What this distress check measures
The K6 measures psychological distress: how often you have felt low, tense or worn down lately, without trying to name a specific condition [1]. It asks how often during the past 30 days you felt [5]:
- nervous
- hopeless
- restless or fidgety
- so depressed that nothing could cheer you up
- that everything was an effort
- worthless
Stress or distress?
This page is called a stress and distress check, but the K6 measures distress rather than stress. The NHS describes stress as usually a reaction to mental or emotional pressure [6]. The K6 does not ask about the pressure itself. It asks how you have been feeling, whatever the cause [5]. That makes it a useful first look if you feel "not right" but are not sure whether it is low mood, worry or something else.
Who developed it
The K6 was developed by Ronald Kessler and colleagues for a national health survey in the United States [1]. Its questions were tested in national mail and telephone surveys, then checked against 153 face-to-face clinical interviews [1]. By 2002, the K6 and its 10-question version were already used in yearly government health surveys in the United States and Canada, and in the World Health Organization's World Mental Health Surveys [1].
It is free to use [3]. The authors also publish a Welsh translation [3].
How the K6 is scored
Each question has five answers, scored from 4 for "all of the time" down to 0 for "none of the time" [4]:
| Answer | Points |
|---|---|
| All of the time | 4 |
| Most of the time | 3 |
| Some of the time | 2 |
| A little of the time | 1 |
| None of the time | 0 |
The six answers add up to a total from 0 to 24 [4]. A higher score means you felt distress more often. The authors use one cut-off [4]:
| Total score | Result |
|---|---|
| 0-12 | Below the screening cut-off |
| 13-24 | At or above the screening cut-off |
The authors chose 13 or more because, in their calibration study, it most evenly balanced false positives against false negatives when estimating serious mental illness across a whole population [4]. They note it is only optimal in a population with the same rate of serious mental illness as the United States [4]. For one person, it is a rough signal, not a verdict.
What your result can and cannot tell you
The K6 puts a number on how heavy the last month has felt. It cannot tell you why. It was built to measure distress in general, not any one condition [1], so it cannot say whether anxiety, depression or something else is behind your score.
It is a screening scale, not a diagnosis. If your score is high, the PHQ-9 depression test and the GAD-7 anxiety test on this site look at more specific symptoms.
How accurate is it?
- First study (2002). In 153 clinical interviews, the K6 and its 10-question version separated people with and without a mental health condition that affected daily functioning, with areas under the curve of 0.87 to 0.88. For conditions causing serious problems with daily functioning, the figure was 0.95 to 0.96 [1].
- Serious mental illness study (2003). In 155 people, the area under the curve for serious mental illness was 0.865. The K6 had a sensitivity of 0.36 and a specificity of 0.96 [2].
A specificity of 0.96 means a high score was rarely a false alarm. A sensitivity of 0.36 means many people with a serious condition scored below the line. A low score is good news, but it does not prove you are fine. The authors also note that their first checks came from a small study in Boston [3].
What to do next in the UK
- If your score is below 13 and you feel you are coping, you may not need to do anything now. Take the check again if things change.
- If your score is 13 or more, or you are worried whatever the number, speak to your GP. The NHS suggests seeing a GP if you are struggling to cope with stress or the things you are trying are not helping [6].
- In England, if you are 18 or over (or 16 or over in some areas), you can refer yourself to NHS talking therapies without talking to a GP [6]. You need to live in England, and you do not need a diagnosis [7].
- In Scotland, your GP practice is the first place to go when it is open [9].
- In Northern Ireland, your GP may treat you directly or refer you to mental health services [12].
- In Wales, your GP can refer you to local primary mental health services, which then have a duty to assess you [15].
If you need help now
- If your life or someone else's is at risk, or you cannot keep yourself safe, call 999 or go to A&E [8].
- England: call 111 and select the mental health option [8].
- Scotland: phone NHS 24 on 111 and choose the mental health option [9].
- Wales: call 111 and press option 2. It is free and open 24 hours a day, 7 days a week, for all ages [10].
- Northern Ireland: call Lifeline on 0808 808 8000. It is free and open 24 hours every day [11].
- Anywhere in the UK: call Samaritans free on 116 123, day or night [13], or text the word SHOUT to 85258 for free text support at any time [14].