Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample

Abstract

The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS–21 ) were examined in nonclinical volunteers (
n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (
n =  67), obsessive-compulsive disorder (
n = 54), social phobia (
n = 74), specific phobia (
n = 17), and major depressive disorder (
n = 46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS–21. In addition, the internal consistency and concurrent validity of the DASS and DASS–21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Full text

Psychological
Assessment
1998. Vol.
10,
No. 2.
176-181
Copyright 1998
by the
American
Psychological
Association,
Inc.
1040-3590/984
VOO
Psychometric
Properties
of the
42-Item
and
21-Item
Versions
of the
Depression
Anxiety
Stress
Scales
in
Clinical
Groups
and
a
Community
Sample
Martin
M.
Antony
Clarke
Institute
of
Psychiatry
and
University
of
Toronto
Peter
J.
Bieling
Clarke Institute
of
Psychiatry
and
University
of
Pennsylvania
Brian
J. Cox and
Murray
W.
Enns
University
of
Manitoba
Richard
P.
Swinson
Clarke Institute
of
Psychiatry
and
University
of
Toronto
The
factor structure, reliability,
and
validity
of the
Depression
Anxiety
Stress
Scales
(DASS;
S. H.
Lovihond
& P. F.
Lovibond,
1995)
and
the
21-item
short
form
of
these measures
(DASS-21)
were
examined
in
nonclinical
volunteers
(n
=
49) and
patients with
Diagnostic
and
Statistical
Manual
of
Mental Disorders (4th ed.; American Psychiatric Association, 1994)
diagnoses
of
panic
disorder
(n
=
67),
obsessive-compulsive
disorder
(n =
54), social phobia
(n =
74), specific phobia
(n =
17),
and
major
depressive
disorder
(n -
46). This study replicates previous findings indicating that
the
DASS
distinguishes
well
between
features
of
depression,
physical
arousal,
and
psychological
tension
and
agitation
and
extends
these
observations
to
the
DASS-21.
In
addition,
the
internal
consistency
and
concurrent
validity
of the
DASS
and
DASS-21
were
in the
acceptable
to
excellent
ranges. Mean
scores
for the
various
groups
were
similar
to
those
in
previous
research,
and in the
expected
direction.
The
implications
of
these
findings
are
discussed.
Although anxiety
and
depression
are
generally believed
to be
distinct
from one
another, anxiety
and
mood
disorders
often
co-
occur (Sanderson,
Di
Nardo, Rapee,
&
Barlow,
1990),
and
scores
from
various
instruments
designed
to
measure each
of
these states tend
to be
highly
intercorrelated
(Clark
&
Watson,
1991).
These
two
consistent
findings
have
led
several theorists
to
develop models
to
help explain
the
overlap between anxi-
ety and
depression.
For
example,
in
their tripartite model
of
anxiety
and
depression,
Clark
and
Watson
(1991)
suggested
that
anxiety
and
depression have both shared
and
unique fea-
tures.
Although both states
are
characterized
by
symptoms
of
elevated negative
affect
(e.g.,
distress,
irritability),
they
differ
with
respect
to the
presence
of
positive
affect
(e.g.,
happiness,
confidence,
enthusiasm)
and
physiological
hyperarousal.
Spe-
Martin
M.
Antony, Anxiety
Disorders
Clinic,
Clarke
Institute
of
Psy-
chiatry,
Toronto, Ontario,
Canada,
and
Department
of
Psychiatry, Univer-
sity
of
Toronto, Toronto, Ontario, Canada;
Peter
J.
Bieling, Anxiety
Disorders Clinic, Clarke Institute
of
Psychiatry, Toronto, Ontario, Can-
ada,
and
Center
for
Cognitive Therapy, University
of
Pennsylvania; Brian
J. Cox and
Murray
W.
Enns, Department
of
Psychiatry, University
of
Manitoba,
Winnipeg,
Manitoba.
Canada;
Richard
P.
Swinson, Anxiety
Disorders
Clinic,
Clarke
Institute
of
Psychiatry, Department
of
Psychia-
try,
University
of
Toronto,
Toronto, Ontario,
Canada.
