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Questionnaire - DASS 21

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. Do not spend too much time on any statement.

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)

Questionnaire - DASS 21

First*
Last*
1. I found it hard to wind down*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
2. I was aware of dryness of the mouth*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
3. I couldn't seem to experience any positive feeling at all*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
4. I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
5. I found it difficult to work up the initiative to do things*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
6. I tended to over-react to situations*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
7. I experienced trembling (eg, in the hands)*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
8. I felt that I was using a lot of nervous energy*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
9. I was worried about situations in which I might panic and make a fool of myself*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
10. I felt that I had nothing to look forward to*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
11. I found myself getting agitated*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
12. I found it difficult to relax*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
13. I felt down-hearted and blue*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
14. I was intolerant of anything that kept me from getting on with what I was doing*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
15. I felt I was close to panic*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
16. I was unable to become enthusiastic about anything*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
17. I felt I wasn't worth much as a person*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
18. I felt that I was rather touchy*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (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 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
20. I felt scared without any good reason*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
21. I felt that life was meaningless*
- 0 (Never)
- 1 (Sometimes)
- 2 (Often)
- 3 (Almost always)
Name
This field is for validation purposes and should be left unchanged.

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