Depression Anxiety Stress Scale-21 (DASS-21)

The DASS-21 is a measure that assesses three negative emotional states: Depression, Anxiety and Stress (Lovibond & Lovibond 1995a).

Number of items: 21 items (7 items for each emotional state).

Procedure/Administration: Self-report format consisting of statements referring to the past week. Each item is scored on a 4-point scale (0 = Did not apply to me at all, to 3 = Applied to me very much or most of the time).

How scored: Scores from each subscale are summed and multiplied by two. Subscale score range from 0 to 42.

Interpretability: Higher scores indicate greater levels of distress. Normative data are available from the DASS manual however these are based on the full DASS (42 items).

Acceptability: Comparison of the DASS-21 to clinical judgment showed that the measure has clinical utility (Mitchell et al. 2007). The scale appears understandable and easy to complete.

Languages: English, Portuguese, and Cantonese.

Usability: N/a

Time to administer: Less than 10 minutes.

Time to score: N/a

Training required: N/a

Availability: Serenity

Equipment required: None


  • A screening tool for identifying, differentiating and assessing depression, anxiety, and stress in patients with SCI
  • Excludes many somatic items that may not be relevant to those with SCI and the instrument has greater sensitivity for identifying SCI patients with possible anxiety disorders (Mitchell et al. 2007). The ability to separately measure the three emotional states may be of considerable use for researchers and clinicians. This is an advantage given that measures of anxiety and depression often do not distinguish between these conditions and anxiety is likely more prevalent than depression.
  • Only one study has assessed the psychometric properties of the instrument among patients with SCI. Sensitivity of the tool is better for anxiety than depression.

Psychometric Summary









Criterion (D and A): Green light

Criterion (S): N/a

SS (D)/ SS (A): Yellow light



Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/A= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.


  • Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995a; 33: 335–342.
  • Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales, 2nd edn. Psychology Foundation of Australia: Sydney, 1995b.
  • Mitchell MC, Burns NR, Dorstyn DS. Screening for depression and anxiety in spinal cord injury with DASS-21. Spinal Cord 2008; 46: 547-551.