Kessler Psychological Distress Scale (K10)
10-item measure of non-specific psychological distress over the past 4 weeks.
Creator
Dr. Ronald C. Kessler, PhDInstructions
The Kessler-10 scale is one of many tools used to screen for psychological distress, such as anxiety or depression.
This is not intended to provide a diagnosis – see a trained health professionals for guidance.
The following ten questions ask about how you have been feeling in the past 4 weeks.
Introduction
The Kessler Psychological Distress Scale (K10) is a 10-question survey that measures general psychological distress, such as anxiety and depressive symptoms, over the past four weeks. Ronald C. Kessler, PhD, a professor at Harvard Medical School, and colleagues developed it in the early 2000s. It was developed with support from the U.S. government’s National Center for Health Statistics for use in the redesigned U.S. National Health Interview Survey. The scale was designed to be sensitive around the threshold for the clinically significant range of distress, to help distinguish cases of serious mental illness from non-cases. It’s widely used in primary care, mental health services, and population surveys. It’s included in the Australian and Canadian equivalents of the U.S. national health survey, and in all the national surveys of the World Mental Health Initiative. The K10 measures overall distress. It doesn’t diagnose a specific disorder.
The Kessler Psychological Distress Scale (K10) is a 10-item questionnaire measuring non-specific psychological distress in the past 4 weeks. Each item is rated from 1 (none of the time) to 5 (all of the time), giving a total score of 10 to 50, reported with subclinical, mild, moderate and severe bands plus depression, anxiety, nervous, agitation, fatigue and negative affect subscale scores.
What it asks
Patients rate how often in the past four weeks they felt: tired for no good reason; nervous; so nervous that nothing could calm them down; hopeless; restless or fidgety; so restless they could not sit still; depressed; that everything was an effort; so sad that nothing could cheer them up; and worthless. Each item uses the same five answers, from “none of the time” to “all of the time.”
How it’s scored
There are two common scoring systems. This tool uses the Australian scoring. They use the same questions and differ only in the points assigned:
US scoring (Harvard): Each answer is scored 0 (“none of the time”) to 4 (“all of the time”), for a total from 0 to 40. The question is presented in order from highest frequency to none, but for scoring, answers are recoded so that 0 indicates no stress and 4 indicates high stress.
Australian scoring: Each answer is scored 1 to 5, for a total from 10 to 50. The Australian total is always exactly 10 points higher than the US total for the same answers.
Higher scores mean higher levels of distress.
How results are interpreted
No universally agreed interpretation categories exist for K10 scores, and a number of different methods are used in Australia, depending on the purpose and setting. Clinical settings commonly use these bands, based on the 10–50 scale:
Australian score (10–50) | US score (0–40) | Interpretation |
|---|---|---|
10–19 | 0–9 | Likely well |
20–24 | 10–14 | Likely mild distress |
25–29 | 15–19 | Likely moderate distress |
30–50 | 20–40 | Likely severe distress |
In the original grouping, these bands indicate whether a person is likely to be well, or likely to have a mild, moderate, or severe mental disorder. A higher score is a reason for further clinical assessment, not a diagnosis.
This is a screening instrument and practitioners should make a clinical judgement as to whether a person needs treatment.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered.
People who score 20 or higher on the K10 are likely to meet the diagnostic criteria for a psychiatric disorder. Scores of 20 plus had a sensitivity to Major Depressive Disorder, Dysthymia, Generalised Anxiety Disorder, Panic Disorder, and Social Phobia ranging from 0.78 to 1 (Donker et al., 2009). Higher total scores on the K10 have been associated with reduced Global Assessment of Functioning (GAF) scores, social support and activity, increased functional impairments, and a higher physical health burden (Atkins et al., 2013).
Limitations
The K10 measures nonspecific distress, so it can’t tell whether symptoms come from depression, anxiety, grief, or another cause. It also has no item on suicidal thoughts, so it can’t be used to assess safety. Kessler’s team notes that symptom screening scales miss people who are successfully treated, such as a person whose condition is well controlled with medication. Interpret the score alongside the patient’s history and a clinical conversation.
All questions & possible results
K10 ItemsTitle not visible
The following ten questions ask about how you have been feeling in the past 4 weeks.
1. About how often did you feel tired out for no good reason?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
2. About how often did you feel nervous?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
3. About how often did you feel so nervous that nothing could calm you down?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
4. About how often did you feel hopeless?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
5. About how often did you feel restless or fidgety?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
6. About how often did you feel so restless you could not sit still?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
7. About how often did you feel depressed?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
8. About how often did you feel that everything was an effort?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
9. About how often did you feel so sad that nothing could cheer you up?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
10. About how often did you feel worthless?
Select one option:
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
Possible results
K10 Score (20-24 pts): Likely to have a mild mental distress
Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.
This is a screening instrument and practitioners should make a clinical judgement as to whether a person needs treatment.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered.
Score range is 10-50 pts
People who score 20 or higher on the K10 are likely to meet the diagnostic criteria for a psychiatric disorder. Scores of 20 plus had a sensitivity to Major Depressive Disorder, Dysthymia, Generalised Anxiety Disorder, Panic Disorder, and Social Phobia ranging from 0.78 to 1 (Donker et al., 2009). Higher total scores on the K10 have been associated with reduced Global Assessment of Functioning (GAF) scores, social support and activity, increased functional impairments, and a higher physical health burden (Atkins et al., 2013).
K10 Score (25-29 pts): Likely to have a moderate mental distress
Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.
