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DASS-21 form

The DASS-21 helps us assess your wellbeing and ensure our programs best support your needs.

About this form

We use the Depression, Anxiety and Stress Scale – 21 items (DASS-21) to help us understand how you’ve been feeling over the past week. Your responses will assist us in determining whether our wellbeing programs are a good fit for you and in tracking your progress.

Please enter your name and email address below, then answer each question as honestly as you can.

There are no right or wrong answers – simply select the option that best describes how much each statement applied to you during the past week.

Privacy and confidentiality

Your information is handled in accordance with Australian privacy laws. Results are stored securely on Australian servers and are only accessible to authorised Mood Active staff. Individual results are never shared publicly and will only be used to assess suitability and measure wellbeing outcomes before and after your program.

Your contact details

Name

Required information

I have registered for a 2-Day Wellbeing Program I am 18 years of age or over I have been diagnosed with a mild to moderate mental health condition I consent to be being contacted via email by Mood Active

DASS-21

I found it hard to wind down

NEVER (Did not apply to me at all) SOMETIMES (Applied to me to some degree, or some of the time) OFTEN (Applied to me to a considerable degree, or a good part of time) ALMOST ALWAYS (Applied to me very much, or most of the time)

I was aware of dryness of my mouth

I couldn’t seem to experience any positive feeling at all

I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)

I found it difficult to work up the initiative to do things

I tended to over-react to situations

I experienced trembling (eg, in the hands)

I felt that I was using a lot of nervous energy

I was worried about situations in which I might panic and make a fool of myself

I felt that I had nothing to look forward to

I found myself getting agitated

I found it difficult to relax

I felt down-hearted and blue

I was intolerant of anything that kept me from getting on with what I was doing

I felt I was close to panic

I was unable to become enthusiastic about anything

I felt I wasn’t worth much as a person

I felt that I was rather touchy

I was aware of the action of my heart in the absence of physicalexertion (eg, sense of heart rate increase, heart missing a beat)

I felt scared without any good reason

I felt that life was meaningless