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ANXIETY AND DEPRESSION REPORT (K10)

This report is strictly confidential so be truthful

10 easy step survey to report on your recent level of psychological distress. Complete this survey to get a snap shot
of how hard you have struggled to be you, in your own head in the past 4 weeks.

in the past 4 weeks…

None of
the time

A little of
the time

Some of
the time

Most of
the time

All of
the time

1. About how often did you feel tired out for no good reason?
- 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?
- 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?
- 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 do you feel hopeless?
- 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?
- 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?
- 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?
- 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 is an effort?
- 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?
- 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?
- None of the time
- A little of the time
- Some of the time
- Most of the time
- All of the time
Name
Email*
K10 - Kessler (2002) Short screening scale of psychological distress.
Total Score

free report!

10 steps toward saying goodbye to anxiety and depression

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10 STEPS TOWARDS SAYING
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