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Two versions of the scales are presented here, one for interviewer-administration and the other for self-administration. Note that the K6 is merely a truncated form of the K10 in which four questions are deleted. The question series presented here include not only the six or ten Likert scale questions in the scales, but also a number of other questions that we routinely administer along with the scales to learn about persistence and impairment. These additional questions are not required to score the K6 or K10.
Permission requests
Use of the K6 and K10 is free and does not require any formal permission or approval. We do ask that you please cite the below article and include the copyright when using these scales. In addition, we would appreciate it if you would send us the citations to all final publications that use the K6/K10.
Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184-189.
Copyright © Ronald C. Kessler, PhD. All rights reserved.
The translations of the K6 and K10 are posted for unrestricted use, with the same requirement to acknowledge the copyright and cite the above article.
Scoring Rules: click here.
For a comprehensive list of articles on the K10 and K6, click here.
All versions of the K6 and K10 are available for download on our website.
K6 |
K10 |
| Self-Administered (English) | Self-Administered (English) |
| Interviewer-administered (English) | Interviewer-administered (English) |
Translated versions of the K6/K10 instruments:
Language |
K6 |
K10 |
| Arabic | ||
| Chinese (Cantonese) | Not available* |
|
| Chinese (Mandarin) | ||
| Danish | Not available* |
|
| Dutch | ||
| Finnish | ||
| French | Not available* |
|
| German | Not available* |
|
| Greek | Not available* |
|
| Hebrew | ||
| Italian | ||
| Japanese | ||
| Malay | Not available* |
|
| Mongolian | Not available* |
|
| Nepali | Not available* |
|
| Persian | Not available* |
|
| Portuguese (for use in Brazil) | Not available* |
|
| Sinhalese | ||
| Spanish (for use in Spain) | ||
| Spanish (for use in Americas) | ||
| Swahili | Not available* |
|
| Swedish | ||
| Tagalog | Not available* |
|
| Turkish | ||
| Urdu | ||
| Vietnamese | Not available* |
|
| Welsh | Not available* |
*Not yet translated in this language.
Additional translations are available on these websites below. Please note that these have not been approved as official WHMH translations.
http://www.dhi.health.nsw.gov.au/Transcultural-Mental-Health-Centre/Resources/Translations-/Kessler10/Kessler10/default.aspx. http://http://www.healthtranslations.vic.gov.au/bhcv2/bhcht.nsf/PresentDetail?Open&s=Kessler_10_(K10)_Assessment_Form..
Are you interested in translating and using the K10/K6 in a language other than English?
Researchers and clinicians from a number of countries have contacted us about translating and validating the K10/6 in their languages. We will post each such translation on our web page when we receive it along with an acknowledgement to the person or persons who made the translation and a citation to any publication that reports the results of the validation. This memo provides a brief overview of requirements for acceptable translations and validations.
I. Translation
The 10 questions in the basic form of the K10 are included in the World Mental Health surveys. These surveys are being carried out in 30 countries around the world and the interview schedule is being translated into 35 different languages. Some, but not all, of the collaborators in the WMH surveys are also translating the K10/K6 self-administration forms into these same languages. We are posting these versions as they become available. For those of you who are interested in translating the K10/6 self-administration forms into your language, we are using the WHO translation protocol for all official K10/K6 translations. Please write and ask us for this protocol. We can then tell you if we already have another group working on a translation in your language and, if not, we can discuss with you a time line for your translation.
II. Validation
K10/K6 validations are being done in primary care clinics, community mental health centers, and social welfare offices. The validation standards differ in each case, but our preference is for validation to be based on a semi-structured research diagnostic interview, such as the SCID, and to have a sufficient number of respondents validated to have the statistical power needed for evaluation. A minimal design would be to carry out a clinical evaluation of 50 people who have a positive K6 score (10 or more on the 0-24 scale) and 50 who have a score in the range 0-9, although larger numbers would be better. The clinical re-interview should be carried out within 2 days of the K6 to make sure respondents are referring to the same 30-day recall period. Clinical interviewers should be blinded to K6 scores. Psychometric analyses of operating characteristics should be based on weighted data that adjust for the over-sampling of K6 positives in the sampling of clinical reappraisal respondents. This weighting is critical, as estimates of sensitivity, specificity, and AUU would be biased in the absence of weighting.
To contact us about K10/K6 translation and validation, email ronkadm@hcp.med.harvard.edu.
Frequently Asked Questions
Q. Has the scale been used in surveys of racial and
ethnic populations?
The K10 has been used in the World Mental Health (WMH) surveys. WMH
includes surveys of over 166,000 people in 30 countries throughout the
world. Calibration of K6/K10 scores to clinical assessments is currently
being carried out and results will be posted when they become available.
In the US, a number of studies are using the K6 or the K10 in studies
of minority samples.
Q. How does the scale work in minority populations?
Scale properties are stable in minority sub-samples of our large surveys.
Q. Has this scale been translated into languages other than English?
Yes, see http://www.hcp.med.harvard.edu/ncs/k6_scales.php.
Q. We note that asking clients about the 'last 4 weeks' may prevent us from identifying change in distress over the course of a brief intervention (i.e. 4-6 weeks). Will it cause significant issues when interpreting scores if we changed the wording to 'in the last 7 days' for each item?
Changing the wording to 'in the last 7 days' is ok and should not cause significant issues in interpreting scores.
Q. Have you ever used the CDC measure of "frequent mental
distress (FMD)" derived from the question "Thinking
about your mental health, for how many days during the past 30 days
was your mental health not good?" in the same survey where K-6
questions are used? If yes, to which extent may FMD and psychological
distress overlay? Do they measure different things?
The FMD question has a much more skewed distribution than the K6
or K10 and should only be used when you are interested in fleshing out
the top 1-2% of the population. The K6 is best to use when you want to
look at serious mental illness (about 5-8% of the population). The K6
was not designed to distinguish the top 1-2% from the rest of the population.
If you want to have sensitivity throughout the severity range, you can
use the K6 or K10 along with the FMD question. Remember, though, that
in order to have adequate statistical power for substantive analysis of the
top 1-2% of the population, you need a very large sample.
Q: A question has been raised by several colleagues about the likelihood
of seriously ill persons who are being successfully treated (manic depressives
with lithium, for example) being picked up by the K6. How do we handle
this problem?
A: Symptom screening scales miss people who are successfully treated.
It takes much more extensive instruments to find people who have, say,
bipolar disorder, but who are being successfully treated. A quick thing
you might want to do if you want to know this stuff in a rough and ready
way: You can ask people if they are in treatment and, if so, you can ask
them to think about the month before treatment and to tell you how they
would respond to the K10/K6 questions for that month. Note that this approach
will only expand your assessment to include people who might have high
distress right now were it not for current treatment (e.g., taking their
lithium every day). You will not pick up people with a history of SMI
who are currently doing well without treatment.
