K10 Questionnaire

Kessler Psychological Distress Scale

woman at a desk experiencing stress

Instructions

The following 10 questions ask about how you have been feeling over the last 30 days. For each question, select the response that best represents how often you felt this way. There are no right or wrong answers.

This form is sent securely and directly to our clinic team, it is not stored anywhere else, and your responses will only be used to support your care.

Your Name:

1. During the last 30 days, about how often did you feel tired out for no good reason?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

2. During the last 30 days, about how often did you feel nervous?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

3. During the last 30 days, about how often did you feel so nervous that nothing could calm you down?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

4. During the last 30 days, about how often did you feel hopeless?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

5. During the last 30 days, about how often did you feel restless or fidgety?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

6. During the last 30 days, about how often did you feel so restless you could not sit still?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

7. During the last 30 days, about how often did you feel depressed?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

8. During the last 30 days, about how often did you feel that everything was an effort?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

9. During the last 30 days, about how often did you feel so sad that nothing could cheer you up?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

10. During the last 30 days, about how often did you feel worthless?

1 – None of the time 2 – A little of the time 3 – Some of the time 4 – Most of the time 5 – All of the time

Explore

Services & Fees
Our Team
Blogs

Get in Touch

Book an Appointment
Make a Referral
Contact Us

Policies

Cancellation Policy
Privacy Policy
Sitemap