Richard
P.
Swinson
is now at
Department
of
Psychiatry,
McMaster
University, Hamilton, Ontario, Canada.
Correspondence
concerning this article should
be
addressed
to
Martin
M.
Antony,
who is now at the
Department
of
Psychology,
St.
Joseph's
Hospital,
50
Charlton
Avenue
East,
Hamilton,
Ontario
L8N
4A6, Canada.
Electronic
mail
may be
sent
to
mantonv@stjosham.on.ca.
cifically,
Clark
and
Watson
(1991)
proposed that
low
levels
of
positive
affect
are
unique
to
depression,
and
physiological
hyperarousal
is
unique
to
anxiety. This tripartite view
has
been
supported
in a
variety
of
studies, including
a
factor analytic
study
by
Watson
et
al.
(1995)
in
which three separate variables
(general distress, anhedonia
vs.
positive
affect,
and
somatic anx-
iety
)
were
found.
Traditional
measures have failed
to
distinguish
well
between
anxiety
and
depression.
The
popular Hamilton scales
for
anxiety
(Hamilton, 1959)
and
depression (Hamilton,
I960)
have been
shown
to
overlap greatly
in
content
and to
correlate
with
one
another quite highly (Clark,
1989;
Moras,
Di
Nardo,
&
Barlow,
1992).
In
addition,
our
findings
(Bieling, Antony,
&
Swinson,
in
press) suggested
that
the
trait version
of the
State-Trait
Anxiety
Inventory
(STAI-T;
Spielberger, 1983)
is at
least
as
sensitive
to
symptoms
of
depression
as it is to
symptoms
of
anxiety.
Finally,
although
the
Beck
Anxiety
Inventory
(BAI;
Beck
&
Steer,
1990)
may
overlap
less
with measures
of
depression com-
pared with other anxiety measures (Beck, Epstein, Brown,
&
Steer,
1988),
we
have argued elsewhere
(Antony,
Swinson, Pur-
don,
&
Downic. 1997; Cox,
Cohen,
Dircnfcld,
&
Swinson,
1996)
that this instrument
has
limitations
as a
measure
of
general
anxiety,
primarily because
the
items tend
to
overlap almost
ex-
clusively with
the
panic attack symptoms
and do not
adequately
capture
other important features
of
anxiety,
such
as
worry, agita-
tion,
and
muscle tension.
The
Depression Anxiety
Stress
Scales
(DASS;
S. H.
Lovi-
bond
& P. F.
Lovibond,
1995)
may
hold more promise
for
distin-
guishing
between
anxiety
and
depression,
as
well
as
between
symptoms
of
physical arousal
and
symptoms
of
generalized
176

BRIEF
REPORTS
177
anxiety
(e.g., tension
or
agitation).
Factor analytic
studies
with
nonclinical
(P. F.
Lovibond
& S. H.
Lovibond,
1995)
and
clini-
cal
samples (Brown,
Chorpita,
Korotitsch,
&
Barlow, 1997)
have confirmed that
the
DASS items
can be
reliably grouped
into
three
scales:
(a)
Depression
(DASS-D),
(b)
Anxiety
(DASS-A),
and (c)
Stress
(DASS-S).
The
Depression
scale
includes items that measure symptoms typically
associated
with
dysphoric
mood (e.g., sadness
or
worthlessness).
The
Anxiety
scale, like
the
BAI,
includes items that
are
primarily related
to
symptoms
of
physical arousal, panic attacks,
and
fear
(e.g.,
trembling
or
faintness).
Finally,
the
Stress scale includes items
that
measure symptoms such
as
tension, irritability,
and a
ten-
dency
to
overreact
to
stressful
events—symptoms
that
are not
assessed
by the
BAI.
To
date, there
are
only
two
published articles addressing
the
psychometric
properties
of the
DASS (Brown
et
al.,
1997;
P. F.
Lovibond
& S. H.
Lovibond,
1995).
