DASS-21 Assessment
Depression, Anxiety & Stress Scales — Validated 21-Item Self-Report
Understanding the DASS-21
The Depression Anxiety Stress Scales (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. It was developed by Lovibond & Lovibond (1995) at the University of New South Wales, Australia.
What it measures:
- Depression subscale: Measures dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia
- Anxiety subscale: Measures autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect
- Stress subscale: Measures difficulty relaxing, nervous arousal, being easily upset/agitated, irritability/over-reactivity, and impatience
How the subscales work: The DASS-21 contains 21 items divided into three subscales of 7 items each. Each item is rated on a 4-point scale (0–3). Because the DASS-21 is a shortened version of the original 42-item DASS, the final score for each subscale is multiplied by 2 to allow comparison with the full DASS normative data.
Research background: The DASS was originally developed by Peter Lovibond and Sydney Lovibond and published in their 1995 manual. It has been translated into more than 50 languages and is used in clinical and research settings worldwide. The three-factor structure has been consistently supported across diverse populations, including clinical samples and community surveys.
Depression vs Anxiety vs Stress
While depression, anxiety, and stress often co-occur, they represent distinct emotional experiences:
Depression is characterized by:
- Persistent sadness, emptiness, or hopelessness
- Loss of interest or pleasure in activities (anhedonia)
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Changes in appetite and sleep patterns
- Low energy and motivation
Anxiety is characterized by:
- Excessive worry or apprehension about the future
- Physical symptoms: rapid heartbeat, trembling, sweating, dry mouth
- Panic-like episodes or fear of panic
- Avoidance of feared situations
- Difficulty controlling worry
- Muscle tension and restlessness
Stress is characterized by:
- Difficulty winding down or relaxing
- Nervous energy and agitation
- Irritability and overreactivity
- Impatience with delays or interruptions
- Feeling “on edge” or keyed up
- Sensitivity to perceived slights
How they overlap: Depression and anxiety frequently co-occur, with some estimates suggesting up to 60% of individuals with one condition also experiencing the other. Chronic stress can contribute to both depression and anxiety. Measuring all three simultaneously, as the DASS-21 does, helps clinicians understand the full emotional picture and tailor treatment accordingly.
When to Seek Help
The DASS-21 uses five severity labels for each subscale: Normal, Mild, Moderate, Severe, and Extremely Severe. Here is what they suggest:
- Normal / Mild: Your scores are within or close to the typical range. Continue to monitor your well-being and practice healthy coping strategies.
- Moderate: You may be experiencing symptoms that are noticeably above average. Consider speaking with your primary care provider or a mental health professional.
- Severe / Extremely Severe: Professional help is strongly recommended. These scores suggest significant distress that would likely benefit from clinical intervention.
Types of professional help available:
- Therapist or Psychologist: Provides talk therapy (psychotherapy) to address thought patterns, behaviors, and emotional regulation
- Psychiatrist: A medical doctor who can prescribe medication and provide therapy, especially helpful for moderate-to-severe symptoms
- Primary Care Physician (GP): Can provide initial screening, prescribe medication, and refer to specialists
Evidence-based therapy types:
- Cognitive Behavioral Therapy (CBT): The most extensively researched therapy for depression and anxiety; focuses on identifying and changing unhelpful thought and behavior patterns
- Dialectical Behavior Therapy (DBT): Combines CBT with mindfulness; particularly effective for emotional dysregulation and stress
- Acceptance and Commitment Therapy (ACT): Focuses on psychological flexibility and values-based living
- Mindfulness-Based Cognitive Therapy (MBCT): Integrates mindfulness practices with cognitive therapy to prevent relapse
Medication options (always under medical supervision):
- SSRIs (e.g., sertraline, escitalopram) — commonly prescribed for depression and anxiety
- SNRIs (e.g., venlafaxine, duloxetine) — effective for depression, anxiety, and chronic pain
- Buspirone — anti-anxiety medication without sedation risk
- Combination approaches — therapy plus medication is often more effective than either alone
Evidence-Based Self-Care Strategies
These strategies have strong research support for reducing symptoms of depression, anxiety, and stress:
- Regular Exercise: Aim for at least 150 minutes of moderate aerobic exercise per week. Research consistently shows exercise can be as effective as medication for mild-to-moderate depression. Even a 30-minute walk has immediate mood-boosting effects.