This is a screening instrument and practitioners should make a clinical judgement as to whether a person needs treatment.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered.
Score range is 10-50 pts
People who score 20 or higher on the K10 are likely to meet the diagnostic criteria for apsychiatric disorder. Scores of 20 plus had a sensitivity to Major Depressive Disorder, Dysthymia, Generalised Anxiety Disorder, Panic Disorder, and Social Phobia ranging from 0.78 to 1 (Donker et al., 2009). Higher total scores on the K10 have been associated with reduced Global Assessment of Functioning (GAF) scores, social support and activity, increased functional impairments, and a higher physical health burden (Atkins et al., 2013).
K10 Score (> 30 pts): Likely to have a severe mental distress
Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.
This is a screening instrument and practitioners should make a clinical judgement as to whether a person needs treatment.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered.
Score range is 10-50 pts
People who score 20 or higher on the K10 are likely to meet the diagnostic criteria for apsychiatric disorder. Scores of 20 plus had a sensitivity to Major Depressive Disorder, Dysthymia, Generalised Anxiety Disorder, Panic Disorder, and Social Phobia ranging from 0.78 to 1 (Donker et al., 2009). Higher total scores on the K10 have been associated with reduced Global Assessment of Functioning (GAF) scores, social support and activity, increased functional impairments, and a higher physical health burden (Atkins et al., 2013).
Anxiety subscale score
Higher scores on these items indicate more severe symptoms of anxiety, such as excessive worry and restlessness.
Items 2, 3, 5 and 6.
Score range: 4-20 pts
Fatigue subscale Score
Higher scores on these items indicate greater fatigue and lack of energy, often associated with depression but also physical ailments.
Individuals with high scores on the fatigue factor are more likely to experience physical impairments that affect their daily activities and overall physical functioning.
Items 1 and 8
Score range: 2-10 pts
Nervous subscale score
Higher scores on these items reflect greater anxiety and nervousness.
Items 2 and 3.
Score range: 2-10 pts
Agitation subscale score
Higher scores on these items suggest increased restlessness and motor agitation, commonly linked to anxiety.
Items 5 and 6
Score range: 2-10 pts
Depression subscale score
Higher scores on these items reflect increased emotional and physical symptoms of depression.
Items 1, 4, 7, 8, 9 and 10.
Score range: 5-30 pts
K10 Score (<20 pts): Likely to be well
Score range is 10-50 pts
Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.
This is a screening instrument and practitioners should make a clinical judgement as to whether a person needs treatment.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered.
Negative affect subscale score
Higher scores on these items reflect greater emotional distress, including feelings of hopelessness, depression, and worthlessness.
Those with elevated scores on the negative affect factor often face a lower quality of life, reduced autonomy, and an increased risk of comorbid alcohol or other drug (AOD) issues (Brooks et al., 2006).
Items 4, 7, 9 and 10
Score range: 4-20 pts
Citation
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L. T., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.
Literature
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L. T., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.
https://www.cambridge.org/core/journals/psychological-medicine/article/abs/short-screening-scales-to-monitor-population-prevalences-and-trends-in-nonspecific-psychological-distress/F141675CCD0E08C0FB98E01C006B4E0DAndrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25(6), 494–497.
https://www.sciencedirect.com/science/article/pii/S1326020023036105?via%3DihubAtkins, J., Naismith, S. L., Luscombe, G. M., & Hickie, I. B. (2013). Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors. BMC Psychiatry, 13(1), 249–249.
https://link.springer.com/article/10.1186/1471-244X-13-249Brooks, R. T., Beard, J., & Steel, Z. (2006). Factor Structure and Interpretation of the K10. Psychological Assessment, 18(1), 62–70.
https://psycnet.apa.org/doiLanding?doi=10.1037%2F1040-3590.18.1.62Donker, T., Comijs, H., Cuijpers, P., Terluin, B., Nolen, W., Zitman, F., & Penninx, B. (2010). The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Research, 176(1), 45–50.
https://www.sciencedirect.com/science/article/abs/pii/S0165178109000201?via%3DihubGonda, T., Deane, F. P., & Murugesan, G. (2012). Predicting clinically significant change in an inpatient program for people with severe mental illness. Australian and New Zealand Journal of Psychiatry, 46(7), 651–658.
https://journals.sagepub.com/doi/10.1177/0004867412445527Lace, J. W., Greif, T. R., McGrath, A., Grant, A. F., Merz, Z. C., Teague, C. L., & Handal, P. J. (2019). Investigating the factor structure of the K10 and identifying cutoff scores denoting nonspecific psychological distress and need for treatment. Mental Health & Prevention, 13, 100–106.
https://www.sciencedirect.com/science/article/abs/pii/S2212657018300825?via%3DihubMerson, F., Newby, J., Shires, A., Millard, M., & Mahoney, A. (2021). The temporal stability of the Kessler Psychological Distress Scale. Australian Psychologist, 56(1), 38–45.
https://www.tandfonline.com/doi/full/10.1080/00050067.2021.1893603Rickwood, D., McEachran, J., Saw, A., Telford, N., Trethowan, J., & McGorry, P. (2023). Sixteen years of innovation in youth mental healthcare: Outcomes for young people attending Australia’s headspace centre services. PloS One, 18(6), e0282040–e0282040.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0282040Slade, T., Grove, R., & Burgess, P. (2011). Kessler Psychological Distress Scale: Normative Data from the 2007 Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45(4), 308–316.
https://journals.sagepub.com/doi/10.3109/00048674.2010.543653
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