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DASS-21 Depression Anxiety Scale: An Overview, Interpretation, Limitations

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According to the World Health Organization, approximately 280 million people worldwide have depression, and 301 million people have anxiety. Additionally, the American Institute of Stress found that approximately 1 in 3 Americans experiences “extreme” amounts of stress. But how do we determine what level of stress is actually “extreme” versus “normal”?

Many mental health professionals use scale questionnaires to gather information about client symptoms and get further insight into the client’s specific concerns if the client struggles to articulate them. Scale questionnaires can indicate how severe symptoms are at present.

The Depression, Anxiety, and Stress Scale, 21 (DASS-21) is one such assessment. It contains 21 questions about an individual’s level of depressive symptoms, anxious distress, and current stress levels to help inform their mental health needs. It uses a four-point rating scale to determine severity and identifies if an individual’s experience is “normal,” mild, moderate, severe, or extremely severe.

The DASS-21: An Overview

The DASS-21 was developed in 1995 by Lovibond and Lovibond through the Psychology Foundation of Australia. Their aim was to create a brief but comprehensive screening tool that could identify clients struggling with anxiety, depression, or stress. It asks about the client’s experience over the past week.

Clients complete the DASS-21 by responding to 21 statements using the following scale:

  • 0: Did not apply to me at all
  • 1: Applied to me to some degree or some of the time
  • 2: Applied to me a considerable degree or a good part of the time
  • 3: Applied to me very much or most of the time

The DASS-21 has three subscales: Depression, Anxiety, and Stress. Each subscale contains seven items, and the provider scores the measure by totaling the client’s responses. The DASS-21 is a shortened form of the DASS-42, a longer measure that provides a more in-depth assessment of depression, anxiety, and stress levels.

Mental health screening measures like the DASS-21 can be useful in determining which clients might need to be referred for further support, assessment, or treatment for their mental health symptoms. It can ensure that the client answers important questions and reduces the likelihood that the provider will forget to ask. Additionally, some clients might be more forthcoming about their symptoms in writing rather than face-to-face with the provider.

Chris Dabbs, PhD, professor of psychology, and licensed counselor, uses the DASS-21 in research and practice. He shared, “It’s got great psychometric properties, particularly internal reliability scores, and discriminant validity with other measures of depression and anxiety.”

Understanding Depression

The DASS-21 measures depression using the Depression subscale. It assesses dysphoric mood, feelings of hopelessness, reduced interest in life, negative self-talk, and outlook on life. The seven depression questions determine how severe a client’s depressive symptoms are at the present time, though it does not gather information about depressive episodes or how long the client has been experiencing the symptoms.

Understanding Anxiety

The Anxiety subscale of the DASS-21 has seven questions to assess the individual’s current level of anxious distress. Again, it does not ask about length of symptoms or specific details about what triggers these symptoms, so the measure would provide general information about anxiety rather than a specific anxiety disorder diagnosis. The anxiety questions include anxiety related to specific situations, muscle tension, and anxious distress.

Understanding Stress

Like the other subscales, the Stress subscale on the DASS-21 contains seven questions. Again, the client does not provide personal details about their life stressors or how long they have been experiencing this level of stress. The stress scale queries for difficulty relaxing, nervousness, irritability, and impatience.

Administration of the DASS-21

The DASS-21 is a self-report scale, meaning that the client fills it out and answers the questions based on how they are feeling. Due to the length, it can be completed in five to 10 minutes.

If you are completing the DASS-21, try to answer with your gut. It can be easy to overthink the questions, but your first instinct is often the most reflective of your experience. There are no right or wrong answers, and you are encouraged to answer honestly so that the provider can best interpret your results and support you.

Interpretation of the DASS-21

After administering the DASS-21, the provider will score the three subscales and interpret the results based on the recommended cutoff scores for severity. Scores in the “normal” range suggest that the individual is not struggling with depression, anxiety, or stress. Higher scores can indicate if the client’s current symptoms are mild, moderate, severe, or extremely severe.

Clients with a mild elevation might simply be having a bad day when they completed the form, or they could have a mental health issue with symptoms that are somewhat managed at this time. Moderate or severe symptoms mean that an individual is likely experiencing a mental health issue or extreme stress. Extremely severe symptoms indicate that the client likely needs support right away, and the provider should intervene immediately to further assess their symptoms and provide resources.

