What is Independent Behavior Scales revised

The Depression-Anxiety-Stress Scales



The recording of psychological stress is of central importance in pain research and treatment. There are particular methodological and conceptual difficulties for depression as a comorbidity in pain. The psychometric properties of the German-language short version of the Depression-Anxiety-Stress-Scales (DASS) were checked. The technique is used in pain research and treatment and is designed to solve specific confusion problems by avoiding somatic items and focusing questions on core psychological aspects of depression, anxiety and stress.


The psychometric properties of the instrument were examined in patients with pain and in various random samples without a primary pain problem (N = 950). The DASS contains 3 scales with 7 items each. Reliability and construct validity of the DASS were compared with HADS (Hospital Anxiety and Depression Scale) and ADS (General Depression Scale). Specificity and sensitivity for depression were determined using a structured clinical interview for DSM-IV (SKID) and also compared with ADD and HADS.


Cronbach's α for the depression scale was at least 0.91, the values ​​of the anxiety and stress scale for the revised version are 0.78-0.82 and 0.81-0.89, respectively. Although the depression scale only contains 7 items, it is just as reliable as the ADS with 21 items. The sensitivity and specificity in classifying clinical cases are better than in HADS.


The DASS is a reliable and economical both in terms of time and costs (the procedure is license-free) alternative to previous procedures for depression screening in pain patients. In addition, the “physical tension” (stress) scale records an aspect that is diagnostically and therapeutically interesting, especially for patients with pain, and has so far only been little researched.



The assessment of mental distress is a central aspect in pain research and treatment. Particularly for depression the comorbidity with pain poses methodological and conceptual challenges. This study examined the psychometric properties of the short version of the depression, anxiety and stress scale (DASS), used in both pain research and treatment and constructed to overcome the particular problems by omitting somatic items and concentrating on the psychological core aspects of depression, anxiety and stress.


The psychometric properties of the DASS-21 were compared between patients with pain and various people without any pain problems (N = 950). The DASS has three subscales, depression, anxiety and stress, each with seven items. The construct validity of the DASS was examined using the hospital anxiety and depression scale (HADS) for anxiety and depression and the general depression scale (General depression scale, ADS) for depression. The sensitivity and specificity for depression were determined against a structured interview for diagnostic and statistical manual of mental disorders (DSM-IV) and compared with the Center for Epidemiological Studies depression scale (CESD) and HADS in pain patients.


Cronbach's alpha of the DASS for the depression subscale was at least 0.91, while the anxiety and stress subscales had Cronbach alphas of 0.78-0.82 and 0.81-0.89, respectively. Although the depression subscale has only 7 items, it is just as reliable as the ADS with 21 items. It also has a better sensitivity and specificity than the HADS in identifying clinical patients with depression.


The DASS is a reliable questionnaire, free to use and brief to administer; Therefore, it is an alternative to the previously used instruments for the screening of depression. Furthermore, the subscale stress measures irritability and tension, which are important aspects of pain experience but underused in assessment procedures for the diagnosis and treatment evaluation of patients with pain.

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Author information


  1. DRK Pain Center, Auf der Steig 14, 55131, Mainz, Germany

    Dr. P. Nilges

  2. Department of Psychology, University of Roehampton, London, England

    C. Essau

Corresponding author

Correspondence to Dr. P. Nilges.

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P. Nilges and C. Essau state that they have no conflict of interest.

This article does not include studies on humans or animals.

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Nilges, P., Essau, C. The Depression-Anxiety-Stress Scales. pain29, 649-657 (2015). https://doi.org/10.1007/s00482-015-0019-z

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  • Questionnaires
  • Psychological stress
  • pain
  • sensitivity
  • Specificity


  • Questionnaire
  • Mental stress
  • Sensitivity
  • Specificity
  • Pain