{
"description": "Please read each statement and choose the answer 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",
"_filename": "questionnaire-dass-21.json",
"package_name": "MyHIE.v4",
"date": "2023-02-23T04:59:30.4857498+00:00",
"meta": {
"source": "http://provider.hie.moh.gov.my",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Questionnaire" ]
},
"publisher": null,
"purpose": "The DASS-21 is the short form of the DASS-42, a self-report scale designed to measure the negative emotional states of depression, anxiety and stress.",
"name": null,
"item": [ {
"code": [ {
"code": "stress"
} ],
"text": "I found it hard to wind down",
"type": "choice",
"linkId": "01",
"prefix": "01",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I was aware of dryness of my mouth",
"type": "choice",
"linkId": "02",
"prefix": "02",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I couldn’t seem to experience any positive feeling at all",
"type": "choice",
"linkId": "03",
"prefix": "03",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)",
"type": "choice",
"linkId": "04",
"prefix": "04",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I found it difficult to work up the initiative to do things",
"type": "choice",
"linkId": "05",
"prefix": "05",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I tended to over-react to situations",
"type": "choice",
"linkId": "06",
"prefix": "06",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I experienced trembling (eg, in the hands)",
"type": "choice",
"linkId": "07",
"prefix": "07",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I felt that I was using a lot of nervous energy",
"type": "choice",
"linkId": "08",
"prefix": "08",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I was worried about situations in which I might panic and make a fool of myself",
"type": "choice",
"linkId": "09",
"prefix": "09",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I felt that I had nothing to look forward to",
"type": "choice",
"linkId": "10",
"prefix": "10",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I found myself getting agitated",
"type": "choice",
"linkId": "11",
"prefix": "11",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I found it difficult to relax",
"type": "choice",
"linkId": "12",
"prefix": "12",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I felt down-hearted and blue",
"type": "choice",
"linkId": "13",
"prefix": "13",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I was intolerant of anything that kept me from getting on with what I was doing",
"type": "choice",
"linkId": "14",
"prefix": "14",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I felt I was close to panic",
"type": "choice",
"linkId": "15",
"prefix": "15",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I was unable to become enthusiastic about anything",
"type": "choice",
"linkId": "16",
"prefix": "16",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I felt I wasn’t worth much as a person",
"type": "choice",
"linkId": "17",
"prefix": "17",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress"
} ],
"text": "I felt that I was rather touchy",
"type": "choice",
"linkId": "18",
"prefix": "18",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)",
"type": "choice",
"linkId": "19",
"prefix": "19",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "anxiety"
} ],
"text": "I felt scared without any good reason",
"type": "choice",
"linkId": "20",
"prefix": "20",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "depression"
} ],
"text": "I felt that life was meaningless",
"type": "choice",
"linkId": "21",
"prefix": "21",
"required": true,
"answerOption": [ {
"valueCoding": {
"code": "0",
"display": "Never"
}
}, {
"valueCoding": {
"code": "1",
"display": "Sometimes"
}
}, {
"valueCoding": {
"code": "2",
"display": "Often"
}
}, {
"valueCoding": {
"code": "3",
"display": "Almost Always"
}
} ]
}, {
"code": [ {
"code": "stress-score"
} ],
"text": "Stress Score",
"type": "integer",
"linkId": "22",
"prefix": "22",
"readOnly": true,
"required": true
}, {
"code": [ {
"code": "anxiety-score"
} ],
"text": "Anxiety Score",
"type": "integer",
"linkId": "23",
"prefix": "23",
"readOnly": true,
"required": true
}, {
"code": [ {
"code": "depression-score"
} ],
"text": "Depression Score",
"type": "integer",
"linkId": "24",
"prefix": "24",
"readOnly": true,
"required": true
} ],
"useContext": [ {
"code": {
"code": "workflow",
"system": "http://hl7.org/fhir/CodeSystem/usage-context-type",
"display": "Workflow Setting"
},
"valueCodeableConcept": {
"coding": [ {
"code": "self-assessment",
"display": "Self-Assessment"
} ]
}
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "Depression Anxiety and Stress Scale 21 (DASS-21)",
"package_version": "2.0.0-alpha",
"status": "active",
"id": "4862b959-a0fc-43e8-bd87-61382777fd5f",
"kind": null,
"url": "http://fhir.hie.moh.gov.my/Questionnaire/questionnaire-dass-21",
"code": [ {
"code": "dass-21"
} ],
"version": null
}