris LM, Robinson J, Menzies RG Predictors of panic symptoms during magnetic resonance imaging scans INT J BEHAV MED 8 (1): 80-87 2001 

Henry JD, Crawford JR, Bedford A, et al. The Personal Disturbance Scale (sAD): normative data and latent structure in a large non-clinical sample PERS INDIV DIFFER 33 (8): 1343-1360 DEC 2002 

Hooke GR, Page AC Predicting outcomes of group cognitive behavior therapy for patients with affective and neurotic disorders BEHAV MODIF 26 (5): 648-658 OCT 2002 

Hunt C The diagnosis and nature of generalized anxiety disorder CURR OPIN PSYCHIATR 13 (2): 157-161 MAR 2000 

Issakidis C, Andrews G Rationing of health care: Clinical decision making in an outpatient clinic for anxiety disorders J ANXIETY DISORD 17 (1): 59-74 2003

Keogh E, Chaloner N The moderating effect of anxiety sensitivity on caffeine-induced hypoalgesia in healthy women PSYCHOPHARMACOLOGY 164 (4): 429-431 DEC 2002 

Keogh E, Cochrane M Anxiety sensitivity, cognitive biases, and the experience of pain J PAIN 3 (4): 320-329 AUG 2002 

Keogh E, Dillon C, Georgiou G, et al. Selective attentional biases for physical threat in physical anxiety sensitivity J ANXIETY DISORD 15 (4): 299-315 JUL-AUG 2001 

Keogh E, Ellery D, Hunt C, et al. Selective attentional bias for pain-related stimuli amongst pain fearful individuals PAIN 91 (1-2): 91-100 MAR 2001 

Keogh E, Herdenfeldt M Gender, coping and the perception of pain PAIN 97 (3): 195-201 JUN 2002 

Keogh E, Mansoor L Investigating the effects of anxiety sensitivity and coping on the perception of cold pressor pain in healthy women EUR J PAIN-LONDON 5 (1): 11-22 2001 

Keogh E, Reidy J Exploring the factor structure of the Mood and Anxiety Symptom Questionnaire (MASQ) J PERS ASSESS 74 (1): 106-125 FEB 2000 

Laurent J, Ettelson R An examination of the tripartite model of anxiety and depression and its application to youth CLIN CHILD FAM PSYCH 4 (3): 209-230 SEP 2001 

Lovibond PF Long-term stability of depression, anxiety, and stress syndromes J ABNORM PSYCHOL 107 (3): 520-526 AUG 1998 

Lovibond, P.F. (submitted). Prediction of emotional disorder from a symptom measure: Vulnerability or continuity?

Lovibond, P.F. & Chan, K.Y.C. (1990). Threat appraisal and trait anxiety. In N. McNaughton & G. Andrews (Eds.). Anxiety (pp. 160-168). Dunedin, N.Z.: University of Otago Press.

Lovibond, P.F., Hanna, S.K., Siddle, D.A.T., & Bond, N.W. (1994). Electrodermal and subjective reactions to fear-relevant stimuli under threat of shock. AUST J PSYCHOL 52, 46, 73-80.

Lovibond, P.F. & Rapee, R.M. (1993). The representation of feared outcomes. BEHAV RES THER, 31, 595-608.

Lynd-Stevenson RM, Hearne CM Perfectionism and depressive affect: the pros and cons of being a perfectionist PERS INDIV DIFFER 26 (3): 549-562 MAR 1999 

Lyne K, Roger D A psychometric re-assessment of the COPE questionnaire PERS INDIV DIFFER 29 (2): 321-335 AUG 2000 

Matthews JM, Hudson AM Guidelines for evaluating parent training programs FAM RELAT 50 (1): 77-86 JAN 2001 

McCabe MP, Ricciardelli LA Sociocultural influences on body image and body changes among adolescent boys and girls J SOC PSYCHOL 143 (1): 5-26 FEB 2003 

McNamara P, Andresen J, Arrowood J, et al. Counterfactual cognitive operations in dreams DREAMING 12 (3): 121-133 SEP 2002

McNamara P, Andresen J, Clark J, et al. Impact of attachment styles on dream recall and dream content: a test of the attachment hypothesis of REM sleep J SLEEP RES 10 (2): 117-127 JUN 2001 

Murrell E, Steel Z, Gaston J, et al. Training the clinical psychologist: Profile of a university-based clinic AUST PSYCHOL 37 (2): 123-128 JUL 2002 

O'Connor BP The search for dimensional structure differences between normality and abnormality: A statistical review of published data on personality and psychopathology J PERS SOC PSYCHOL 83 (4): 962-982 OCT 2002 

