AMITY UNIVERSITY MUMBAI

Name: Harish Pannala

Enrolment No: A70240720147

Roll. No: PSYBSCB2005

Practical Assignment – 2

Semester – 4

Year: 2020-23

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 CONSENT FORM

I, Harish Pannala student from BSc. Clinical Psychology am conducting a Psychological

Experiment on: Mr. Bhardwaj.
Your participation is solicited, yet it is strictly voluntary. Please be aware that you are free to
withdraw at any point throughout the duration of the experiment/test. Your results will be
kept confidential and not disclosed to anyone without your permission or your name will not
be associated with any test findings. Your participation in this study will require
approximately 30 minutes. Please indicate with your signature on the space below that you
understand your rights and agree to participate in the test NEO-FFI-3.
By my signature below, I acknowledge that I consent to a psychological experiment/test
conducted by (Harish Pannala). I have been informed of the study and have read consent
form.
I fully understand my rights and obligations as a participant, and I willingly agree to this
assessment/test.

Signature of the Subject

Date: 22.02.2022

HARISH PANNALA

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Sl. No Topic Page. No

1 Consent Form 2

2 Purpose of the Test 4

3 Introduction 4

4 Methodology 11

5 Test Description 11

6 Case History 13

7 Procedure 16

8 Scoring and 17
Interpretation
9 Discussion 18

10 Conclusion and 20
Recommendation

11 References 20

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PURPOSE OF THE TEST:
 To assess depression, anxiety and stress using the depression-anxiety-stress scale 21 (DASS-
21).

INTRODUCTION:

Depression:

Depression (major depressive disorder) is a very common and serious medical illness that
negatively affects your feelings, the way you think and how you act because on your thoughts
and feelings. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a
loss of interest in activities you once enjoyed, these persistent feelings of sadness and loss of
interest in activities cause major downfall in life. It can lead to a variety of emotional and
physical problems.

Causes of Depression:

Psychological Biological Factors Social Factors

Factors
Physical, emotional Chronic (Long term, not Loss of employment, (or) prospects for
(or) sexual abuse of necessarily dangerous), physical a job.
any kind illness.
Neglect from Primary Life threatening illness like cancer Divorce through martial problems (or)
caretakers (e.g., (or) glycaemia. infidelity.
Parents and guardians
(or) guardians)
Loss of someone close Physical health problems that can Toxic relationship with another
to them change lifestyles choices a lot. relationship, romantic (or) friendly.
Traumatic events in Interruption in sleep cycle (or) Social Isolations from Social situations.
the very past (or) deep sleep problems.
recent.
Unstable family Conditions affecting the brain (or) Bullying and harassment in school (or)
situations the nervous system. work life.

Symptoms of Depression:
 Physiological Factor
Feelings of Sadness and
emptiness.
Frustration and irritability.
Loss of interest in activities.
Trouble thinking and
concentrating.
Issues remembering things.
Feeling of worthlessness
(or) guilt.
Biological Factor
Reduced appetite and weight
loss.
Sleeping too little (or) too
much.
Tiredness and complete lack
of effort.
Unexplainable backpain (or)
headache.
Slower body movements
Unstable and uncontrolled
senses.
Social Factor
Avoiding Social events and
activities.
Possibly drug (or) other
substance abuse.
Difficulty in communication
with others.
Avoiding friends (or) bigger
groups.
Loss of care of self
Seeking identity crisis from
others.

Anxiety: Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel
restless and tense, and have a rapid heartbeat. It can be a normal reaction to stress. For
example, you might feel anxious when faced with a difficult problem at work, before taking a
test, or before making an important decision. It can help you to cope. The anxiety may give
you a boost of energy or help you focus. But for people with anxiety disorders, the fear is not
temporary and can be overwhelming. Anxiety disorders are conditions in which you have
anxiety that does not go away and can get worse over time. The symptoms can interfere with
daily activities such as job performance, schoolwork, and relationships.