Together, these studies sug-
gest
that
the
DASS
has
excellent internal
consistency
and
tempo-
ral
stability
and
provides
a
better
separation
of the
features
of
anxiety
and
depression, relative
to
other existing measures.
The
present study aimed
to
replicate
and
expand
on
previous
studies
of the
DASS.
In
addition
to
replicating analyses
of the
factor
structure, internal consistency,
and
concurrent validity
of
the
DASS,
the
present
study
differs
from
previous studies
in
several
ways. First,
all
patients were diagnosed according
to
Diagnostic
and
Statistical
Manual
of
Mental
Disorders
(4th
ed.;
DSM-fV,
American Psychiatric Association, 1994) criteria
rather
than
DSM-III-R
(3rd
ed.,
rev.;
American
Psychiatric
Association, 1987) criteria,
as was the
case
in
previous studies
(e.g..
Brown
et
al.,
1997).
Second,
this
is the first
study
to
include several clinical groups
as
well
as a
comparison group
of
nonclinical controls. Finally, whereas previous studies have
only
reported
the
psychometric
properties
of the
42-item DASS,
the
present
study
also provides analyses based
on the
21-item
version
(DASS-21).
Method
Participants
were
outpatients
diagnosed
with
panic
disorder
with
or
without
agoraphobia
(«
= 67;
M
age =
36.8 years;
64%
female),
obses-
sive-compulsive
disorder
(n
=
54; M age =
36.4
years;
43%
female),
social
phobia
(n = 74; M age
=
35.0
years;
44%
female), specific
phobia
(n = 17; M age =
34.3
years;
78%
female),
or
major
depressive
disorder
(n = 46; M age =
44.9 years;
46%
female).
A
group
of
nonclinical
volunteers
(n
=
49; M age =
28.4 years;
61%
female)
served
as a
comparison
group.
All
participants
provided
informed
consent
and
were
required
to be
between
the
ages
of 18 and 65
years.
Patients
with
current
diagnoses
of
substance
abuse—dependence,
psychotic
disorder,
or
bipolar
disorder
were
excluded
from the
database.
Diagnoses
in the
patient
groups
were
based
on the
Structured
Clinical
Interview
for
DSM-/K(SCID-IV;
First,
Spitzer,
Gibbon,
&
Williams,
1996).
Partici-
pants
in the
nonclinical volunteers group
received
a
telephone
interview
that
was
based
on the
screening
questions
from
the
SCID-IV
to
ensure
that they
did not
have
a
history
of any of the
major forms
of
psychopathology.
Participants
completed
the
DASS
as
well
as
several
other
self-report
measures
(described
below).
In
addition
to the
42-item
DASS,
S. H.
Lovibond
and P. F.
Lovibond
(1995)
suggested
that
a
subset
of
these
items
(seven
from
each
subscale)
can be
administered
as a
short
version.
The
items
that constitute this 21-item
measure
(DASS-21)
ate
listed
in
the
DASS manual,
although
no
data
on the
psychometric
properties
of
the
DASS-21
have
been
published.
Totals
for
each
scale
on the
DASS-21
are
doubled,
so
that
they
are
comparable
to
those
for the 42-
item DASS.
In the
present
study,
participants
completed
the
DASS
and
the
appropriate
items were
extracted
for
analyses
of the
DASS-21.
Tb
assess
concurrent
validity
of
the
DASS,
participants
also
completed
the
BAI,
Beck
Depression
Inventory
(BDI;
Beck,
Rush,
Shaw,
&
Emery,
1979),
and
STAI-T.
The BAI
(Beck
&
Steer, 1990)
is a
21-item
scale
designed
to
measure
symptoms
of
clinical
anxiety
(e.g.,
"heart
pounding
or
racing"
or
"fear
of
losing
control")
and has
been
shown
to
have
good
psychometric
properties
(Beck,
Epstein,
Brown,
&
Steer,
1988).
The BDI is a
widely used
measure
of
depressive
sytnptomology,
created
in
1961
(Beck,
Ward,
Mendelson,
Mock,
&
Erbaugh,
1961)
and
revised
in
1979 (Beck
et
al.,
1979)
to its
current form.
