DASS-21 Questionnaire

Depression, Anxiety & Stress Scales

stacked stones representing calm and balance

Instructions

Please read each statement and select the response 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.

This form is sent securely and directly to our clinic team, it is not stored anywhere else, and your responses will only be used to support your care.

Your Name:

For each item, choose the response that best applied to you over the past week: 0 – Did not apply to me at all (never), 1 – Applied to me to some degree, or some of the time (sometimes), 2 – Applied to me to a considerable degree, or a good part of time (often), 3 – Applied to me very much, or most of the time (almost always).

1. I found it hard to wind down

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

2. I was aware of dryness of my mouth

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

3. I couldn't seem to experience any positive feeling at all

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

4. I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

5. I found it difficult to work up the initiative to do things

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

6. I tended to over-react to situations

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

7. I experienced trembling (eg, in the hands)

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

8. I felt that I was using a lot of nervous energy

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

9. I was worried about situations in which I might panic and make a fool of myself

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

10. I felt that I had nothing to look forward to

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

11. I found myself getting agitated

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

12. I found it difficult to relax

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

13. I felt down-hearted and blue

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

14. I was intolerant of anything that kept me from getting on with what I was doing

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

15. I felt I was close to panic

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

16. I was unable to become enthusiastic about anything

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

17. I felt I wasn't worth much as a person

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

18. I felt that I was rather touchy

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

19. I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

20. I felt scared without any good reason

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

21. I felt that life was meaningless

0 – Never 1 – Sometimes 2 – Often 3 – Almost always

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