Although the DASS-21 provides subscale scores, Dr. Dabbs noted that the total score can also be useful. He shared: “I believe it conceptually works best to use the total score. In that way, I find giving the DASS-21 comparable to giving a combination of PHQ-9/GAD-7/MDQ [other mental health screening measures], but the DASS-21 is only one tool which makes scoring and interpretation much simpler.”

Limitations and Other Considerations

Brief screeners like the DASS-21 gather a small amount of information snapshotting the individual’s mental state at the time when they completed the measure. While this can be useful in a primary care setting when there is not time to complete extensive testing, this means that providers who administer the DASS-21 only gather a small amount of information about the client. It might reflect that further intervention or assessment is needed, but the DASS-21 alone is unlikely to provide comprehensive information about an individual’s diagnosis or treatment needs, and clients who obtain elevated scores may need a more comprehensive psychological evaluation.

The DASS-21 also only looks at symptoms of anxiety, depression, and stress, and so it might not reflect other mental health concerns including (but not limited to) obsessive compulsive-type disorders, trauma, or psychosis.

Dr. Dabbs noted that this measure is less in-depth than some other screening measures: “The major limitation is that it doesn’t give you as much data as a more extensive individual measure of the sub-scales would (e.g., a BDI or a BAI).”

The major limitation is that it doesn’t give you as much data as a more extensive individual measure of the sub-scales would (e.g., a BDI or a BAI).

Additionally, because the DASS-21 assesses how the person is doing when they complete the measure, it does not show trends or changes in symptoms unless it is given repeatedly, and the provider tracks the scores. For instance, an individual experiencing a stressful week due to a work project might obtain a higher DASS-21 score, which could lower on its own when that project is complete.

No piece of data is useful in isolation. Any provider who uses the DASS-21 still needs to directly communicate with clients about mental health and potential symptoms. The DASS-21 (and any other mental health screener) is not a substitute for an open conversation between the provider and patient.

Finally, the DASS-21 does not ask about suicidal ideation or thoughts of self-harm. Research shows that it is important for healthcare providers to assess for thoughts of suicide in all clients, in addition to asking about mental health in general. In order to comply with this standard for best practice, providers would have to assess for suicide in addition to administering the DASS-21.

Conclusion

Screening measures like the DASS-21 can be useful in determining if a client might need more support for their mental health, though they are not all-encompassing. It is unlikely that a provider will be able to determine a specific diagnosis from the DASS-21, though it could yield insight into what further support would be appropriate.

The DASS-21 is brief but provides specific and comprehensive cutoff scores about an individual’s current levels of anxiety, depression, and stress. It can open up the conversation about an individual’s current mental health and can ensure that the provider thoroughly screens for these concerns. It can normalize discussion of the difficulties an individual is experiencing and help de-stigmatize the conversation around mental health.

If you have concerns about your mental health, help is available. Your primary doctor can help you figure out what support you need and how to access it. You can also use a directory to find a therapist. Remember, there is no minimum amount of difficulty that you have to reach. You deserve support.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. World Health Organization. Depressive Disorder (Depression).

  2. World Health Organization. Anxiety Disorders.

  3. The American Institute of Stress. Causes & Sources of Stress.

  4. Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales. (2nd Ed.)Sydney: Psychology Foundation.

  5. Bajaj P, Borreani E, Ghosh P, Methuen C, Patel M, Joseph M. Screening for suicidal thoughts in primary care: the views of patients and general practitioners. Ment Health Fam Med. 2008;5(4):229-235.

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By Amy Marschall, PsyD

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.


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How to Enjoy Your Alone Time

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Do you find yourself feeling overwhelmed by the hustle and bustle of daily life? In a world that never stops moving (literally), it can sometimes feel like we’re never left alone. Our phones are always buzzing with nonstop notifications, the neighborhood is alive with activity, and our house, well, it’s rarely quiet there with the kids, pets, partners, or roommates. Sometimes, it feels impossible to get away and shut up your thoughts.

But what if we said, the best way to find some much-needed peace is to step back and spend some time away from it all? A little alone time is a great way to reflect, recharge, and reconnect with ourselves.

Solitude offers an opportunity to connect with ourselves, our natural environment, or even our spirituality.

—
WHITNEY OTTO, MA, CPCC

Finding five minutes to yourself is much easier said than done, especially when you’re always on the go for whatever event life throws at you next. Ahead, we explore how you can make the most of your alone time, plus dive into all the benefits of solitude.