Causes of anxiety:

Biological causes- The biological aspect of the biopsychosocial model refers to the body's
physiological, adaptive responses to fear. It also refers to genetic traits, and the brain
functioning that we "inherit." More specifically, what is passed down is a genetic
vulnerability expressed as a "personality type" (Bourne, 2000). This personality type
describes a person who is more reactive, more sensitive, and/or more easily excitable in the
presence of stress.

Psychological causes- Although we may be born with a biologically determined, heightened

sensitivity to stress, this fact alone is insufficient to create an anxiety disorder. The
psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and
perceptions about our experiences, our environment, and ourselves. These cognitive patterns
affect our perceived sense of control over our environment. These cognitive patterns also
influence how we assess and interpret events in our environment as either threatening or
nonthreatening.

Social causes- These thoughts (cognitions) about our environment, and ourselves, play a key
role in the formation of an anxiety disorder. For instance, one child's mother makes a
correction to her son's homework. He interprets this as helpful and indicative of his parent's
confidence in his ability to learn.

Another child's mother makes a correction to her daughter's homework, and instead of
interpreting this as helpful, the daughter interprets this as an indication of her limitations, and
her parent's lack of confidence in her abilities. This further strengthens her own lack of
confidence in herself.

Causes of anxiety:

Biological causes- The biological aspect of the biopsychosocial model refers to the body's
physiological, adaptive responses to fear. It also refers to genetic traits, and the brain
functioning that we "inherit." More specifically, what is passed down is a genetic
vulnerability expressed as a "personality type" (Bourne, 2000). This personality type
describes a person who is more reactive, more sensitive, and/or more easily excitable in the
presence of stress.

Psychological causes- Although we may be born with a biologically determined, heightened

sensitivity to stress, this fact alone is insufficient to create an anxiety disorder. The
psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and
perceptions about our experiences, our environment, and ourselves. These cognitive patterns
affect our perceived sense of control over our environment. These cognitive patterns also
influence how we assess and interpret events in our environment as either threatening or
nonthreatening.

Social causes- These thoughts (cognitions) about our environment, and ourselves, play a key
role in the formation of an anxiety disorder. For instance, one child's mother makes a
correction to her son's homework. He interprets this as helpful and indicative of his parent's
confidence in his ability to learn. Another child's mother makes a correction to her daughter's
homework, and instead of interpreting this as helpful, the daughter interprets this as an

indication of her limitations, and her parent's lack of confidence in her abilities. This further
strengthens her own lack of confidence in herself.

Symptoms of anxiety-

Physical symptoms: Cold or sweaty hands, dry mouth, heart palpitations, nausea, numbness
or tingling in hands or feet, muscle tension, shortness of breath.

Mental symptoms:

Feeling panic, fear and uneasiness, nightmares, repeated thoughts or flashbacks of traumatic
experiences, uncontrollable, obsessive thoughts.

Behavioural symptoms:

Inability to be still and calm, ritualistic behaviours, such as washing hands repeatedly, trouble
sleeping.

Stress: Stress is a feeling of emotional or physical tension. It can come from any event or
thought that makes you feel frustrated, angry or nervous. Stress is our body’s response to
pressure. Many different situations or life events can cause stress. It is often triggered when
we experience something new, unexpected or that threatens our sense of self, or when we feel
we have little control over a situation. We all deal with stress differently. Our ability to cope
can depend on our genetics, early life events, personality and social & economic
circumstances.

Psychological Factors Biological Factors Social Factors

Negative emotional Sustained cortisol release
associations. leading to stress in immune
functioning.
Previous experience of Chronic pain occurs as a
painful and stressful events. result of both increased
cortisol levels and wound
treatment.
Individual differences in Increased heart rate,
perception and appraisal of a respiration rate and blood
painful (or) a stressful event. pressure.
Poor strategies for coping Lowered immune system
with pain (or) stress. functioning, which if
prolonged can result in a
detrimental excessive
immune response.
Poor availability and quality
of social support networks
and personal relationships.
Poor mobility and activity
levels.
Negative social comparisons
with other patients at
different stages of recovery.
Negative environmental
factors.