It is a
21-item scale
derived from
clinical
observations
and
appears
to be a
reliable
and
valid
measure
of
depression
(Beck,
Steer,
&
Garbin,
1988).
Finally,
the
STAI-T
(derived from
the
larger
STAI
Scale,
Form
Y)
measures
a
stable
propensity
to
experience
anxiety
and
tendencies
to
perceive
stressful
situations
as
threatening!
Test-retest
reliabilities
for the
STAI-T
are
high, ranging from
.73 to
.86.
Concurrent
validity with
other
anxiety
questionnaires
ranges
from
.73 to .85
(Spielberger,
1983).
The
STAI-T
was not
included
in the
package
completed
by
individuals
in
the
major
depressive
disorder
group;
findings
that
are
based
on
this
measure
are
only
reported for the
anxiety
disorders
and
nonclinical
volunteers
groups.
Results
and
Discussion
Factor
Analyses
DASS.
We
used
an
exploratory
factor
analysis
to
examine
the
structure
of the
DASS
in the
entire clinical sample
(N =
258), excluding
the
nonclinical controls.
We
used principal
components
extraction,
and the
number
of
factors
was
deter-
mined
by
eigenvalues
and the
scree test
(Cattell,
1966).
These
criteria
suggested
a
three-factor solution (eigenvalues 18.92,
4.24,
and
2.06),
accounting
for 60% of the
variance.
We
applied
an
oblimin
rotation
to
this initial solution. Previous research
and
theory suggest that
the
three
scales,
and the
constructs they
are
designed
to
measure,
are
correlated
(P. F.
Lovibond
& S. H.
Lovibond,
1995). Thus,
a
factor solution that
was
based
on a
nonorthogonal
rotation
was
likely
to
result
in a
more
interpret-
able
simple
structure. Correlations among factors were similar
to
those
in
previous research
(P. F.
Lovibond
& S. H.
Lovibond,
1995),
with
Stress
and
Depression factors correlating
at
.60,
Stress
and
Anxiety
correlating
at
.55,
and
Anxiety
and
Depres-
sion correlating
at
.40.
The
factor
loadings
for
each item
are
displayed
in
Table
1.
Items with loadings
of .30 or
greater were considered
to
load
on
a
particular
factor.
The first
factor corresponded
to the
DASS-S
scale,
with
all
14
items that make
up
this scale loading
on the
first
factor.
Two
items
on the
DASS-S
scale
had a
complex
structure,
also loading
on the
anxiety
factor.
The
second
factor
paralleled
the
DASS-D
scale. Each
of the 14
items loaded
on
this
factor,
and no
items
had
complex
loadings.
The final
factor
corresponded
to the
DASS-A
scale.
All but one of the 14
items
that make
up the
DASS-A
scale loaded
on
this
factor.
The one
item
on the
Anxiety
scale
('
'I
feared that
I
would
be
thrown
by
some trivial
but
unfamiliar
task'')
that
did not
load
on
this
factor
had a .32
loading
on the
Stress
factor.
One
additional

178
BRIEF
REPORTS
Table
1
Items
and
Factor
Loadings
for the
Depression
Anxiety
Stress
Scale
(DASS)
Items
Item
and
item
no.
(in
parentheses)
DASS Stress scale
I
found myself getting upset
by
quite trivial things (1).
I
found
myself getting upset
rather
easily
(11).
I
found that
I was
very irritable (27).
I
found
myself getting agitated (39).
I
felt
I was
rather touchy (18).
I was
intolerant
of
anything that kept
me
from
getting
on
with what
I
was
doing (35).
I
tended
to
over-react
to
situations (6).
I
found
myself getting impatient when delayed
in any way
(e.g.,
. . .)
(14).
I
found
it
difficult
to
relax (8).
I
found
it
hard
to
calm down after something upset
me
(29).
I
found
it
difficult
to
tolerate
interruptions
to
what
I was
doing (32).
I
felt
that
I was
using
a lot of
nervous energy (12).