At a Glance

We often feel pressured to be constantly connected. But sometimes, the best thing we can do for ourselves is to step back and spend some time by ourselves. It’s easy to feel guilty about wanting alone time, but the truth is, solitude can be incredibly refreshing. By learning to embrace these quiet moments, we give ourselves the space to unwind, think clearly, and just be—without the pressure of being “on” all the time. Many people think being alone means being lonely, but that couldn’t be further from the truth. Alone time gives us an opportunity to rest, recharge our batteries, and find inner peace.

The Benefits of Solitude

The benefits of solitude can be surprising, especially when we’re used to being constantly surrounded by others. Here’s why spending time alone can actually be a good thing:

  • Enables self-reflection: When we’re alone, we finally have a chance to think without interruptions. It gives us space to figure out how we’re feeling, what we really want, and what’s important to us.
  • Improves mental clarity: Life gets noisy, and it can be hard to think straight with constant distractions. Being alone allows us to clear out the mental clutter, helping us feel more focused and calm. We can sort through our thoughts and come out feeling refreshed.
  • Recharges our energy levels: It’s natural to feel drained and burnt out after a long day of constantly interacting with people. A little alone time is the perfect way to recharge. 
  • Reduces stress: Spending time alone can reduce stress and anxiety, giving the mind a chance to rest and relax, says Tatiana Rivera Cruz, MSW, LCSW, a therapist at ADHDAdvisor.
  • Takes the social pressure off: Socializing often comes with pressure and expectations such as trying to make conversation or worrying about what others think. Being alone gives us a break and lets us switch off our social persona.

  • Promotes independence: Spending time alone helps us get comfortable with ourselves. We start to realize that we don’t always need others to feel happy, entertained, or complete. It builds our confidence in doing things by ourselves, whether it’s going to the movies, taking a trip, or just being at home.
  • Improves relationships: Paradoxically, spending time alone can actually strengthen our relationships. When we take a step back from our relationships, we often return feeling refreshed and more connected. 
  • Sparks creativity: Some of our best ideas come when we’re alone. Without other people’s opinions or distractions, our minds can wander, and that’s when creativity kicks in. Whether it’s solving a problem or coming up with a new idea, solitude can spark that “aha!” moment.
  • Boosts productivity: No distractions, no interruptions—that’s the magic of solitude. When we’re alone, we can focus on what we need to do and get it done faster, whether it’s work, a hobby, or even self-care.

How to Practice Solitude

Practicing solitude doesn’t have to be complicated, and it doesn’t mean cutting yourself off from the world. It’s more about intentionally carving out some alone time for yourself to recharge and reflect. 

Here are some ways to practice solitude and get more comfortable with being alone:

  • Start small: If the idea of being alone feels a little daunting, start with short periods of time. Maybe it’s 10 minutes in the morning before everyone wakes up or a short walk in the evening when you get home from work. Gradually increase the time as you get more comfortable with it.
  • Disconnect from your devices: Try turning off your phone, stepping away from social media, and giving yourself a break from the endless notifications. This helps create a boundary between you and the outside world, giving you uninterrupted time to recharge.
  • Create a quiet space: Designate a space in your home where you can retreat for some alone time. It could be a cozy corner with a comfy chair, or a peaceful spot outside. Having a place to unwind makes the prospect more inviting.
  • Take up a solo hobby: Whether it’s reading, painting, or cooking, a solo hobby gives you a chance to focus on doing something you love without distractions. It’s also a great way to unwind and tap into your creativity while enjoying your own company.

  • Journal your thoughts: Journaling is a great way to spend time alone with yourself. It helps you reflect on what’s going on in your life, how you’re feeling, and what you want.
  • Practice mindfulness: Activities like meditation, yoga, or even deep breathing exercises can help you focus on the present moment. They can help you connect with yourself and make solitude feel more peaceful.
  • Take yourself out: Try doing activities by yourself, like going for a walk, grabbing lunch, watching a movie, or even going on a trip. Doing things you enjoy alone helps you feel more independent and empowered.

Everyone defines solitude in different ways. For some people it means spending a day by themselves out shopping or at a coffee shop. For others it may mean going for a hike alone. The amount of solitude is unique to each person, as are the ways they enjoy time with themselves.

—
WHITNEY OTTO, MA, CPCC

Signs You Need Alone Time

Sometimes, we don’t realize that we’re in desperate need of some solitude until we’re feeling totally overwhelmed. Here are some signs that it’s time to carve out some alone time.

