Depression, Anxiety, Stress Scale-21 (DASS-21)

Using 21 items rated on a four-point Likert scale (ranging from 0 [did not apply to me at all] to 3 [applied to me very much or most of the time]), the DASS-21 assesses three types of psychological distress: stress (seven items), anxiety (seven items), and depression (seven items). Example items for the DASS-21 are “I found it hard to wind down” (for stress), “I was aware of dryness of my mouth” (for anxiety), and “I could not seem to experience any positive feeling at all” (for depression). The item scores are summated in each subscale to indicate the level of psychological distress, where higher scores indicate a higher level of depression, anxiety, or stress. The psychometric properties of the DASS-21 and the Chinese DASS-21 have been found to be good [23, 24]. Moreover, DASS-21 was recently used to assess the mental health of the general population [2, 3], workforce [25], patients with mental illness [26, 27], schoolchildren [28], and healthcare workers [29, 30]. The present study found that the Chinese DASS-21 had good internal consistency (α = 0.82 for stress subscale; 0.79 for anxiety subscale; and 0.84 for depression subscale).