I
found
it
hard
to
wind down (22).
I was in a
state
of
nervous tension (33).
DASS Depression scale
I
could
see
nothing
to be
hopeful
about (37).
1
felt
that
life
was
meaningless (38).
I
felt
that
I had
nothing
to
look forward
to
(10).
I
felt
I was
pretty worthless (34).
I
felt
that
life
wasn't worthwhile (21).
I was
unable
to
become enthusiastic about anything (31).
I
felt
I
wasn't worth much
as a
person (17).
I
felt
I had
lost interest
in
just about everything
(16).
I
couldn't
seem
to
experience
any
positive feeling
at all
(3).
I
felt
down-hearted
and
blue (26).
I
couldn't
seem
to get any
enjoyment
out of the
things
I did
(24).
I
felt
sad and
depressed (13).
I
found
it
difficult
to
work
up the
initiative
to do
things (42).
I
just couldn't seem
to get
going (5).
DASS Anxiety scale
I
experienced trembling (41).
I had a
feeling
of
shakiness
(e.g.,
. . .)
(7).
I had a
feeling
of
faintness (15).
I
experienced breathing
difficulty
(e.g
)
(4).
1
was
aware
of the
action
of my
heart
in the
absence
of
physical
exertion (e.g.,
. . .)
(25).
I
felt
I was
close
to
panic (28).
I had
difficulty
in
swallowing (23).
I
felt
scared without
any
good reason (20).
I
felt
terrified (36).
I was
worried about situations
in
which
I
might panic
and
make
a
fool
of
myself (40).
I was
aware
of
dryness
of
mouth (2).
I
found
myself
in
situations which made
me so
anxious
I was
most
relieved
when
they ended (9).
I
perspired noticeably
in the
absence
of
high temperatures
or
physical
exertion (19).
I
feared that
I
would
be
"thrown"
by
some trivial
but
unfamiliar task
(30).
Factor
1
.821
.809
.771
.762
.748
.742
.691
.620
.600
.599
.592
.572
.518
.428
.107
.070
.004
.048
-.005
.021
.024
.039
-.041
-.149
-.126
-.205
-.165
-.110
-.183
-.083
-.173
.104
.131
.260
.035
.161
.146
.184
.060
.419
.193
.316
Factor
2
-.015
-.126
-.199
-.022
-.157
.027
-.076
-.000
-.076
-.131
-.075
.014
-.007
-.088
.951
.946
.896
.875
.879
.856
.844
.837
.835
.768
.730
.678
.631
.570
-.189
-.096
-.025
.136
.086
.032
-.009
-.078
-.167
-.018
-.074
.038
-.049
-.129
Factor
3
-.098
-.080
-.143
.082
-.074
.006
.083
.104
.177
.106
.111
.245
.312
.373
-.028
.023
.030
-.043
.040
-.081
-.027
-.123
-.050
.032
-.005
.026
.003
.044
.813
.812
.783
.731
.694
.655
.615
.597
.595
.526
.525
.417
.366
.276
Note.
From
Manual
for the
Depression Anxiety Stress Scales (2nd
ed.),
by S, H.
Lovibond
and P, F.
Lovibond, 1995, Sydney, Australia: Psychology Foundation
of
Australia.
The
DASS items
are in the
public
domain. Item numbers
do not
correspond
to the
item numbers reported
by
Brown
et
al.
(1997).
The
present
study
used
the
questionnaire provided with
the
DASS manual
(S. H.
Lovibond
& P. F.
Lovibond, 1995),
whereas Brown
et al.
(1997)
used
an
earlier
version
with
a
different
item order
(T. A.
Brown
& P. F.
Lovibond, personal
communication,
May
1997).
Factor loadings >.30
are
presented
in
boldface type.

BRIEF
REPORTS
179
Table
2
hems
and
Factor Loadings
for the
Depression Anxiety Stress
Scale-21
(DASS-21)
Items
Item
and
item
no.
Factor Factor Factor
(in
parentheses)
123
DASS-21
Stress scale
I was
intolerant
of
anything that kept
me from
getting
on
with what
I was
doing
(14).
