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Measures Guide

Depression Anxiety and Stress Scale (DASS)

A close look at the Depression, Anxiety and Stress Scale, a self-report questionnaire measuring the 3 symptoms. It's available in three different versions: DASS-10, DASS-21, and DASS-42.

A close look at the Depression, Anxiety and Stress Scale, a self-report questionnaire measuring the 3 symptoms. It's available in three different versions: DASS-10, DASS-21, and DASS-42.

A close look at the Depression, Anxiety and Stress Scale, a self-report questionnaire measuring the 3 symptoms. It's available in three different versions: DASS-10, DASS-21, and DASS-42.

By Maggie Bowman

Psychology Research Assistant

Published

Published

4 Dec 2021

4 Dec 2021

TL;DR

Available on Bravely Connect

The DASS (Depression, Anxiety and Stress Scale) is a self-report questionnaire that measures symptoms of depression, anxiety, and stress. It is available in three different versions: DASS-10, DASS-21, and DASS-42.

  • The DASS-10 is the briefest version of the scale, consisting of 10 items. It measures overall symptoms of depression, anxiety, and stress.

  • The DASS-21 is a longer version of the scale, consisting of 21 items, which measure three separate subscales: depression, anxiety, and stress. Each subscale consists of 7 items.

  • The DASS-42 is the longest version of the scale, consisting of 42 items, which measure three separate subscales: depression, anxiety, and stress. Each subscale consists of 14 items.

All versions of the DASS are scored using a 4-point Likert scale, with scores ranging from 0 to 3. The higher the score, the more severe the symptoms. They are not suitable for diagnosis and do not provide a clear distinction between the three conditions. They are mainly used as a screening tool to assess the level of symptoms. The DASS measures have been found to have good reliability and validity, and have been translated into many languages. The DASS is widely used internationally in both research and clinical settings.


Highlights

📏 Lengths: 10 questions (1-2 minutes), 21 questions (3-5 minutes) and 42 questions (8-10 minutes).

📋 Administration: Self-Report

🎯 Uses: For monitoring symptoms of depression, anxiety, and stress

⚠️ Important Caveats: The anxiety subscale does not well capture symptoms of GAD. They cannot be used for diagnosis. The DASS-10 is unable to measure depression, anxiety and stress individually.

✅ Available in Bravely Connect? Yes

🌏 Culturally Applicable? Western-Centric with cultural adaptations

💬 Translations? 55 and counting


The DASS Question type and length

The client is presented with 10, 21 or 42 questions depending on whether you are utilising the brief form (DASS-10), the original version (DASS-21) or the long version (DASS-42). All questions are statements with the same 4 subjective answers:

  • Did not apply to me at all

  • Applied to me to some degree, or some of the time

  • Applied to me to a considerable degree or a good part of time

  • Applied to me very much or most of the time

The DASS-10 takes 1-2 minutes, the DASS-21 takes 3-5, and the DASS-42 takes 8-10 minutes to be completed.

For the full list of questions check out the measures on Bravely Connect, or follow the following links to the original unautomated versions:


What does the DASS-10, DASS-21 and DASS-42 measure

Each version of the DASS measures depression, anxiety and stress. More specifically:


The depression subscales assess:

  • Dysphoria

  • Hopelessness

  • Devaluation of life

  • Self-deprecation

  • Lack of interest

  • Anhedonia

  • Inertia


The anxiety subscales assess:*

  • Autonomic arousal*

  • Skeletal muscle effects

  • Situational anxiety

  • Subjective experience of anxious affect


The stress subscales assess:

  • Difficulty relaxing

  • Nervous arousal

  • Being easily upset/agitated

  • Irritable

  • Over-reactive

  • Impatient


* Note that when Lovibond and Lovibond (1995) developed the anxiety subscale they weren’t talking about generalised anxiety disorder, but instead specific experiences of anxiety and fear e.g. panic, social anxiety and phobias. The stress subscale better maps onto generalised anxiety disorder symptoms.


DASS-10, DASS-21 and DASS-42 Categories

DASS-10

The DASS-10’s factor structure is that of stress-anxiety and depression. However, the authors decided to only offer clinical cut-off scores for the total DASS-10 score which is described as distress.

DASS-21 and DASS-42

The DASS-21 and DASS-42 have the same factor structure, allowing the scores to be broken down into the subscores Depression, Anxiety and Stress.