Symptoms of Stress:

Psychological Biological Behavioural

Anxious and afraid.
Urge to cry (or) to hide.
Angry and Aggressive.
Sad and irritable.
Negative attitude (or)
thoughts.
Excessive daydreaming
about “getting away from it
all”.
Sweating
Heart palpitations
Drug (or) Alcohol Abuse
Aches and pains
Shallow breathing (or)
hyperventilating.
Digestive problems such as
constipation, bloating (or)
diarrhoea.
Experience sexual problems.
Tearful and sensitive
behaviour.
Smoking, drinking alcohol
(or) take drugs more than
usual.
Inflexible (or) indecisive.
Have problems for getting
sleep.
Withdraw from other people
(or) snap at them.

Uses:
The DASS in research

The DASS may be administered either in groups or individually for research purposes. The
capacity to discriminate between the three related states of depression, anxiety and stress
should be useful to researchers concerned with the nature, ethology and mechanisms of
emotional disturbance.

As the essential development of the DASS was carried out with non-clinical samples, it is
suitable for screening normal adolescents and adults. Given the necessary language
proficiency, there seems no compelling case against use of the scales for comparative
purposes with children as young as 12 years. It must be borne in mind, however, that the
lower age limit of the development samples was 17 years.

Clinical use of the DASS

The principal value of the DASS in a clinical setting is to clarify the locus of emotional
disturbance, as part of the broader task of clinical assessment. The essential function of the
DASS is to assess the severity of the core symptoms of depression, anxiety and stress. It must
be recognised that clinically depressed, anxious or stressed persons may well manifest
additional symptoms that tend to be common to two or all three of the conditions, such as
sleep, appetite, and sexual disturbances. These disturbances will be elicited by clinical
examination, (or) using general symptom checklists as required.

The DASS may be administered and scored by non-psychologists, but decisions based on
score profiles should be made only by experienced clinicians who have carried out an
appropriate clinical examination. It should be noted also that none of the DASS items refers
to suicidal tendencies because items relating to such tendencies were found not to load on any
scale. The experienced clinician will recognise the need to determine the risk of suicide in
seriously disturbed persons.

Research:

1. Screening for depression and anxiety in spinal cord injury with DASS-21: The
Study design included comparison of two self-report instruments with a structured
diagnostic interview. The objective was to investigate the properties of the
Depression Anxiety Stress Scales-21 (DASS-21) in patients with spinal cord injuries
and was conducted in South Australian Spinal Cord Injuries Service, Hampstead
Rehabilitation Centre, Northfield, South Australia. A total of forty paraplegic or
tetraplegic patients took part in the study. Depression, anxiety, and stress were
examined using two self-report measures, the DASS-21 and the Brief Symptom
Inventory (BSI). These variables were compared to one another as well as diagnoses
based on the Mini International Neuropsychiatric Interview. Both self-report
measures had mean values that were below clinical thresholds.

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 Anxiety and depression were shown to be more prevalent on the DASS-21 than on the
BSI. DASS-21 was as sensitive as the BSI but had a poorer specificity for anxiety and
depression detection. In a rehabilitation environment, the DASS-21 is a viable screening
tool for individuals with spinal cord injuries. It is more sensitive to detecting people who
may have anxiety disorders than it is to detect those who may have depressive disorders.

2. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across

four racial groups by Peter J. Norton Ph.D.: Growing cross-cultural awareness has led
researchers to examine frequently used research instruments and assessment tools in
racially diverse populations. The present study was conducted to assess the
psychometric characteristics of the 21-item version of the Depression, Anxiety, and
Stress Scales (DASS-21) among different racial groups. The DASS-21 was chosen
because it appears to be a dependable and easy to administer measure, ideal for both
clinical and research purposes. Results suggest that the internal consistency, and
convergent and divergent validity of the DASS-21 are similar across racial groups.
Multigroup CFA, however, indicated that item loadings were invariant, while scale
covariances were not invariant. This suggests that, although the items may load
similarly on the depression, anxiety and stress constructs, these constructs may be
differentially inter-related across groups. Implications for application in clinical
practice are discussed.

3. Assessment of Depression, Anxiety and Stress among Covid-19 Patients by Using

DASS-21 Scales: To determine the level of depression, anxiety and stress with respect to
age and gender a research study was conducted among COVID-19 patients admitted at
Rawalpindi Institute of Urology & Transplantation Pakistan by using DASS 21 scale.
Cross-sectional descriptive research was done among the subjects using consecutive
sampling. There were 61 study subjects, out of which 72.1% had a normal score of
depression. Anxiety and stress were reported to have normal score among 75.4% of the
patients. Females in our study were determined to have significantly higher level of
depression, anxiety and stress in comparison with those of males. Results show that
females need adequate counselling pertinent to COVID-19 for mitigation of its
psychological impact.

History:

One of the commonly used scales for detection of mental health problems is the
Depression, Anxiety and Stress Scale. Since its introduction in 1995, the DASS and its
short-form—the DASS-21—have been widely used to assess depression, anxiety and
stress among adults. Analyses of data among adults using this measure yield consistent
results about its psychometric properties. It has been shown to be reliable and valid with
a three-factor structure. The reliability and validity of both the DASS and the DASS-21
have been replicated among clinical, as well as non-clinical adult samples. The same
three-factor structure has been seen when the measure is used among diverse cultural and
ethnic groups.

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The DASS-21 has also been shown to have strong concurrent validity with other
measures of depression, anxiety and stress including the Beck Depression Inventory, the
Beck Anxiety Inventory and the State-Trait Anxiety Inventory Trait.

Applications:

The DASS - 21 is a set of three self-report scales that measures the emotional states of
depression, anxiety and stress. It is a suitable instrument to screen for depressive disorder
and may help therapists to identify cases that are at high threat of being affected by a co -
morbid major depression (clinical depression) and in requirement for further diagnostic
assessment.

For clinical settings, the scale is suitable to assist in diagnosing and outcome monitoring
and for non - clinical settings, it is suitable as a mental health screener.

Advantages and disadvantages:

Advantages:

The main advantage of the DASS-21 in a clinical setting is to assist in more accurately
locating the source of a client’s emotional disturbance. Its principal use is to identify the
primary symptoms of depression, anxiety, and stress. The DASS-21 is a helpful tool to
use alongside other data gathered during a clinical assessment and can provide you with
valuable insight into a client’s emotional levels of functioning. The DASS-21 can be
used as part of an initial clinical assessment and to measure a client’s progress over time.

Disadvantages:

There are several published studies showing that the DASS21 has the same factor
structure and gives similar results to the full DASS (see Publication’s page). In general,
the full DASS is often preferable for clinical work, and the DASS21 is often best for
research purposes.

The items in the DASS21 were selected based on several criteria:

- good factor loadings

- coverage of all subscales within each scale

- item means, such that DASS21 scores for each scale should be very close to exactly
half the full-scale score

Remember when using the DASS21 to multiply the obtained scale scores by 2, so that
they can be compared to the DASS normative data and to other published DASS

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 References: (APA format)

- Mitchell, M. C., Burns, N. R., & Dorstyn, D. S. (2008). Screening for depression and
anxiety in spinal cord injury with DASS-21. Spinal Cord, 46(8), 547-551.

