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 Continue 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 Continue 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