DASS-10, DASS-21 and DASS-42 Factor structure

DASS-10 Factor Structure

Exploratory factor analyses were run as part of the development of DASS-10 from the already well-established DASS-42. These analyses found that 2 highly correlated factors (Anxiety-Stress and Depression) loaded onto a higher order factor labelled as Distress.

DASS-21 and DASS-42 Factor Structure

Both the DASS-21 and DASS-42 have been found to align with their original aim, with a general factor of psychological distress further broken down into three correlated factors of depression, anxiety and stress.


The history and theory behind DASS-10, DASS-21 and DASS-42

The original version of the DASS was presented by Lovibond et al. in 1983 at the 18th annual conference of the Australian Psychological Society. However, the first published version of the DASS was in Lovibond & Lovibond’s 1995 paper where the test was developed using a sample of 504 students, followed by being normed on a sample of 1044 men and 1870 women between the ages of 17 and 69. These scores were then checked for validity against outpatient groups of individuals with anxiety and depressive disorders, myocardial infarction patients, patients with insomnia, and patients undergoing treatment for sexual, menopausal, and depressive disorders. In this same paper, Lovibond & Lovibond presented the DASS-21 as a shorter alternative to the longer version of the DASS, with scores standardised by simply multiplying each of the scores by 2.

An even shorter version of the DASS, the DASS-10, was more recently developed by Professor Kim Halford in consultation with Dr Aaron Frost. They developed the DASS-10 as a progress monitoring tool for therapists that was brief, reliable, valid, and freely available in the public domain. The items were taken from the original DASS and were validated in two clinical samples of adults totalling over 2000 people. And they found that the items chosen, and the subsequent distress scores, discriminated between a clinical sample and a community sample, and were sensitive to clinical change.


DASS-10, DASS-21 and DASS-42 Cultural Adaptations

There are already 55 translations of the DASS-21/DASS-42 (find them here), and this number continues to grow. There are also a number of studies that have validated these translations within specific cultural populations. Including, but not limited to:

  • Portuguese (Reliability of .80 for anxiety and .84 for depression)

  • Korean (reliability of .84 for depression, .94 for anxiety, and .89 for stress)

  • Malaysian (reliability of .92 for depression, .87 for anxiety, and .89 for stress)

  • Brazilian Portuguese (reliability .92 for depression, .86 for anxiety, and .90 for stress)

It’s important to highlight that translation alone does not guarantee a high level of validity and reliability within the target population. For example, Oei et al. (2013) argue that the Westernised versions of the DASS, after translation, should not be used with Asian populations because of cultural differences in emotional expression. They subsequently developed their own Asian-specific version of the DASS which is 18 questions long. When finding the DASS that’s best for your client, it’s always best to look for adaptations that are translated but have also been validated with people from the target culture.


DASS-10, DASS-21 and DASS-42 Scoring Interpretation

For each version of the DASS, the following scoring is given for each answer:

  • Did not apply to me at all = 0

  • Applied to me to some degree, or some of the time = 1

  • Applied to me to a considerable degree or a good part of time = 2

  • Applied to me very much or most of the time = 3

This means that the DASS-10 is scored out of a maximum of 30, with scores 7 and above being considered the cut-off for clinically relevant levels of distress.

For the DASS-21, scoring is standardised with the DASS-42. So, scores are summed for each of the 3 subscores (depression, anxiety and stress) and multiplied by 2.

For both of these measures, there are the following cut-offs for qualitative labels.


Depression

  • Normal = 0-9

  • Mild = 10-13

  • Moderate = 14-20

  • Severe = 21-27

  • Extremely severe = 28


Anxiety

  • Normal = 0-7

  • Mild = 8-9

  • Moderate = 10-14

  • Severe = 15-19

  • Extremely severe = 20+


Stress

  • Normal = 0-14

  • Mild = 15-18

  • Moderate = 19-25

  • Stress = 26-33

  • Extremely severe = 34+


It’s important to note that the DASS-21 is based on a dimensional rather than a categorical conception of psychological disorder. This means the DASS cannot be used directly to allocate patients to discrete diagnostic categories in classificatory systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD).


Who developed the measures, licensing and how to obtain DASS-10, DASS-21 and DASS-42

The DASS-21 and DASS-42 were developed by Professor Syd Lovibond and Professor Peter Lovibond. The shorter version, the DASS-10, was developed by Professor Kim Halford and Dr Aaron Frost.