.839 -.011 -.094
I
felt
I was
rather touchy (18).
.806 .131
-.113
I
found
it
difficult
to relax
(12). .694 .030 .149
I
found
myself getting
agitated
(11).
.682 .114 .125
I
felt
that
1 was
using
a lot of
nervous energy (8).
.671
—.054
.183
I
found
it
hard
to
wind down (I). .645
-.054 .256
I
tended
to
over-react
to
situations (6).
.523 .199 .192
DASS-21
Depression
scale
I
felt
that life
was
meaningless (21).
I
felt
that
I had
nothing
to
look forward
to
(10).
I
couldn't seem
to
experience
any
positive feeling
at all
(3).
I was
unable
to
become enthusiastic about anything (16).
I
felt
that
I
wasn't worth much
as a
person (17).
1
felt
down-hearted
and
blue (13).
I
found
it
difficult
to
work
up the
initiative
to do
things (5).
DASS-21
Anxiety scale
I was
aware
of the
action
of my
heart
in the
absence
of
physical exertion
(e.g.,
. . .)
(19).
I
experienced
breathing
difficulty
(e.g.,
. . .)
(4).
I
experienced trembling
(e.g.,
in the
hands) (7).
I
felt
I was
close
to
panic (15).
I
felt
scared
without
any
good reason (20).
.1
was
worried about situations
in
which
I
might panic
and
make
a
fool
of
myself (9).
I was
aware
of
dryness
of my
mouth (2).
-.025
-.071
-.046
.033
.013
.102
.323
.011
-.023
-.151
.236
.167
.176
.123
.906
.898
.858
.849
.802
.784
.550
-.092
-.103
.230
.041
.133
.035
.018
-.076
.059
.121
.034
-.002
.021
-.120
.820
.805
.768
.660
.583
.543
.483
Note.
From Manual
for the
Depression Anxiety Stress Scales (2nd
ed.j,
by S. H.
Lovibond
and P. F.
Lovibond,
1995, Sydney, Australia: Psychology Foundation
of
Australia.
The
DASS items
are in the
public
domain. Items
are
based
on
item numbers
on the
DASS-21
provided with
the
DASS manual
(S. H.
Lovibond
& P. F.
Lovibond,
1995).
Factor loadings
>,30
are
presented
in
boldface
type.
item
("I
found
myself
in
situations which made
me so
anxious
DASS
and the
DASS-21
displayed
excellent
factor
structures,
I was
most relieved when they
ended")
loaded
on
both
the the
DASS-21
solution
was
somewhat more
interpretable
in
Anxiety
and
Stress
factors. Overall,
the
factor
structure
in the
terms
of
lower
intercorrelations
of
factors, higher mean load-
present sample
was
comparable with that
found
in
other studies, ings,
and
fewer
cross-loading
items,
and
those
items
with
complex
loadings
have been similarly iden-
tifi™i™1SVBrT1
"?"t
1997)'
t
™oc
,
Reliability
and
Concurrent
Validity
DASS-21.
To
evaluate
the
factor structure
of
the
DASS-21,
}
we
performed exploratory factor analysis with principal
compo-
To
assess
the
internal consistency
of the
DASS
and
DASS-21
nents
on the
DASS-21
items
in the
clinical sample
(N =
258).
Scales
in the
entire sample, Cronbach's alphas were computed.
As
in the
DASS analysis, oblimin rotation
was
used
to
derive Cronbach's alphas
for
the
DASS Depression,
Anxiety,
and
Stress
the
best simple structure. Both
the
scree
plot
and
eigenvalues
subscales
were .97, .92,
and
.95, respectively. Cronbach's alphas
greater than
one
suggested
a
three-factor solution (eigenvalues
for the
DASS-21
subscales were
.94 for
Depression,
.87 for
9.07, 2.89,
and
1.23), accounting
for 67% of the
variance.
