DASS-21 Assessment

For any questions please contact us at info@midispensary.com.au or call 1300 MI TIME (1300 648 463).

Patient Details

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First Name *

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DASS 21

Instructions – 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. The rating scale is as follows:

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 — 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.

2. I was aware of dryness of my mouth *

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.

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

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.

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

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.

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

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.

6. I tended to over react to situations *

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.

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

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.

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

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.

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

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.

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

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.

11. I found myself getting agitated *

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.

12. I found it difficult to relax *

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.

13. I felt down-hearted and blue *

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.

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

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.

15. I felt I was close to panic *

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.

16. I was unable to become enthusiastic about anything *

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.

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

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.

18. I felt that I was rather touchy *

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.

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 — 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.

20. I felt scared without any good reason *

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.

21. I felt that life was meaningless *

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.

Thank you for submitting your answers, our MiDispensary practitioners will discuss your answers with you in your next appointment.

I declare all answers provided herein are true and accurate to the best of my knowledge and belief.

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