  • Experiencing social fatigue: If hanging out with people suddenly feels more exhausting than enjoyable, it’s a sign that your social battery might be running low. You may find yourself craving a break from constant interaction.
  • Craving peace and quiet: “The best indicator of a need for solitude is a desire for it. Do you find yourself daydreaming about time alone?” asks Otto.
  • Struggling to focus: If you’re finding it hard to concentrate, feeling mentally scattered, or unable to stay on top of tasks, it may be because your brain needs time to unwind and reset.
  • Feeling overwhelmed or stressed: If you’re constantly feeling overwhelmed, anxious, or stressed, it might be a sign that you need a break from all your responsibilities.
  • Getting easily irritated: If you get easily irritated, it may be a signal that you need to step back and recharge, says Cruz. 
  • Feeling emotionally drained: If you’re feeling emotionally depleted like you’re constantly giving but not receiving, it’s a clear signal that you need to take time for yourself. Alone time can help you refill your emotional cup.

  • Feeling disconnected from yourself: If you feel like you’ve lost touch with your own thoughts and feelings, it’s a sign that some alone time could help you reconnect with yourself.
  • Constantly seeking distractions: If you’re always looking for something to do—scrolling through social media, binge-watching shows, or filling every minute with plans—it might be a way of avoiding some much-needed alone time to process your thoughts.

Listening to these signs can lead to a healthier balance in your life, says Cruz.

Setting Boundaries

Sometimes, the demands of work, family, and social obligations make it hard to carve out time for yourself. Setting boundaries can be a game-changer, helping you cordon off some alone time. 

Here are some practical steps to help you create and protect that space:

  • Communicate your needs: Let the people around you—friends, family, coworkers—know that you need time alone. Be direct but kind in explaining that you’re overwhelmed and need some alone time to relax.
  • Block off time slots: Block off specific times in your schedule dedicated to being alone, just like you would for meetings or social plans. Whether it’s an hour in the morning or a day on the weekend, treat this time as non-negotiable.
  • Learn to say no: It’s okay to say no to plans or commitments that overwhelm you. If you’re feeling stretched thin, politely decline invitations and explain that you need time to rest. Don’t let others guilt you into doing more than you’re willing to.
  • Set time limits: When you’re spending time with friends or family, let them know in advance how long you’re available. For example, you might say, “I’m happy to catch up, but I’ll need to head home by 9 p.m. to get some rest.” Being upfront can help manage everyone’s expectations.
  • Accept that some people may be unhappy: Everyone may not understand or appreciate your need for solitude. Focus on your own needs rather than worrying about their approval.

Overcoming the Stigma of Solitude

Unfortunately, the concept of solitude often has a stigma attached to it. For starters, it is often mistaken for loneliness. Furthermore, “we are socialized to think that wanting solitude means that there is something wrong with us—that we are antisocial or not skilled at making good connections,” Otto explains.

However, it’s important for us to distinguish between enjoying some alone time versus feeling lonely. Research shows us that reframing solitude as a beneficial experience can make a major difference in how we feel about it. Cultivating a mindful approach to solitude and viewing it as a form of self-care rather than isolation can help shift the conversation, says Cruz.

Here are some strategies to overcome the stigma and start enjoying alone time:

  • Challenge conventional beliefs: Society often glamorizes socializing, making it seem like being constantly surrounded by people is the only way to be happy or successful. Push back against this idea by recognizing that solitude doesn’t mean you’re antisocial or lonely—it just means you value time alone to reflect, grow, and recharge.
  • Focus on the benefits of solitude: Instead of worrying about how others might perceive your alone time, remind yourself of the many benefits. When you focus on how good it feels to have some time for yourself, you’ll be less likely to be concerned with what others think.
  • Surround yourself with supportive people: If you feel judged for wanting alone time, it’s important to have people in your life who accept and respect your boundaries. Surround yourself with friends and family who understand that you need some downtime without making you feel guilty about it.
  • Redefine alone time as empowering: Society tends to associate being alone with being lonely, but solitude can be empowering. Reframe your mindset to see alone time as a period of personal strength, self-sufficiency, and independence. By embracing solitude, you’re showing that you don’t rely on others for happiness—you can create it on your own.

  • Practice self-compassion: It’s easy to fall into the trap of feeling guilty for wanting time alone, but practice being kind to yourself. Recognize that it’s perfectly normal and healthy to want some alone time.

Cultivating a mindful approach to solitude and viewing it as a form of self-care rather than isolation can help shift the conversation.

—
TATIANA RIVERA CRUZ, MSW, LCSW

Takeaways

Savoring solitude isn’t about feeling lonely—it’s about getting comfortable in your own company, recharging, and finding peace in the pause. It’s time to recognize how precious alone time is and make it a priority.

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By Sanjana Gupta

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.


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