In
Anxiety,
and .91 for
Stress.
the final
solution,
the
Stress
and
Depression
factors were
corre-
Tb
examine
the
concurrent validity
of the
DASS
and
DASS-21
lated
at
.48, Stress
and
Anxiety were correlated
at
.53,
and
Scales, correlations
with
other measures
of
depression
and
anxiety
Anxiety
and
Depression were correlated
at
.28. These between- were
computed.
Correlations between
the
various DASS
and
factor
correlations were somewhat lower
in
magnitude than
the
DASS-21
Scales
and the
BDI,
BAI,
and the
STAI-T
were corn-
correlations
for the
entire item set.
puted
in the
clinical sample.
The
resulting correlation
coefficients
The
factor loadings
for
each item
of the
DASS-21
are
dis-
are
displayed
in
Table
3. The
DASS-S
scale correlated
to a
moder-
played
in
Table
2.
Overall,
the
factor structure
of the
DASS-21
ately
high level
with
measures
of
depression
and
anxiety.
As ex-
was
very
similar
to the
larger pool
of
items. Although both
the
pected,
the
DASS-D
scale correlated most highly
with
another

180
BRIEF
REPORTS
Table
3
Correlations
of the
Depression Anxiety Stress Scale
(DASS)
and
21-ltem
DASS
(DASS-21)
Subscales
With
Other Measures
of
Anxiety
and
Depression
in
Clinical Patient Groups
DASS
and
DASS-21
subscales
Measure
DASS-S
DASS-D
DASS-A
DASS-D
DASS-A
BDI
BAI
STAI-T
.63
.74
.62
.64
.59
_
.44
.77
.42
.65
—
.57
.84
.44
DASS21-S
DASS2I-D
DASS21-A
DASS2I-D
DASS21-A
BDI
BAI
STAI-T
.57
.72
.69
.70
.68
.46
.79
.51
.71
.62
.85
.55
Note,
Analyses
did not
include
individuals
in the
nonclinical
volunteer
group.
Because
patients
in the
major
depressive
disorder
group
did not
complete
the
STAI-T, analyses
for
this
measure
are
based
on the
anxiety
disorder
groups
only.
Data
collection
with
the
ASI
did not
begin
until
this
study
was
underway,
so findings
derived
from
this
measure
are
based
on a
subset
of the
anxiety
disorder
patients
only
(n
=
85).
DASS-
S =
DASS
Stress
scale;
DASS-D
=
DASS
Depression
scale;
DASS-
A
=
DASS
Anxiety
scale;
BDI
=
Beck
Depression
Inventory;
BAI =
Beck
Anxiety
Inventory;
STAI-T
=
State-Trait
Anxiety
Inventory-
Trait
version.
measure
of
depression
and
moderately with
the
anxiety measures.
Finally,
the
DASS-A
scale
correlated
most
highly
with
the BAI
and
was
moderately
correlated
with
the
STAI-T.
Indeed,
the
STAI-T
correlated
most strongly with
DASS-D
(r =
.65), sug-
gesting that
the
STAI-T
scale
may
contain items
that
assess
de-
pression
in
addition
to
anxiety. This pattern
of
results
was
very
similar
for the
DASS-21
Scales.
Although there were some
changes
in
magnitude,
the
relative strength
of the
relationships
of
the
DASS-21
scales
to
these other measures
of
anxiety
and
depres-
sion were virtually unchanged.
Comparing
DASS
and
DASS-21
Scores
Across
Groups
To
compare
DASS
and
DASS-21
scores
across groups,
we
conducted
a
series
of
one-way analyses
of
variance
(ANOVAs).
Five diagnostic groups
(panic
disorder,
obsessive-compulsive
disorder,
social
phobia, specific phobia,
and
major depressive
disorder),
as
well
as the
nonclinical volunteers group were com-
pared.
As
indicated
in
Table
4, the
pattern
of
findings
was
identi-
cal for the
DASS
and
DASS-21.
For all
three subscales,
the
overall
ANO\As
were
significant
and
were followed
up
with
Duncan's multiple-range
tests.
Overall,
patients
in the
major
depressive
disorder
condition
tended
to
score
highest
on the
Depression
and
Stress
subscales,
whereas
individuals
in the
panic
disorder
group
scored
highest
on the
Anxiety subscale.
