Depression Anxiety Stress scale (DASS-21) Please complete the following questionnaire prior to your mental health treatment plan and mental health treatment plan review appointments. Your responses will be sent to your doctor and will not be saved elsewhere. Read each statement and choose the option that 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. The rating scale is as follows: 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 Name Date of birth 1. I found it hard to wind downNeverSometimesOftenAlmost always 2. I was aware of dryness of my mouthNeverSometimesOftenAlmost always 3. I couldn’t seem to experience any positive feeling at allNeverSometimesOftenAlmost always 4. I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)NeverSometimesOftenAlmost always 5. I found it difficult to work up the initiative to do thingsNeverSometimesOftenAlmost always 6. I tended to over-react to situationsNeverSometimesOftenAlmost always 7. I experienced trembling (e.g. in the hands)NeverSometimesOftenAlmost always 8. I felt that I was using a lot of nervous energyNeverSometimesOftenAlmost always 9. I was worried about situations in which I might panic and make a fool of myselfNeverSometimesOftenAlmost always 10. I felt that I had nothing to look forward toNeverSometimesOftenAlmost always 11. I found myself getting agitatedNeverSometimesOftenAlmost always 12. I found it difficult to relaxNeverSometimesOftenAlmost always 13. I felt down-hearted and blueNeverSometimesOftenAlmost always 14. I was intolerant of anything that kept me from getting on with what I was doingNeverSometimesOftenAlmost always 15. I felt I was close to panicNeverSometimesOftenAlmost always 16. I was unable to become enthusiastic about anythingNeverSometimesOftenAlmost always 17. I felt I wasn’t worth much as a personNeverSometimesOftenAlmost always 18. I felt that I was rather touchyNeverSometimesOftenAlmost always 19. I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat)NeverSometimesOftenAlmost always 20. I felt scared without any good reasonNeverSometimesOftenAlmost always 21. I felt that life was meaninglessNeverSometimesOftenAlmost always Time is Up!