The Break Wellbeing Check

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The Break Wellbeing Check (DASS-21)

Instructions

Please read each statement and select the number that best describes how much the statement applied to you over the past week.

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

This questionnaire is a screening tool only and is not intended to provide a diagnosis. If you are experiencing immediate distress or are at risk of harm, call 000 immediately or seek urgent professional support.

I found it hard to wind down *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I was aware of dryness of my mouth *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I couldn't seem to experience any positive feeling at all *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion) *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I found it difficult to work up the initiative to do things *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I tended to over-react to situations *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I experienced trembling (e.g. in the hands) *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt that I was using a lot of nervous energy *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I was worried about situations in which I might panic and make a fool of myself *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt that I had nothing to look forward to *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I found myself getting agitated *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I found it difficult to relax *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt down-hearted and blue *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I was intolerant of anything that kept me from getting on with what I was doing *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt I was close to panic *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I was unable to become enthusiastic about anything *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt I wasn't worth much as a person *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt that I was rather touchy *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

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) *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt scared without any good reason *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

I felt that life was meaningless *0 - Did not apply to me at all1 - Applied to me to some degree2 - Applied to me a considerable degree3 - Applied to me very much

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The Break Wellbeing Check (DASS-21)

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