All 3 measures are freely available. They are in the public domain and can be used electronically, but there should be a reference to the DASS website: www.psy.unsw.edu.au/dass and the original article where the measure was developed.

All 3 versions of the DASS are available on Bravely Connect as part of our automated measures:

See the DASS-10 on Bravely Connect →

See the DASS-21 on Bravely Connect →

See the DASS-42 on Bravely Connect →


Limitations, biases and when you shouldn’t use DASS-10, DASS-21 and DASS-42

It’s important to highlight that DASS-10, DASS-21 and DASS-42 were all developed in Australia, meaning it’s a Western-centric measure. This means that, as mentioned earlier, despite there being many translations, the negative emotions measured will still be based on a Western context. This is why studies have found that in some countries the DASS-21 can only really be used as a measure of distress, rather than being able to measure depression, anxiety and stress individually. If possible, search for a culturally validated version of the DASS aligned with the culture of the person you are working with.

As highlighted earlier, the DASS should not be used solely to provide a diagnosis. As a measure, the DASS sees depression, anxiety and stress as negative emotions we all experience on a continuum. The measure was developed based on an adult sample up to 69 years of age, but studies have since found that the measure can be used with older adults, too, as the language is relatively simple. On top of this, studies have validated the use of the DASS with individuals with a diagnosis of autism without intellectual disabilities. Peter Lovibond recently released a youth version of the DASS that can be used for children as young as 7 years old, and is also a public domain instrument.


As always, if you’ve found a measure you would like adding to Bravely Connect as an automated measure, just drop us a measure request here.

TL;DR

Available on Bravely Connect

The DASS (Depression, Anxiety and Stress Scale) is a self-report questionnaire that measures symptoms of depression, anxiety, and stress. It is available in three different versions: DASS-10, DASS-21, and DASS-42.

  • The DASS-10 is the briefest version of the scale, consisting of 10 items. It measures overall symptoms of depression, anxiety, and stress.

  • The DASS-21 is a longer version of the scale, consisting of 21 items, which measure three separate subscales: depression, anxiety, and stress. Each subscale consists of 7 items.

  • The DASS-42 is the longest version of the scale, consisting of 42 items, which measure three separate subscales: depression, anxiety, and stress. Each subscale consists of 14 items.

All versions of the DASS are scored using a 4-point Likert scale, with scores ranging from 0 to 3. The higher the score, the more severe the symptoms. They are not suitable for diagnosis and do not provide a clear distinction between the three conditions. They are mainly used as a screening tool to assess the level of symptoms. The DASS measures have been found to have good reliability and validity, and have been translated into many languages. The DASS is widely used internationally in both research and clinical settings.


Highlights

📏 Lengths: 10 questions (1-2 minutes), 21 questions (3-5 minutes) and 42 questions (8-10 minutes).

📋 Administration: Self-Report

🎯 Uses: For monitoring symptoms of depression, anxiety, and stress

⚠️ Important Caveats: The anxiety subscale does not well capture symptoms of GAD. They cannot be used for diagnosis. The DASS-10 is unable to measure depression, anxiety and stress individually.

✅ Available in Bravely Connect? Yes

🌏 Culturally Applicable? Western-Centric with cultural adaptations

💬 Translations? 55 and counting


The DASS Question type and length

The client is presented with 10, 21 or 42 questions depending on whether you are utilising the brief form (DASS-10), the original version (DASS-21) or the long version (DASS-42). All questions are statements with the same 4 subjective answers:

  • Did not apply to me at all

  • Applied to me to some degree, or some of the time

  • Applied to me to a considerable degree or a good part of time

  • Applied to me very much or most of the time

The DASS-10 takes 1-2 minutes, the DASS-21 takes 3-5, and the DASS-42 takes 8-10 minutes to be completed.

