K10: Kessler Psychological Distress Scale
What the K10 measures, how it is scored and grouped in Australia, what a total says about the likelihood of a disorder, how it is used with the GP, the K6 and K5, and who it has not been validated for.
Quick check
Answer each one in your own words, then open the model answer to compare. Signed in, your answers are kept and marked, and the plan uses them.
1.A 31-year-old man completes a K10 on a mental health website before his first session and brings the printout, which lists each of his ten answers with its score and a total of 19. The practice reads totals against the primary care grouping. What does the psychologist make of the 19?
Model answer
The printout shows some answers scored 0, which means the website scored each answer from 0 to 4, so 19 on that form is 29 on Australian scoring, at the top of the band for a likely moderate disorder. Read as it stands, 19 would sit in the "likely to be well" band, and the two readings lead to different conversations with the client and with the GP. The psychologist would convert the total before grouping it, record the form and the scoring in the file, and give the practice's own K10 at the session so that the next comparison is on one scoring.
2.A GP's referral records a K10 of 31, completed three weeks ago in the waiting room. At the first session the psychologist gives the K10 again and the client scores 22. The client asks whether that means she is already getting better. What does the psychologist say?
Model answer
Both forms ask about the past four weeks, so the two windows overlap by a week, and the first was completed unsupervised in a waiting room while the second was completed in a consulting room at the start of treatment. The K10's stability over short intervals is not well established, so a nine-point fall cannot be read as improvement on its own. The psychologist would say that the second total is lower, that the two were taken in different settings, and that the K10 will be repeated at review on one scoring so that change can be tracked. Both totals go in the file with their dates.
3.A psychologist at an Aboriginal community-controlled health service receives a GP referral with a K10 of 38 and the note "severe, please prioritise". The Aboriginal health worker who did the intake yarn says the client seemed tired and worried about family business rather than unwell. Does the psychologist prioritise the appointment?
Model answer
The psychologist offers an early appointment, because a total that high is the client's own report of a month of distress and the K10 does not cover risk, so the client should be seen and asked about risk directly. The band "likely severe disorder" cannot be read as it would be for the survey population, since the K10's validation did not include Aboriginal and Torres Strait Islander peoples, and the cultural safety guidelines recommend acknowledging that limit. With the health worker, the psychologist would ask how the form was completed, what the client meant by the items scored highest, and about risk. The total is recorded with its limits stated, and the assessment is based mainly on the social and emotional wellbeing history.
4.A 74-year-old man is referred with a K10 of 26 and the GP's note "moderate distress, likely depression". He has chronic back pain and sleeps four hours a night. On the form he has scored 5 for feeling tired out for no good reason and 5 for everything being an effort, and 2 on every other item. How does the psychologist report the total?
Model answer
The K10 has no subscales and the items are not validated for separate reading, so the total is reported as 26 and grouped as the referrer's form groups it. The psychologist would also state what the total is made of: ten of the 26 points come from two items that pain and sleep loss raise, and the other eight items are each scored 2. In adults over 65 a total under 30 is weaker evidence of a disorder, and the K10 does not point to depression in particular. The psychologist should assess his mood by interview, treat the GP's "likely depression" as a hypothesis to test, and not let the band stand in for the assessment.
5.A GP's referral comes in on a Friday afternoon with a K10 of 41 and the note "severe depression, suicidal?, please see urgently". The psychologist's first available appointment is in three weeks. Does the psychologist phone the client to ask about risk, or contact the GP to say the referral cannot be taken urgently?
Model answer
The psychologist phones the client first, because the GP's question mark is a risk question that neither the referral nor the K10 answers, and the client is the one who can. The total makes a disorder very likely, but it cannot rule suicidal thinking in or out, since no item asks about it. From the client's answers about thoughts, plans and means, the psychologist decides whether a three-week wait is safe, an earlier or interim appointment is needed, or the GP should see the client again for a risk assessment that day. Handing the referral back without speaking to the client would leave the GP's question open for the weekend.