Osman A, Downs WR, Barrios FX, et al. Factor structure and psychometric characteristics of the Beck Depression Inventory-II J PSYCHOPATHOL BEHAV 19 (4): 359-376 DEC 1997 

Page AC Assessment of panic disorder CURR OPIN PSYCHIATR 11 (2): 137-141 MAR 1998

Page AC Blood-injury-injection fears and fainting: Nature, assessment, and management BEHAV CHANGE 15 (3): 160-164 1998 

Page AC, Bennett KS, Carter O, et al. The blood-injection symptom scale (BISS): Assessing a structure of phobic symptoms elicited by blood and injections BEHAV RES THER 35 (5): 457-464 MAY 1997 

Parisod E, Murray RF, Cousins MJ Conversion disorder after implant of a spinal cord stimulator in a patient with a complex regional pain syndrome ANESTH ANALG 96 (1): 201-206 JAN 2003 

Piira T, Chow J, Suranyi MG The role of cognitive factors in the adjustment of home dialysis carers PSYCHOL HEALTH 17 (3): 313-322 JUN 2002 

Pillay AL, Edwards SD, Gambu SQ, et al. Depression among university students in South Africa PSYCHOL REP 91 (3): 725-728 Part 1 DEC 2002 

Pillay AL, Edwards SD, Sargent C, et al. Anxiety among university students in South Africa PSYCHOL REP 88 (3): 1182-1186 Part 2 JUN 2001 

Ralph A, Haines A, Harvey J, et al. Parenting issues and behaviour problems of young children in a community sample BEHAV CHANGE 16 (3): 143-154 1999 

Ricciardelli LA, McCabe MP Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys BEHAV RES THER 39 (11): 1317-1328 NOV 2001 

Ricciardelli LA, McCabe MP Self-esteem and negative affect as moderators of sociocultural influences on body dissatisfaction, strategies to decrease weight, and strategies to increase muscles among adolescent boys and girls SEX ROLES 44 (3-4): 189-207 FEB 2001 

Richardson S, McCabe MP Parental divorce during adolescence and adjustment in early adulthood ADOLESCENCE 36 (143): 467-489 FAL 2001 

Richmond RL, Kehoe L, Hailstone S, et al. Quantitative and qualitative evaluations of brief interventions to change excessive drinking, smoking and stress in the police force ADDICTION 94 (10): 1509-1521 OCT 1999 

Richmond RL, Wodak A, Kehoe L, et al. How healthy are the police? A survey of life-style factors ADDICTION 93 (11): 1729-1737 NOV 1998 

Sanders MR, Markie-Dadds C, Tully LA, et al. The Triple P-positive parenting program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems J CONSULT CLIN PSYCH 68 (4): 624-640 AUG 2000 

Sanders MR, Montgomery DT, Brechman-Toussaint ML The mass media and the prevention of child behavior problems: The evaluation of a television series to promote positive outcomes for parents and their children J CHILD PSYCHOL PSYC 41 (7): 939-948 OCT 2000 

Santor DA, Ramsay JO Progress in the technology of measurement: Applications of item response models PSYCHOL ASSESSMENT 10 (4): 345-359 DEC 1998 

Shaw AD, Brooks JL, Dickerson JWT, et al. Dietary triggers in irritable bowel syndrome NUTR RES REV 11 (2): 279-309 DEC 1998 

Shepherd H, Ricciardelli LA Test of Stice's dual pathway model: Dietary restraint and negative affect as mediators of bulimic behavior BEHAV RES THER 36 (3): 345-352 MAR 1998 

Shortt AL, Barrett PM, Dadds MR, et al. The influence of family and experimental context on cognition in anxious children J ABNORM CHILD PSYCH 29 (6): 585-596 DEC 2001 

Smith L, Sinclair KE, Chapman ES Students' goals, self-efficacy, self-handicapping, and negative affective responses: An Australian senior school student study CONTEMP EDUC PSYCHOL 27 (3): 471-485 JUL 2002 

Spangenberg JJ, Theron JC Stress and coping in parents of children with Down Syndrome STUD PSYCHOL 43 (1): 41-48 2001 

Spangenberg JJ, Theron JC Stress and coping strategies in spouses of depressed patients J PSYCHOL 133 (3): 253-262 MAY 1999 

Stacey BG The Depression Scale of the Psychogeriatric Assessment Scales AUST J AGEING 17 (3): 132-134 AUG 1998

Sullivan K, Richer C Malingering on subjective complaint tasks - An exploration of the deterrent effects of warning ARCH CLIN NEUROPSYCH 17 (7): 691-708 OCT 2002 

Taleporos G, McCabe MP Development and validation of the Physical Disability Sexual and Body Esteem scale SEX DISABIL 20 (3): 159-176 FAL 2002 

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