For the full list of questions check out the measures on Bravely Connect, or follow the following links to the original unautomated versions:


What does the DASS-10, DASS-21 and DASS-42 measure

Each version of the DASS measures depression, anxiety and stress. More specifically:


The depression subscales assess:

  • Dysphoria

  • Hopelessness

  • Devaluation of life

  • Self-deprecation

  • Lack of interest

  • Anhedonia

  • Inertia


The anxiety subscales assess:*

  • Autonomic arousal*

  • Skeletal muscle effects

  • Situational anxiety

  • Subjective experience of anxious affect


The stress subscales assess:

  • Difficulty relaxing

  • Nervous arousal

  • Being easily upset/agitated

  • Irritable

  • Over-reactive

  • Impatient


* Note that when Lovibond and Lovibond (1995) developed the anxiety subscale they weren’t talking about generalised anxiety disorder, but instead specific experiences of anxiety and fear e.g. panic, social anxiety and phobias. The stress subscale better maps onto generalised anxiety disorder symptoms.


DASS-10, DASS-21 and DASS-42 Categories

DASS-10

The DASS-10’s factor structure is that of stress-anxiety and depression. However, the authors decided to only offer clinical cut-off scores for the total DASS-10 score which is described as distress.

DASS-21 and DASS-42

The DASS-21 and DASS-42 have the same factor structure, allowing the scores to be broken down into the subscores Depression, Anxiety and Stress.


DASS-10, DASS-21 and DASS-42 Factor structure

DASS-10 Factor Structure

Exploratory factor analyses were run as part of the development of DASS-10 from the already well-established DASS-42. These analyses found that 2 highly correlated factors (Anxiety-Stress and Depression) loaded onto a higher order factor labelled as Distress.

DASS-21 and DASS-42 Factor Structure

Both the DASS-21 and DASS-42 have been found to align with their original aim, with a general factor of psychological distress further broken down into three correlated factors of depression, anxiety and stress.


The history and theory behind DASS-10, DASS-21 and DASS-42

The original version of the DASS was presented by Lovibond et al. in 1983 at the 18th annual conference of the Australian Psychological Society. However, the first published version of the DASS was in Lovibond & Lovibond’s 1995 paper where the test was developed using a sample of 504 students, followed by being normed on a sample of 1044 men and 1870 women between the ages of 17 and 69. These scores were then checked for validity against outpatient groups of individuals with anxiety and depressive disorders, myocardial infarction patients, patients with insomnia, and patients undergoing treatment for sexual, menopausal, and depressive disorders. In this same paper, Lovibond & Lovibond presented the DASS-21 as a shorter alternative to the longer version of the DASS, with scores standardised by simply multiplying each of the scores by 2.

An even shorter version of the DASS, the DASS-10, was more recently developed by Professor Kim Halford in consultation with Dr Aaron Frost. They developed the DASS-10 as a progress monitoring tool for therapists that was brief, reliable, valid, and freely available in the public domain. The items were taken from the original DASS and were validated in two clinical samples of adults totalling over 2000 people. And they found that the items chosen, and the subsequent distress scores, discriminated between a clinical sample and a community sample, and were sensitive to clinical change.


DASS-10, DASS-21 and DASS-42 Cultural Adaptations

There are already 55 translations of the DASS-21/DASS-42 (find them here), and this number continues to grow. There are also a number of studies that have validated these translations within specific cultural populations. Including, but not limited to:

  • Portuguese (Reliability of .80 for anxiety and .84 for depression)

  • Korean (reliability of .84 for depression, .94 for anxiety, and .89 for stress)

  • Malaysian (reliability of .92 for depression, .87 for anxiety, and .89 for stress)

  • Brazilian Portuguese (reliability .92 for depression, .86 for anxiety, and .90 for stress)

It’s important to highlight that translation alone does not guarantee a high level of validity and reliability within the target population. For example, Oei et al. (2013) argue that the Westernised versions of the DASS, after translation, should not be used with Asian populations because of cultural differences in emotional expression. They subsequently developed their own Asian-specific version of the DASS which is 18 questions long. When finding the DASS that’s best for your client, it’s always best to look for adaptations that are translated but have also been validated with people from the target culture.


DASS-10, DASS-21 and DASS-42 Scoring Interpretation

For each version of the DASS, the following scoring is given for each answer:

  • Did not apply to me at all = 0

  • Applied to me to some degree, or some of the time = 1

  • Applied to me to a considerable degree or a good part of time = 2

  • Applied to me very much or most of the time = 3

This means that the DASS-10 is scored out of a maximum of 30, with scores 7 and above being considered the cut-off for clinically relevant levels of distress.

For the DASS-21, scoring is standardised with the DASS-42. So, scores are summed for each of the 3 subscores (depression, anxiety and stress) and multiplied by 2.