- Sleep Hygiene: Maintain a consistent sleep schedule (same bedtime and wake time, including weekends). Keep your bedroom cool, dark, and quiet. Avoid screens for 1 hour before bed. Aim for 7–9 hours per night. Poor sleep both causes and worsens depression, anxiety, and stress.
- Mindfulness & Meditation: Even 10 minutes of daily mindfulness meditation reduces anxiety and stress. Apps like Headspace, Calm, and Insight Timer can help beginners. Mindfulness-Based Stress Reduction (MBSR) is an 8-week program with strong evidence for stress reduction.
- Social Connection: Loneliness is a major risk factor for depression. Prioritize face-to-face interactions, even brief ones. Join a group, volunteer, or reconnect with old friends. Quality matters more than quantity.
- Reduce Alcohol & Caffeine: Alcohol is a depressant that worsens mood long-term despite short-term relief. Caffeine can increase anxiety and interfere with sleep. Try reducing both and monitor how you feel over 2–4 weeks.
- Journaling: Writing about thoughts and feelings for 15–20 minutes can reduce stress and improve emotional clarity. Gratitude journaling (listing 3 things you’re grateful for daily) is linked to improved mood and well-being.
- Progressive Muscle Relaxation (PMR): Systematically tensing and releasing muscle groups from head to toe. Takes 10–15 minutes and significantly reduces physical tension, anxiety, and stress. Particularly effective before sleep.
Frequently Asked Questions
The DASS-21 (Depression Anxiety Stress Scales — 21 items) is a validated self-report questionnaire that measures three related but distinct negative emotional states: depression, anxiety, and stress. It was developed by Lovibond & Lovibond (1995) at the University of New South Wales. The DASS-21 is a shortened version of the original 42-item DASS and is widely used in clinical practice, research, and community screening worldwide.
The PHQ-9 (Patient Health Questionnaire-9) measures only depression severity based on DSM diagnostic criteria, making it useful for diagnosing major depressive disorder. The DASS-21, on the other hand, measures three separate constructs — depression, anxiety, and stress — in a single assessment. While the PHQ-9 is often used as a diagnostic screening tool, the DASS-21 provides a broader picture of emotional distress and is particularly useful when clinicians want to assess multiple dimensions simultaneously. The two tools can complement each other in clinical practice.
The DASS-21 classifies each subscale into five severity levels: Normal, Mild, Moderate, Severe, and Extremely Severe. These cutoffs are based on normative data from large community samples. “Normal” means your score falls within the range typical of the general population. “Mild” suggests symptoms above the community mean but below clinical concern. “Moderate” indicates above-average levels that may benefit from monitoring or intervention. “Severe” and “Extremely Severe” suggest clinically significant symptoms where professional help is recommended.
For individuals monitoring their mental health, retaking the DASS-21 every 2–4 weeks is reasonable. In clinical settings, it is commonly administered at each therapy session or at regular intervals (e.g., monthly) to track treatment progress. Avoid taking it more than once a week, as natural fluctuations in mood may not reflect meaningful change. The DASS-21 asks about the past week, so results can vary based on recent events.
No. The DASS-21 is a screening and measurement tool, not a diagnostic instrument. It measures the severity of symptoms related to depression, anxiety, and stress, but it cannot diagnose clinical disorders such as major depressive disorder, generalized anxiety disorder, or any other mental health condition. A formal diagnosis requires a comprehensive evaluation by a qualified mental health professional who considers your full history, symptoms, and functioning.
If your scores fall in the Normal or Mild range, continue monitoring your well-being and practicing healthy coping strategies. If your scores are in the Moderate range, consider discussing them with your primary care provider or a therapist. If your scores are in the Severe or Extremely Severe range, we strongly encourage you to seek professional help — these scores indicate significant distress that typically responds well to evidence-based treatments such as CBT, medication, or a combination of both. You can print or share your results to bring to a healthcare appointment.
Medical Disclaimer
This DASS-21 Assessment is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The DASS-21 is a screening tool, not a clinical diagnostic instrument. Your results should be interpreted in the context of a comprehensive assessment by a qualified healthcare professional. If you are experiencing a mental health crisis, please contact the 988 Suicide & Crisis Lifeline (call or text 988) or go to your nearest emergency department. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.
References
- Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychology Foundation of Australia; 1995.
- Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(Pt 2):227-239.
- Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176-181.
- Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J Clin Psychol. 2012;68(12):1322-1338.
DASS-21: Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia.