- Peter J. Norton Ph.D. (2007) Depression Anxiety and Stress Scales (DASS-21):
Psychometric analysis across four racial groups, Anxiety, Stress & Coping, 20:3, 253-
265, DOI: 10.1080/10615800701309279

- Felix Torres, M.D., MBA, DFAPA, (October 2020) What Is Depression?

https://www.psychiatry.org/patients-families/depression/what-is-depression

2. - Brown AY. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Nov. 17, 2016,
Depression (major depressive disorder) https://www.mayoclinic.org/diseases-
conditions/depression/symptoms-causes/syc-20356007
3. - Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK:
Comorbidity of mental disorders with alcohol and other drug abuse. Results from the
epidemiologic catchment area (ECA) study. JAMA 1990; 264: 2511–2518.
4. - Beaufort, I., De Weert-Van Oene, G., Buwalda, V., de Leeuw, J., & Goudriaan, A.
(2017). The Depression, Anxiety and Stress Scale (DASS-21) as a Screener for
Depression in Substance Use Disorder Inpatients: A Pilot Study. European Addiction
Research, 23(5), 260-268. https://doi.org/10.1159/000485182
5. - Depression Anxiety Stress Scales – Short Form (DASS-21). NovoPsych. (2022).
Retrieved 15 February 2022, from
https://novopsych.com.au/assessments/depression/depr

METHODOLOGY:

Test Description:

1.Full test name and Author names and year when it was developed.
2. Write about how many items and Domains are there in the test.
3. Explain domains in 2-3 lines each.
4. Table of +&-Items.
5.Write about Norms.
6.Validity.

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7.Reliability
8.Scoring
9.Interpretation.

 The DASS-21 is a self-administering questionnaire

that consists of 21 items, divided into 3 domains of 7 items each.

NAME OF DOMAIN ITEMS IN THE DOMAIN TOTAL ITEMS

Depression (D) 3,5,10,13,16,17,21 7

Anxiety (A) 2,4,7,9,15,19,20 7

Stress (S) 1,6,8,11,12,14,18 7

CASE HISTORY:

Mrs. Sharma is depressed over her family life as no one supports her in house chores.
Especially her husband doesn’t spend time with her kids too by making an excuse of work.
She is completely fed up with this and now wants to go back to her native permanently with
her kids leaving her husband alone.

She is thinking of killing herself with this depression, anxiety and stress. Her job also is also
included in this matter and now she can’t manage everything alone. All this was before the
Covid – 19 Pandemic.

Once the pandemic has begun and the lockdown was imposed, she was finding it tough as all
things were shut and she doesn’t even know how to manage.

In rare cases, her kids were helping her out by washing utensils and cutting the vegetables to
make her work easy.

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Her childhood was amazing with her parents/friends/peers by talking with them, doing
combine studies (or) going out for a movie (or) a park etc.

Family history is average. She has 2 children, and the Postponement and sadism disorders are
running in the family.

No substances addictions are in the family.

MENTAL STATUS EXAMINATIONS:

1.General Appearance:
The patient was stable and calm, dressed up neatly and dapped. Good eye contact and
psychomotor skills are good.
2.Speech:
Speech was relevant and coherent. When a question was asked, he was able to answer
relevantly and expressed his feelings which a psychologist could give a suitable remedy.

3.Mood:
Her mood was overanxious and frustrated due to studies and fear of examination.

1.Thoughts:
Steam:
No abnormalities were observed in the steam.
Possession:
No possessions were observed in the steam.
Content:
He had post –occupations, over loading ideas with depression and anxiety.

4.Perceptions:
No perception abnormalities were seen.

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5.Cognitions:
I. Orientation:
Place: Navi Mumbai
Person: Oriented
Time: 09.30 am
Impression: He was oriented to time, place and person.
II.Attention and Concentration:
A. Digit Spam:
Forward: 3 digits and Backwards: 2 digits
B. Calculation
Serial threes: No errors, Serial seven: 1 error
C.Money Calculations:
He was good at calculations.

III.Memory
A. Recent Memory:
Breakfast: Poha
Left for Hospital: 08.45am
Medications: Not taken any
B. Remote Memory:
Date of Birth: 12.04.2004
Ph. No: +91-929*******
C.Immediate Memory:
Was able answer the basic questions immediately.
Impression: Memory is not bad.

