DASS	
       Name:  <PtFullName>	Date: <TodaysDate>   Doctor: <DrName> 	
	Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week.  There are no right or wrong answers.  Do not spend too much time on any statement.	
	The rating scale is as follows:
0  Did not apply to me at all
1  Applied to me to some degree, or some of the time
2  Applied to me to a considerable degree, or a good part of time
3  Applied to me very much, or most of the time
	
1	I found myself getting upset by quite trivial things		S	
2	I was aware of dryness of my mouth		A	
3	I couldn't seem to experience any positive feeling at all		D	
4	I experienced breathing difficulty (eg, excessively rapid breathing,
breathlessness in the absence of physical exertion)		A
	
5	I just couldn't seem to get going		D	
6	I tended to over-react to situations		S	
7	I had a feeling of shakiness (eg, legs going to give way)		A	
8	I found it difficult to relax		S	
9	I found myself in situations that made me so anxious I was most
relieved when they ended		A
	
10	I felt that I had nothing to look forward to		D	
11	I found myself getting upset rather easily		S	
12	I felt that I was using a lot of nervous energy		S	
13	I felt sad and depressed		D	
14	I found myself getting impatient when I was delayed in any way
(eg, lifts, traffic lights, being kept waiting)		S
	
15	I had a feeling of faintness		A	
16	I felt that I had lost interest in just about everything		D	
17	I felt I wasn't worth much as a person		D	
18	I felt that I was rather touchy		S	
19	I perspired noticeably (eg, hands sweaty) in the absence of high
temperatures or physical exertion		A
	
20	I felt scared without any good reason		A	
21	I felt that life wasn't worthwhile		D	

DASS 21 SCORE

DEPRESSION SCORE	ANXIETY SCORE	STRESS SCORE	

	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 +	

  

  
 
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