DASS, the Depression Anxiety Stress Scales, (Available from The Psychology Foundation, Room 1005 Mathews Building, University of New South Wales, NSW 2052, Australia) is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom.{{cite journal , last=Lovibond , first=P.F. , author2=Lovibond, S.H., title=The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories , date=March 1995 , journal=Behaviour Research and Therapy , volume=33 , issue=3 , pages=335–343 , doi=10.1016/0005-7967(94)00075-U , pmid=7726811 Each of these is rated on a four-point

Likert scale A Likert scale ( , commonly mispronounced as ) is a psychometric scale commonly involved in research that employs questionnaires. It is the most widely used approach to scaling responses in survey research, such that the term (or more fully the ...

of frequency or severity of the participants' experiences over the last week to emphasize states over traits. These scores ranged from 0, meaning that the client believed the item "did not apply to them at all", to 3, meaning that the client considered the item to "apply to them very much or most of the time". It is also stressed in the instructions that there are no right or wrong answers.

Scales

The sum of the relevant 14 items for each scale constitute the participants' scores for each of Depression,

Anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

, and Stress, including items such as "I couldn't seem to experience any positive feeling at all", "I was aware of the dryness of my mouth" and "I found it hard to wind down" in the respective order of the scales. The order of the 42 items has been randomized so that items of the same scale are not clustered together. Each of the scales is then broken down into subscales comprising two to five items each. The Depression scale has subscales assessing dysphoria,

hopelessness Depression is a mental state of low mood and aversion to activity, which affects more than 280 million people of all ages (about 3.5% of the global population). Classified medically as a mental and behavioral disorder, the experience of ...

, devaluation of life, self-deprecation, lack of interest/involvement,

anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers t ...

, and inertia. The Anxiety scale assesses autonomic arousal,

skeletal muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

effects, situational anxiety, and subjective experience of anxious affect. The Stress scale's subscales highlight levels of non-chronic arousal through difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive, and impatient.

Purpose

The main purpose of the DASS is to isolate and identify aspects of emotional disturbance, for example, to assess the degree of severity of the core symptoms of depression, anxiety, or stress. The initial aims of the scale's constructions were to define the full range of core symptoms of depression and anxiety, meet rigorous standards of psychometric adequacy, and develop maximum discrimination between the depression anxiety scales. While the DASS can be administered and scored by individuals without

psychology Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...

qualifications, it is recommended that the interpretation and decisions based on results are made by an experienced

clinician A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for pa ...

in combination with other forms of assessment.

Development

The Depression, Anxiety, and Stress Scales were developed by researchers at the

University of New South Wales The University of New South Wales (UNSW), also known as UNSW Sydney, is a public research university based in Sydney, New South Wales, Australia. It is one of the founding members of Group of Eight, a coalition of Australian research-intensive ...

(

Australia Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...

).University of New South Wales Depression Anxiety Stress Scales http://www2.psy.unsw.edu.au/groups/dass/ The test was developed using a sample of responses from the comparison of 504 sets of results from a trial by students, taken from a larger sample of 950 first-year university student responses. The test was then normed on a sample of 1044 men and 1870 women aged between 17 and 69 years, across participants of varying backgrounds, including university students, nurses in training, and blue and white collared employees of a major airline, bank, railway workshop, and

naval dockyard A naval base, navy base, or military port is a military base, where warships and naval ships are docked when they have no mission at sea or need to restock. Ships may also undergo repairs. Some naval bases are temporary homes to aircraft that us ...

. The scores were subsequently checked for validity against outpatient groups, including patients with anxiety and depressive disorders,

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...

patients, pateints with

insomnia Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...

, as well as patients undergoing treatment for

sexual Sex is the biological distinction of an organism between male and female. Sex or SEX may also refer to: Biology and behaviour * Animal sexual behaviour **Copulation (zoology) ** Human sexual activity **Non-penetrative sex, or sexual outercourse ...

menopausal Menopause, also known as the climacteric, is the time in women's lives when Menstruation, menstrual periods stop permanently, and they are no longer fertility, able to bear children. Menopause usually occurs between the age of 47 and 54. Medic ...

, and depressive disorders. While the test was not normed against samples younger than 17, due to the simplicity of language, there has been no compelling evidence against the use of the scales for comparison against children as young as 12. The reliability scores of the scales in terms of Cronbach's alpha scores rate the Depression scale at 0.91, the Anxiety scale at 0.84, and the Stress scale at 0.90 in the normative sample. The

mean There are several kinds of mean in mathematics, especially in statistics. Each mean serves to summarize a given group of data, often to better understand the overall value (magnitude and sign) of a given data set. For a data set, the ''arithme ...

s and

standard deviation In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean (also called the expected value) of the set, while ...

s for each scale are 6.34 and 6.97 for depression, 4.7 and 4.91 for anxiety, and 10.11 and 7.91 for stress, respectively. The mean scores in the normative sample did vary slightly between genders as well as varying by age, though the threshold scores for classifications do not change by these variations. The Depression and Stress scales meet the standard threshold requirement of 0.9 for research; however, the Anxiety scale still meets the 0.7 thresholds for clinical applications and is still close to the 0.9 required for research.

References

Anxiety Depression screening and assessment tools Psychological tests and scales