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IV.Intelligence:
A. Information: Five Presidents: Ramnath Kovind, APJ Abdul Kalam, Pratibha Patil, Dr
Rajendra Prasad, Pranab Mukherjee
Five CMs of any states: Naveen Patnaik, Ashok Gehlot, Uddhav Thackeray, MK Stalin,
Bhupesh Bhagel.

B. Abstraction:
Similarities: Laptop, Tablets: Electronics
Baseball, Soccer: Games
Impression: Intelligence is Good.
V.Judgement:
She has a very good judgement process. Judges ‘others and how to behave accordingly.
VI.Insight:
She thinks that this environment will continue till his studies are completed and thinks so
deeply that his parents will pressurise him on studies.
Insight: Level III.

MATERIALS REQUIRED:

a. Pencil
b. Eraser
c. DASS-21 response sheet

Norms: The DASS-21 has been normed with data used for interpretive purposes based on a
sample from 1794 non-clinical adults. Various studies have confirmed the effectiveness of
the scale for both, adults, and older adults in both clinical and nonclinical sample populations.
However, the use of the scale with children and adolescents are not yet well supported. In
adult populations, the use of this scale has been proved to be effective across a varied cross-
section of racial and cultural backgrounds, genders, and nationalities.

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 Although the test was developed using individuals who were older than 17 years of age, due
to the simplicity of language, there has been no solid evidence against the usage of the scale
for comparison against children as young as 12 years of age.

Reliability: A study was conducted on Vietnamese adolescents. As a results A total of

1,616/1,745 (92.6%) students returned a filled questionnaire. Complete responses for the
DASS-21 were available for 1,387 students (85.8%) and the analysis was restricted to these
individuals. The internal consistency by Cronbach alpha statistics were calculated for the
overall scale and the three subscales to assess reliability in terms of internal consistency. The
DASS-21-V had adequate to very good internal consistency of 0.906 for the overall scale,
0.835 for the Depression subscale, 0.737 for the Anxiety subscale and 0.761 for the Stress
subscale.

Validity: The test was developed using a sample of responses from the comparison of 504
sets of results from a trial by students, taken from a larger sample of 950 first year university
student responses. The scores were subsequently checked for validity against outpatient
groups including patients suffering from anxiety, depression, and other mental disorders.
While the test was developed with individuals older than 17 years of age, due to the
simplicity of language, there has been no compelling evidence against the use of the scales
for comparison against children as young as 12. Consistent with the DASS-42, the DASS-21
has internal consistency and concurrent validity in acceptable to excellent ranges.

PROCEDURE:
Arrangement of Materials:

Instructions to the Subject:

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 (N)
1: Applied to me to some degree, or some of the time- SOMETIME (S)
2: Applied to me to a considerable degree, or good part of time- OFTEN (O)
3: Applied to me very much, or most of the time- ALMOST ALWAYS (AA)

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Precautions:
Please read each statement and circle a number 0, 1, 2 or 3 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.

CONDUCTION:

The client was given the questionnaire with the materials mentioned above and she started to
mark the options. The room where the test was conducted was ventilated, sanitized for a safe
environment due to the ongoing Covid-19 Pandemic.

OBSERVATIONS:
The observations are- the client was reading the questionnaire as it contained 21 questions
and she was enjoying the questions were arranged and ticking the options according to her
experience and with a calm mind.

RETROSPECTIVE REPORT:
The subject was enjoying the test and comfortably answering all the 21 questions according
to her experiences related to the questions and the options with a calm mind.