Individuals
in the
nonclinical volunteers group scored lower
on
all
three
subscales
than individuals
in all of the
clinical groups.
Conclusion
The
present
study confirms
previous
findings
indicating that
the
DASS
is a
reliable
and
valid method
of
assessing features
Table
4
Comparison
of
Diagnostic Groups
and
Controls
on the
Depression Anxiety Stress Scale
(DASS)
and
21-ltem DASS (DASS-21) Scale
Subscale
PD
OCD
sex:
SP
MOD
NCV
DASS
Stress
M
SD
Depression
M
SD
Anxiety
M
SD
20.27,
10.82
12.76,
9.47
16.19,
9.96
17.57.
„
10.67
13.43.
11.51
8.80k
6.69
17.07..b
10.36
13.20,
8.94
11.22C
8.90
14.18,,
11.17
10.59,
10.72
6.35b
6.13
25.54C
9.03
29.74,
8.42
12.85C
8.67
4.12a
3.81
2.18C
2.83
1.43d
1.86
26.60*
46.25»
22.13*
.31
.43
.27
DASS-21
Stress
M
SD
Depression
M
SD
Anxiety
M
SD
20.00,
11.60
12.75.
10.15
18.72,
10.77
17.59.,b
10.98
13.30.
11.83
9.26.
7.56
16.57.,,
10.91
13.19.
9.28
12.22,
10.20
13.29b
11.85
10.82,
11.25
6.59b
6.59
24.30,
9.84
9.18
14.04C
9.78
3.51,,
3.78
2.12,
3.64
1.22d
1.77
23.36*
42.30*
24.86*
.28
.41
.29
Note.
PD =
panic
disorder
with
or
without
agoraphobia;
OCD =
obsessive-compulsive
disorder;
SOC
=
social
phobia;
SP
=
specific
phobia;
MDD
—
major
depressive
disorder;
NCV =
nonclinical
volunteers.
Means
sharing
the
same
subscripts
(across
groups)
do not
differ
at p <
.05.
*p
<
.001.

BRIEF
REPORTS
181
of
depression, anxiety,
and
tension-stress.
The
present
findings
are
also
somewhat consistent with
the
tripartite model
of
anxiety
and
depression described
earlier
(Clark
&
Watson,
1991).
Spe-
cifically,
the
DASS-D
scale appears
to
measure features that
are
unique
to
depression
(low positive
affect),
the
DASS-A
scale measures features proposed
to be
unique
to
anxiety
(physi-
cal
hyperarousal),
and the
DASS-S
scale
measures features
of
both anxiety
and
depression (e.g., tension
or
irritability).
This
view
is
supported
by the
observation that
DASS-S
scores
were
elevated across anxious
and
depressed
groups, whereas
DASS-D
scores
were
elevated
only
in
depressed
patients. Less
consistent
with this
view
was the finding
that depressed patients
had
moderately elevated
DASS-A
scores,
second
only
to pa-
tients
in the
panic disorder group. According
to the
tripartite
model,
DASS-A
scores
might have been
expected
to be
lower
in
the
depressed
group than
in the
various anxiety disorders
groups.
In
summary,
the
DASS appears
to be an
excellent instrument
for
measuring features
of
depression, hyperarousal,
and
tension
in
clinical
and
nonclinical groups. Furthermore,
the
21-item
version
of the
measure
appears
to
have
several
advantages
rela-
tive
to the
42-item
version, including
fewer
items,
a
cleaner
factor
structure,
and
smaller
interfactor
correlations.
Although
findings
for
the
DASS-21
remain
to be
replicated
in an
indepen-
dent
sample,
the
21-item version
may be
preferable
to the
full
42-item DASS.
The
main advantage
of the
larger version
is the
additional
clinical information provided.
Future
studies should
begin
to
assess
the
sensitivity
of the
DASS
and
DASS-21
for
measuring change that
follows
treatment
for
anxiety disorders
and
major
depression.
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•