K10

Name:

 

Date:

 

Please read each statement and select a response N, L, S, M or A which indicates how much the statement applied to you in the past 4 weeks. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:
N: None of the time
L: A little of the time
S: Some of the time
M: Most of the time
A: All of the time

   

N

L

S

M

A

1.

About how often did you feel tired out for no good reason?

 

2.

About how often did you feel nervous?

 

3.

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

 

4.

About how often did you feel hopeless?

 

5.

About how often did you feel restless or fidgety?

 

6.

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

 

7.

About how often did you feel depressed?

 

8.

About how often did you feel that everything was an effort?

 

9.

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

 

10.

About how often did you feel worthless?

 

 

Please print this page for future reference as it is not saved on refreshing or closing this window.

 

 

Results

 

Total: