Emotional distress can influence pain, sleep, recovery, motivation, concentration, activity participation, training consistency and confidence with movement.
The Depression Anxiety Stress Scales, commonly called the DASS, were developed to measure three related negative emotional states: depression, anxiety and stress. The DASS-21 is the shorter 21-item version.
The DASS-21 may be useful when a professional needs a structured way to understand current distress symptoms and whether further support or referral may be appropriate.
It is commonly used in:
wellbeing screening
persistent pain monitoring
rehabilitation contexts
research
workplace wellbeing
student wellbeing
general psychological distress monitoring
progress tracking alongside other measures
The DASS-21 should be used within professional scope. Elevated scores should be handled sensitively and may indicate the need for further assessment or referral.
Outcome measure: Depression Anxiety Stress Scales – 21
Abbreviation: DASS-21
Category: Psychological distress screening questionnaire
Type: Self-report symptom severity measure
Number of items: 21
Subscales: Depression, Anxiety and Stress
Items per subscale: 7
Recall period: Previous week
Raw item score: 0–3
DASS-21 scoring rule: Subscale raw scores are multiplied by 2
Higher score means: Greater symptom severity
Key limitation: DASS-21 is not a diagnostic tool
The DASS-21 is the short version of the DASS-42.
It includes three subscales:
Depression
Anxiety
Stress
Each subscale has 7 items.
The client rates how much each statement applied to them over the past week.
The DASS-21 is designed to measure symptom severity, not to diagnose mental health conditions.
The DASS-21 is used because distress symptoms can affect function, recovery, participation and quality of life.
A client may report:
low mood
reduced motivation
anxiety symptoms
panic-like symptoms
irritability
difficulty relaxing
stress overload
sleep disruption
reduced confidence
reduced activity participation
The DASS-21 may help professionals:
establish a baseline distress profile
monitor symptom change over time
identify whether referral may be appropriate
support sensitive wellbeing conversations
compare distress scores with pain, sleep and function
track progress across a support or management period
improve documentation of psychological distress context
The score should be interpreted alongside client discussion, goals, history, risk factors, physical assessment, support networks and professional judgement.
The DASS-21 measures symptoms related to depression, anxiety and stress.
The Depression scale may reflect:
low mood
hopelessness
lack of interest
lack of enjoyment
low motivation
self-devaluation
The Anxiety scale may reflect:
physiological arousal
panic-like symptoms
fear
nervousness
situational anxiety
bodily anxiety symptoms
The Stress scale may reflect:
difficulty relaxing
irritability
tension
agitation
impatience
nervous arousal
It does not directly measure:
clinical diagnosis
suicide risk
trauma symptoms
obsessive-compulsive symptoms
psychosis
bipolar disorder
cause of distress
treatment need
work readiness
sport readiness
The DASS-21 may be useful for:
wellbeing professionals
rehabilitation practitioners working within scope
allied health support teams
exercise professionals using referral-aware screening
movement assessment professionals
workplace wellbeing teams
students learning outcome measures
professionals monitoring distress alongside physical symptoms
It may be relevant for clients with:
persistent pain
stress-related symptoms
anxiety symptoms
low mood symptoms
reduced wellbeing
sleep disruption
reduced confidence
recovery concerns
high life load
reduced participation linked with distress
Use the DASS-21 when you want a structured snapshot of depression, anxiety and stress symptom severity over the past week.
It may be useful at:
baseline wellbeing screening
reassessment
progress review
persistent pain assessment
return-to-training monitoring
workplace wellbeing review
referral-support discussion
follow-up monitoring
It should be used with care and within professional scope.
Use caution when:
the client is in crisis
suicide or self-harm concerns are present
distress is severe or rapidly worsening
the professional is not trained to respond appropriately
the score is being used as a diagnosis
the result is interpreted without discussion
language, literacy or cultural context affects responses
the client is younger than the intended age group for the version used
The DASS-21 should not be used to:
diagnose depression
diagnose anxiety disorders
diagnose stress disorders
assess suicide risk on its own
replace mental health assessment
replace medical assessment
determine treatment need on its own
clear someone for sport or work
replace professional judgement
If a client reports risk of harm, severe distress or concerning symptoms, follow the relevant referral, escalation or emergency process.
You need:
DASS-21 questionnaire
scoring instructions
baseline and retest dates
safe referral pathway if elevated scores occur
appropriate privacy and consent context
Optional related information may include:
sleep notes
pain ratings
fatigue ratings
workload notes
recovery notes
training exposure
support network notes
relevant referral notes
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire asks about symptoms of depression, anxiety and stress over the past week. It does not diagnose a mental health condition, but it can help us understand whether distress may be affecting your wellbeing, recovery or participation.”
The DASS-21 can be completed:
on paper
digitally
independently
verbally if assistance is required
before a session
during reassessment
as part of wellbeing or progress monitoring
Ask the client to:
answer based on the past week
choose how much each statement applied to them
answer every item where possible
avoid overthinking each item
ask for clarification if they do not understand an item
complete the same version at retest
Each item is scored from 0 to 3.
Each subscale has 7 items.
Calculate:
Depression raw score
Anxiety raw score
Stress raw score
Then multiply each subscale raw score by 2 to compare with the DASS-42 severity bands.
Subscales should be interpreted separately rather than combined into one diagnostic label.
Retest at meaningful time points, such as:
baseline
progress review
after a support period
after a major workload or training change
after a symptom flare-up
follow-up monitoring
For consistency, record the same version, date, current context, sleep, workload, major life stressors and whether support or referral has changed.
The DASS-21 asks about distress symptoms. It does not assess suicide risk directly.
If a client reports severe distress, risk of harm, crisis, or safety concerns, do not rely on the DASS-21 alone. Follow appropriate referral, escalation or emergency procedures.
The DASS-21 has three subscales.
Each subscale raw score is multiplied by 2 before severity interpretation.
Normal: 0–9
Mild: 10–13
Moderate: 14–20
Severe: 21–27
Extremely severe: 28+
Normal: 0–7
Mild: 8–9
Moderate: 10–14
Severe: 15–19
Extremely severe: 20+
Normal: 0–14
Mild: 15–18
Moderate: 19–25
Severe: 26–33
Extremely severe: 34+
A higher score may suggest greater current symptom severity in that domain.
Elevated scores may support:
further conversation
monitoring
referral consideration
additional mental health assessment
review of sleep, pain, workload and support factors
A high score does not diagnose a mental health condition.
A lower score may suggest fewer symptoms in the past week.
A low score does not rule out distress, especially if symptoms fluctuate, the client under-reports, or the questionnaire does not capture their main concern.
A DASS-21 score does not prove:
diagnosis
cause of distress
risk level
suicide risk status
treatment need
work readiness
sport readiness
whether one intervention caused the change
Example wording:
“Your DASS-21 results give us a snapshot of depression, anxiety and stress symptoms over the past week. They do not diagnose a condition, but they can help us decide whether further support, monitoring or referral may be useful.”
For general fitness clients, DASS-21 scores may help show whether distress may be influencing sleep, motivation, exercise consistency or recovery.
For athletes, elevated scores may reflect training stress, competition pressure, injury concerns, life load or broader mental health symptoms.
The score should not be used to determine sport readiness on its own.
For older adults, interpretation should consider health status, medication context, social support, pain, sleep, cognitive factors and life changes.
For youth clients, use age-appropriate versions and consider parent/guardian support, school context and referral pathways.
For persistent pain clients, DASS-21 may help monitor distress that interacts with pain, sleep, fatigue, function and participation.
For workplace populations, scores should be interpreted with consideration of workload, role demands, support, safety and occupational health processes.
Meaningful change helps determine whether a score change is likely to matter.