For both of these measures, there are the following cut-offs for qualitative labels.


Depression

  • Normal = 0-9

  • Mild = 10-13

  • Moderate = 14-20

  • Severe = 21-27

  • Extremely severe = 28


Anxiety

  • Normal = 0-7

  • Mild = 8-9

  • Moderate = 10-14

  • Severe = 15-19

  • Extremely severe = 20+


Stress

  • Normal = 0-14

  • Mild = 15-18

  • Moderate = 19-25

  • Stress = 26-33

  • Extremely severe = 34+


It’s important to note that the DASS-21 is based on a dimensional rather than a categorical conception of psychological disorder. This means the DASS cannot be used directly to allocate patients to discrete diagnostic categories in classificatory systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD).


Who developed the measures, licensing and how to obtain DASS-10, DASS-21 and DASS-42

The DASS-21 and DASS-42 were developed by Professor Syd Lovibond and Professor Peter Lovibond. The shorter version, the DASS-10, was developed by Professor Kim Halford and Dr Aaron Frost.

All 3 measures are freely available. They are in the public domain and can be used electronically, but there should be a reference to the DASS website: www.psy.unsw.edu.au/dass and the original article where the measure was developed.

All 3 versions of the DASS are available on Bravely Connect as part of our automated measures:

See the DASS-10 on Bravely Connect →

See the DASS-21 on Bravely Connect →

See the DASS-42 on Bravely Connect →


Limitations, biases and when you shouldn’t use DASS-10, DASS-21 and DASS-42

It’s important to highlight that DASS-10, DASS-21 and DASS-42 were all developed in Australia, meaning it’s a Western-centric measure. This means that, as mentioned earlier, despite there being many translations, the negative emotions measured will still be based on a Western context. This is why studies have found that in some countries the DASS-21 can only really be used as a measure of distress, rather than being able to measure depression, anxiety and stress individually. If possible, search for a culturally validated version of the DASS aligned with the culture of the person you are working with.

As highlighted earlier, the DASS should not be used solely to provide a diagnosis. As a measure, the DASS sees depression, anxiety and stress as negative emotions we all experience on a continuum. The measure was developed based on an adult sample up to 69 years of age, but studies have since found that the measure can be used with older adults, too, as the language is relatively simple. On top of this, studies have validated the use of the DASS with individuals with a diagnosis of autism without intellectual disabilities. Peter Lovibond recently released a youth version of the DASS that can be used for children as young as 7 years old, and is also a public domain instrument.


As always, if you’ve found a measure you would like adding to Bravely Connect as an automated measure, just drop us a measure request here.

Transform your therapy practice with Bravely Connect

Embrace the future of therapy with Bravely Connect. Say goodbye to the hassle of admin, and hello to better client engagement and therapeutic alliance.

With seamless management of scheduling, records, and outcomes, you're ready to elevate your practice. Discover the Bravely Connect difference and start a new era of streamlined practice management!

Transform your therapy practice with Bravely Connect

Embrace the future of therapy with Bravely Connect. Say goodbye to the hassle of admin, and hello to better client engagement and therapeutic alliance.

With seamless management of scheduling, records, and outcomes, you're ready to elevate your practice. Discover the Bravely Connect difference and start a new era of streamlined practice management!

Transform your therapy practice with Bravely Connect

Embrace the future of therapy with Bravely Connect. Say goodbye to the hassle of admin, and hello to better client engagement and therapeutic alliance.

With seamless management of scheduling, records, and outcomes, you're ready to elevate your practice. Discover the Bravely Connect difference and start a new era of streamlined practice management!

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Streamlining your mental health practice with simplified scheduling, tracking, assignments, outcome scoring and client documentation. By elevating client engagement and motivation, you can create a collaborative experience you both will love.

Made with ❤️ from

© 2023 Bravely Tech Pte Ltd.

Streamlining your mental health practice with simplified scheduling, tracking, assignments, outcome scoring and client documentation. By elevating client engagement and motivation, you can create a collaborative experience you both will love.

Made with ❤️ from

© 2023 Bravely Tech Pte Ltd.

Streamlining your mental health practice with simplified scheduling, tracking, assignments, outcome scoring and client documentation. By elevating client engagement and motivation, you can create a collaborative experience you both will love.

Made with ❤️ from

© 2023 Bravely Tech Pte Ltd.