MENTAL HEALTH SURVEY - PTSD Resurrected Inc

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K10 Survey

Kessler (2002)

For all questions, please tick

the appropriate square

Initials:

Date:

QUESTION: In the past 4 weeks...

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

01 About How often do you feel tired out for no good reason?12345

02 About how often did you feel nervous?12345

03 About how often did you feel so nervous that nothing could calm you down?12345

04 About how often did you feel hopeless?12345

05 About how often did you feel restless or fidgety?12345

06 About how often did you feel so restless you could not sit still?12345

07 About how often did you feel depressed?12345

08 About how often did you feel that everything is an effort?12345

09 About how often did you feel so sad that nothing could cheer you up?12345

10 About how often did you feel worthless?12345

K10 Scores Key

10-15 = Low Distress – No Help Required

16-19 = Mild Distress – Self Help

20-24 = Moderate Distress – Self Help

25-29 = Severe Distress – Some Support Required

30-50 = Extremely Severe Distress - Professional Help Required

⁰/50

PERSONAL WELL BEING SURVEY

No Satisfaction At all
Completely Satisfied

0
1
2
3
4
5
6
7
8
9
10

1. How satisfied are you with your life as a whole?
12345678910

2. How satisfied are you with your standard of living?
12345678910

3. How satisfied are you with your health?
12345678910

4. How satisfied are you with what you are currently achieving in life?
12345678910

5. How satisfied are with your personal relationships?
12345678910

6. How satisfied are you with how safe you feel?
12345678910

7. How satisfied are you with feeling part of your community?
12345678910

8. How satisfied are you with your future security?
12345678910

TOTAL SCORE: 0

Multidimensional Scale of Perceived Social Support

Read Each Statement Carefully and indicate how you feel about each one.

"1" if you Very Strongly Disagree
"2" if you Strongly Disagree
"3" if you Mildly Disagree
"4" if you are Neutral
"5" if you Mildly Agree
"6" if you Strongly Agree
"7" if you Very Strongly Agree

Very Strongly Disagree
Strongly Disagree
Mildly Disagree
Neutral
Mildly Agree
Strongly Agree
Very Strongly Agree

01 There is a special person who is around when I am in need.1234567

02 There is a special person with whom I can share joys and sorrows.1234567

03 My family really tries to help me.1234567

04 I get the emotional help & support I need from my family.1234567

05 I have a special person who is a real source of comfort to me.1234567

06 My friends really try to help me.1234567

07 I can count on my friends when things go wrong.1234567

08 I can talk about my problems with my family.1234567

09 I have friends with whom I can share my joys and sorrows.1234567

10 There is a special person in my life who cares about my feelings.1234567

11 My family is willing to help me make decisions.1234567

12 I can talk about my problems with my friends.1234567

TOTAL SCORE: 0

Δ

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PTSD Resurrected INC
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ABN: 86 498 503 140
TFN: 775 090 721
Charity No: CH3004

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