High-quality, universally applicable MCID or MDC values for every DASS-21 population are limited.
DASS-21 change should be interpreted with:
baseline comparison
repeated measurement
symptom discussion
sleep and workload context
support or referral changes
pain and function changes
client goals
professional judgement
A change in score should not be interpreted as proof that one intervention caused improvement or worsening.
The DASS severity bands provide a structured way to describe symptom severity.
However, scores may vary by:
age
population
health context
language
culture
pain status
life stress
sleep
work or study load
timing of assessment
Practical comparison guidance:
interpret each subscale separately
use the multiplied score for severity bands
compare with the client’s own baseline
consider context over the past week
avoid treating severity bands as diagnosis
use elevated scores to guide conversation and referral where appropriate
The DASS-21 is widely used and has been validated across many populations and languages.
Research supports the DASS-21 as a reliable measure of depression, anxiety and stress symptom severity, though factor structure and interpretation may vary across populations.
Reliability and validity are strongest when:
the correct version is used
the same version is repeated
all items are completed
the client understands the scale
scoring rules are followed correctly
scores are interpreted within context
referral processes are available for elevated scores
Interpret cautiously when:
many items are missing
language or cultural context affects responses
the client is in crisis
symptoms are complex or severe
the score is used without discussion
the result is used as a diagnosis
Common errors include:
treating DASS-21 as a diagnosis
forgetting to multiply subscale scores by 2
combining subscales into one unsupported diagnostic label
ignoring severe or extremely severe scores
using it without a referral pathway
interpreting scores without client discussion
ignoring suicide or safety concerns
using it outside professional scope
Limitations include:
self-report can be influenced by willingness to disclose
it captures the past week only
it does not assess suicide risk directly
it does not diagnose mental health conditions
it does not assess all mental health concerns
severity bands are not diagnostic thresholds
it should not replace mental health assessment where needed
The DASS-21 may help professionals:
document baseline distress symptoms
monitor depression, anxiety and stress symptom severity
support referral conversations
identify when further support may be appropriate
understand how distress may relate to pain, sleep, training or participation
track change over time
improve whole-person assessment reasoning
For persistent pain and rehabilitation contexts, the DASS-21 can help identify whether emotional distress may be interacting with recovery, activity tolerance or participation.
For workplace and sport contexts, it can support screening and monitoring, but results should be handled confidentially and within appropriate professional boundaries.
The DASS-21 measures symptoms related to depression, anxiety and stress over the past week.
The DASS-21 has 21 items, with 7 items for each subscale.
Each item is scored from 0 to 3. Each subscale raw score is summed and multiplied by 2 before using severity bands.
No. The DASS-21 measures symptom severity but does not diagnose mental health conditions.
A high score may indicate greater symptom severity and may support further conversation, monitoring or referral.
No. It does not directly assess suicide risk. Safety concerns require appropriate assessment and escalation.
Yes. Depression, Anxiety and Stress should be interpreted as separate but related domains.
It can be repeated at baseline, reassessment, progress review and follow-up, especially when monitoring change over time.
DASS-21 is a 21-item self-report measure.
It measures depression, anxiety and stress symptom severity over the past week.
Each subscale has 7 items.
Raw subscale scores are multiplied by 2 before severity interpretation.
DASS-21 does not diagnose mental health conditions.
It does not assess suicide risk directly.
Elevated scores should be handled sensitively and within professional scope.
Interpretation is strongest when combined with discussion, context, support pathways and professional judgement.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. https://doi.org/10.1037/1040-3590.10.2.176
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales: Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239. https://doi.org/10.1348/014466505X29657
Lovibond, P. F., & Lovibond, S. H. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation of Australia.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
Osman, A., Wong, J. L., Bagge, C. L., Freedenthal, S., Gutierrez, P. M., & Lozano, G. (2012). The Depression Anxiety Stress Scales-21: Further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology, 68(12), 1322–1338. https://doi.org/10.1002/jclp.21908
