Depression Anxiety Stress Scale-21 (DASS-21)

Clinical Summary

Jump to: Tool Description | Interpretability | Measurement Property Summary

Tool Description

  • screening tool for identifying, differentiating and assessing depression, anxiety, and stress in patients with SCI.
  • These three negative emotional states: 1) Depression, 2) Anxiety and 3) Stress, represent the test’s 3 subscales.

ICF Domain:

Body Function – Subcategory: Mental Functions.

Number of Items:

21

Brief Instructions for Administration & Scoring

Administration:

  • Self-report format consisting of statements referring to the past week.
  • The reported time to administer is less than 10 minutes.

Equipment: None.

Scoring:

  • 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).
  • Sum the score of each item to get a total score.

Interpretability

MCID: not established
SEM: not established
MDC: not established

  • Higher scores indicate greater levels of distress.
  • Normative data for the general population are available from the DASS manual which must be ordered, however these are based on the full DASS (42 items).
  • For the DASS-21, the following cut-off scores have been recommended for each subscale (subscale scores = sum of item scores):

 

Depression

Anxiety

Stress

Normal

0-4

0-3

0-7

Mild

5-6

4-5

8-9

Moderate

7-10

6-7

10-12

Severe

11-13

8-9

13-16

Extremely severe

14+

10+

17+

  • No normative data have been established for the SCI population
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).

Languages:

Available in English, Portuguese, Arabic and Cantonese.

Training Required:

None, but training in psychological science (emotion, psychopathology and assessment) is helpful. Reading the manual (http://www2.psy.unsw.edu.au/dass/order.htm) is also recommended.

Availability:

See the ‘How to use’ page.

Clinical Considerations

  • 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.
  • Comparison of the DASS-21 to clinical judgment showed that the measure has clinical utility (Mitchell et al. 2007).

Measurement Property Summary

# of studies reporting psychometric properties: 1

Reliability:

No values were reported for the reliability of the DASS-21 for the SCI population.

Validity:

  • Correlation of the DASS-21 Anxiety subscale is excellent with the Brief Symptom Inventory Anxiety subscale (r=0.61)
  • Correlation of the DASS-21 Depression subscale is excellent with the Brief Symptom Inventory Depression subscale (r=0.70).
  • The Depression subscale of the DASS-21 is reported to have a sensitivity of 57.0% and a specificity of 67.0%
  • The Anxiety subscale of the DASS-21 is reported to have a sensitivity of 86.0% and a specificity of 64.0%.

[Mitchell et al. 2008]

Responsiveness:

No values were reported for the responsiveness of the DASS-21 for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the DASS-21 for the SCI population.

Reviewer

Dr. Janice Eng, Christie Chan

Date Last Updated:

Feb 1, 2013