• 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.

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.
  • Two studies have 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).

ICF Domain

Body Function ▶ Mental Functions


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

Number of Items





  • 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.


Available in English, Portuguese, Arabic and Cantonese

Training Required

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


Can be found here. 

The file above contains the scale items and scoring instructions.

# of studies reporting psychometric properties: 2


  • 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).
  • 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+

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI


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


  • Correlation of the DASS-21 Anxiety subscale is High with the Brief Symptom Inventory Anxiety subscale (r = 0.61).
  • Correlation of the DASS-21 Depression subscale is High 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)


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.


Dr. Ben Mortenson, Jeremy Mak, John Zhu

Date Last Updated

22 August 2020

Kilic SA, Dorstyn DS, Guiver NG. Examining factors that contribute to the process of resilience following spinal cord injury. Spinal Cord. 2013;51(7):553-7.

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995a; 33: 335–342.

Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales, 2nd edn. Psychology Foundation of Australia: Sydney, 1995b.

Mitchell MC, Burns NR, Dorstyn DS. Screening for depression and anxiety in spinal cord injury with DASS-21. Spinal Cord 2008; 46: 547-551.