"Tacklit"Tacklit: Kessler 10 (K10) background and scoring
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K10

Kessler 10

What is the Kessler 10 (K10) assessment and what does it test for?

Kessler 10, often referred to as K10, is a brief assessment of psychological distress in the anxiety and depression spectrum. It does not derive the source of the distress, it only vaguely outlines the frequency and severity of the distress. It was designed for, and popularly used in, general population surveys. Studies have shown that the K10 scores differ with different diagnoses and should be used alongside other outcome measures if more specific diagnostic information is required.

When should the Kessler 10 (K10) be used?

The K10 should be used to establish the frequency of psychological distress experienced in the 4 weeks prior to the assessment. It should not be used to determine historical symptoms, acute psychosis or suicidal symptoms. It should not be used as a diagnostic tool. It may be used to help medical professionals categorise psychological distress into depressive or anxious fields, or to deduce the pathway of treatment required for an individual.

The K10 can also be used as an outcome measure to monitor treatment outcomes: scores are likely to decrease with effective treatments.

It should be noted that the K10 was designed for use in Western, English speaking countries and there is a growing evidence base for its limitations within indigenous, refugees, ethnic groups or when translated to different languages.

How is the Kessler 10 (K10) scored?

The K10 is a 10 part questionnaire from which the client chooses the most appropriate answer on a 5 point scale: 1 (none of the time) to 5 (all of the time). The lowest score possible is 10 and the highest score is 50. The relationship between scores and psychological distress is linear, meaning a low score equates to lower levels of distress and vice versa.

Score Interpretation

There are no universally outlined categories for the scoring of the K10 and it depends on the setting and purpose of delivery. In Australia, it is widely accepted to use the following generalised categories:

  • 10-15: Low
  • 16-21: Moderate
  • 22-29: High
  • 30+ Very High

It should be noted that these categories do not reflect the multifactorial nature of the K10. It is the responsibility of the practitioner to determine the appropriateness of the questionnaire, and to establish which sections the client has scored highly in to reflect the nature of their psychological distress. For example, those with depressive symptoms will usually score higher for lethargy than those with anxiety related symptoms. The K10 does not cover symptoms of acute or severe psychosis or suicidal thoughts.

Evidence and research supporting the Kessel 10 (K10)

The K10 is a widely peer reviewed, well-validated and highly useful clinical measure of psychological symptoms. It is now one of the most popular psychological distress outcome measures for large scale studies and primary care settings due to its ease of use & delivery, high factorial & construct validity and high predictability. The K10 is largely favoured due to its brevity and excellent predictive value for past-30-day disorders. As with all outcome measures, it has limitations and should be used alongside other tools and professional guidance.

There is a growing evidence base investigating its validity when used with non-English languages, refugees, military personnel and indigenous people. In Australia, the K10 and K5 are deemed appropriate for use with the Aboriginal and Torres Strait Islander people but they may be more likely to favour the adapted K5 version which is considered more culturally appropriate due to the omission of the question regarding ‘worthlessness’.

What questions does the Kessel 10 (K10) ask?

  1. During the last 30 days, about how often did you feel tired out for no particular reason?
  2. During the last 30 days, about how often did you feel nervous?
  3. During the last 30 days, about how often did you feel so nervous that nothing could calm you down?
  4. During the last 30 days, about how often did you feel hopeless?
  5. During the last 30 days, about how often did you feel restless or fidgety?
  6. During the last 30 days, about how often did you feel so restless you could not sit still?
  7. During the last 30 days, about how often did you feel depressed?
  8. During the last 30 days, about how often did you feel that everything was an effort?
  9. During the last 30 days, about how often did you feel so sad that nothing could cheer you up?
  10. During the last 30 days, about how often did you feel worthless?

Answer scoring

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

References

  • Kessler, R., Andrews, G., Colpe, .et al (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959-956.
  • Andrews, G., Slade, T (2001). Interpreting scores on the Kessler Psychological Distress Scale (k10). Australian and New Zealand Journal of Public Health, 25, 494-497.
  • Hugues Sampasa-Kanyinga, H., Zamorski, M., and Colman, I (2018). The psychometric properties of the 10-item Kessler Psychological Distress Scale (K10) in Canadian military personnel. PLoS One, 13(4): e0196562. [Online].
  • Stolk, Y., Kaplan, I., and Szwarc, J (2014). Clinical use of the Kessler Psychological distress scales with culturally diverse groups. Psychiatric Research, 23(2), 161-183.
  • Kessler, R., et al. (2003). Screening for serious mental illness in the general population. Arch Gen Psychiatry. 60(2):184-189.
  • Searle, A., Van Hooff, M., Steele, N., et al (2014). The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population. Int J Methods Psychiatric Research. 24(1):32-45.
  • Steel, Z., Brooks, R. And Beard, J. (2006). Factor Structure and Interpretation of the K10. Psychological Assessment. 18(1):62-70
  • Australian Bureau of Statistics. (2007) Information Paper: Use of the Kessler Psychological Distress Scale In ABS Health Surveys, Australia. [Online] available via: https://www.abs.gov.au/ausstats/abs@.nsf/lookup/4817.0.55.001chapter92007-08 on 12/01/2021
  • Slade, T., Grove, R., and Burgess, B. (2011). Kessler Psychological Diress Scale: Normative Data from the 2007 Australian National Survey of Mental Health and Well-being. Australian & New Zealand journal of Psychiatry. 45(4):308-316.
  • Uddin, M., Islam, F., Al Mahmud, A. (2018). Psychometric evaluation of and interview-administered version of the Kessler 10-item questionnaire (K10) for measuring Psychological distress in rural Bangladesh. BMJ Open. 2018;8:e022967
  • DACAS. The Kessler 10 - Information for Health Professionals. [online] available via: https://www.dacas.org.au/sites/default/files/inline-files/Kessler10-health-professionals.pdf on 12/01/2021
  • McNamara, B. J., Banks, E., Gubhaju, L., Williamson, A., Joshy, G., Raphael, B., & Eades, S. J. (2014). Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: A comparison of the K-10 and K-5. Australian and New Zealand Journal of Public Health, 38(6), 567-573

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