SCORING AND INTERPRETATIONS OF THE RESULT:

Sr. No NAME OF RAW SCORE TOTAL RANGE
THE DOMAIN SCORE
1. Depression 14 28 Extremely
Serve
2. Anxiety 12 24 Severe
3. Stress 10 20 Moderate

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 DASS-21 Graph
30 28

25 24
20
20
Total Score

15

10

0
Depression Anxiety Stress
Domains

DISCUSSIONS:

Depression:

Depression (major depressive disorder) is a very common and serious medical illness that
negatively affects your feelings, the way you think and how you act because on your thoughts
and feelings. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a
loss of interest in activities you once enjoyed, these persistent feelings of sadness and loss of
interest in activities cause major downfall in life. It can lead to a variety of emotional and
physical problems. Mrs. Sharma scored a score of 28 in this domain which is extremely
severe. As per the case study mentioned – above, it explains us how depressed she was while
handling all the works through her husband’s negligence in the name of office work.

If she continues to be like this, her BP and diabetic levels will raise high leading to brain
strokes and other related problems which she needs a medical care from now and the help in
the household chores is mandatory from her husband.

Anxiety:

Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel restless
and tense, and have a rapid heartbeat. It can be a normal reaction to stress. For example, you
might feel anxious when faced with a difficult problem at work, before taking a test, or before
making an important decision. It can help you to cope.

18
The anxiety may give you a boost of energy or help you focus. But for people with anxiety
disorders, the fear is not temporary and can be overwhelming. Anxiety disorders are
conditions in which you have anxiety that does not go away and can get worse over time. The
symptoms can interfere with daily activities such as job performance, schoolwork, and
relationships. In this domain, Mrs. Sharma has scored a score of 24 which is in a severe level.
She is always anxious about her daily routine like by doing all the household chores alone
along with her job.

If this continues, as mentioned- above, her BP and sugar levels will rise to the core, and she
might be adhered to brain stroke which is a tough situation for the entire family.

Stress:

Stress is a feeling of emotional or physical tension. It can come from any event or thought
that makes you feel frustrated, angry or nervous. Stress is our body’s response to pressure.
Many different situations or life events can cause stress. It is often triggered when we
experience something new, unexpected or that threatens our sense of self, or when we feel we
have little control over a situation. We all deal with stress differently. Our ability to cope can
depend on our genetics, early life events, personality and social & economic circumstances.

The physiological or psychological response to internal or external stressors. Stress involves

changes affecting nearly every system of the body, influencing how people feel and behave.

Stress will be created when the depression and anxiety are shown together.

In this domain, Mrs. Sharma has scored a score of 20. As all the chores and job are done by
her, she is completely stressed up and wants a hand to help and take some rest which can
make manage her things and family well.

SUMMARY:

The DAS Scale -21 is a 21-questionnaire test where it determines our Depression, Anxiety
and Stress level, where the clients will be asked to answer and according to the results the
remedy can be given. If a person has a very high score in a particular domain, the therapist
will analyse by asking questions and give a remedy to him.

My client has a high score in Depression domain which is very common and serious medical
illness that negatively affects your feelings, the way you think and how you act because on
your thoughts and feelings. Fortunately, it is also treatable.

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Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed,
these persistent feelings of sadness and loss of interest in activities cause major downfall in
life. It can lead to a variety of emotional and physical problems.

She needs to keep herself calm and not to think about what the things are going around her.
The more she thinks, the more it bothers her.

CONCLUSIONS:

The purpose of the test is to assess depression, anxiety and stress using the depression-
anxiety-stress scale 21 (DASS-21).
The participant was made to "write only where it is indicated in this booklet. Carefully read
all the instructions before beginning. This questionnaire contains 21 statements. Read each
statement carefully. For each statement fill in the circle with the response that best represents
her opinion. Making sure that his answer is in the correct box.

RECOMMENDATIONS:
Medications and psychotherapy are effective for most people with depression. Your primary
care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many
people with depression also benefit from seeing a psychiatrist, psychologist or other mental
health professional.

REFERENCES:

Should be in APA 7th Format

Some references
https://www.citethisforme.com/
https://www.youtube.com/watch?v=JmVZP2309P4

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