Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative

Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a six‐item scale developed to provide a brief valid screen for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM‐IV) SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined N = 41,770 respondents). Twelve‐month prevalence of DSM‐IV SMI was assessed with the fully‐structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores, taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve, was generally substantial (median 0.83; range 0.76–0.89; inter‐quartile range 0.81–0.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied. Copyright © 2010 John Wiley & Sons, Ltd.

[1]  Katherine B. Morton,et al.  The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures , 2010, International journal of methods in psychiatric research.

[2]  C. Hanlon,et al.  Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. , 2010, Journal of affective disorders.

[3]  T Fassaert,et al.  Psychometric properties of an interviewer‐administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents , 2009, International journal of methods in psychiatric research.

[4]  R. Kessler,et al.  DSM–IV personality disorders in the WHO World Mental Health Surveys , 2009, British Journal of Psychiatry.

[5]  G. Patton,et al.  The identification of young people's emotional distress: a study in primary care. , 2009, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  Y. Ono,et al.  The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan , 2008, International journal of methods in psychiatric research.

[7]  T. B. Üstün,et al.  Sample designs and sampling procedures. , 2008 .

[8]  T. B. Üstün,et al.  Translation procedures and translation assessment in the World Mental Health Survey Initiative. , 2008 .

[9]  T. B. Üstün,et al.  Implementation of the World Mental Health Surveys. , 2008 .

[10]  Ronald C. Kessler,et al.  The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders. , 2008 .

[11]  R. Araya,et al.  Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires , 2007, Psychological Medicine.

[12]  R. Baggaley,et al.  Short communication: Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso , 2007, Tropical medicine & international health : TM & IH.

[13]  Norito Kawakami,et al.  Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. , 2007, World psychiatry : official journal of the World Psychiatric Association.

[14]  A. Mackinnon,et al.  Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population , 2007, Psychiatry Research.

[15]  R. Kessler,et al.  Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. , 2007, The British journal of psychiatry : the journal of mental science.

[16]  M. Hellard,et al.  Reliability and Validity of the Kessler 10 and Patient Health Questionnaire among Injecting Drug Users , 2007, The Australian and New Zealand journal of psychiatry.

[17]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[18]  G. Rao Rational Medical Decision Making: A Case-Based Approach , 2006 .

[19]  Fausto Mazzi,et al.  Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys , 2006, International journal of methods in psychiatric research.

[20]  A. Lurigio,et al.  Screening for serious mental illness in populations with co-occurring substance use disorders: Performance of the K6 scale. , 2006, Journal of substance abuse treatment.

[21]  Olga V. Demler,et al.  The Prevalence and Correlates of Nonaffective Psychosis in the National Comorbidity Survey Replication (NCS-R) , 2005, Biological Psychiatry.

[22]  A. Baillie Predictive gender and education bias in Kessler's psychological distress Scale (k10) , 2005, Social Psychiatry and Psychiatric Epidemiology.

[23]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[24]  Olga V. Demler,et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[25]  Olga V. Demler,et al.  The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population , 2005, Psychological Medicine.

[26]  David R. Anderson,et al.  Multimodel Inference , 2004 .

[27]  R. Kessler,et al.  Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. , 2004, JAMA.

[28]  T. B. Üstün,et al.  The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) , 2004, International journal of methods in psychiatric research.

[29]  R. Kessler,et al.  The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being , 2003, Psychological Medicine.

[30]  R. Kessler,et al.  Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative , 2003, Archives of general psychiatry.

[31]  이동우 한국어판 Composite International Diagnostic Interview의 타당도 , 2003 .

[32]  R. Kessler,et al.  Short screening scales to monitor population prevalences and trends in non-specific psychological distress , 2002, Psychological Medicine.

[33]  D. Margolis,et al.  Statistical characteristics of area under the receiver operating characteristic curve for a simple prognostic model using traditional and bootstrapped approaches. , 2002, Journal of clinical epidemiology.

[34]  G. Andrews,et al.  Stratum-specific likelihood ratios of the General Health Questionnaire in the community: help-seeking and physical co-morbidity affect the test characteristics , 2002, Psychological Medicine.

[35]  Gordon H. Guyatt,et al.  Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice; Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice , 2003, BMJ : British Medical Journal.

[36]  J. Coyne,et al.  Validity and efficiency of screening for history of depression by self-report. , 2001, Psychological assessment.

[37]  S. Rabe-Hesketh,et al.  Stratum-specific likelihood ratios of two versions of the General Health Questionnaire , 2001, Psychological Medicine.

[38]  Thomas J. Carmody,et al.  The Inventory of Depressive Symptomatology (IDS): Clinician (IDS‐C) and Self‐Report (IDS‐SR) ratings of depressive symptoms , 2000 .

[39]  S. Embretson,et al.  Item response theory for psychologists , 2000 .

[40]  D. Regier,et al.  Unmet Need in Psychiatry: The epidemiology of mental disorder treatment need: community estimates of ‘medical necessity’ , 2000 .

[41]  Shekhar Saxena,et al.  On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population , 1999 .

[42]  J. Mundt,et al.  Computerized assessment of depression and anxiety over the telephone using interactive voice response. , 1999, M.D. computing : computers in medical practice.

[43]  R. Kessler,et al.  The World Health Organization Composite International Diagnostic Interview short‐form (CIDI‐SF) , 1998 .

[44]  S. M. Rogers,et al.  Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. , 1998, Science.

[45]  R. Kessler,et al.  Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US national comorbidity survey (NCS) , 1998 .

[46]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[47]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[48]  R. Hambleton,et al.  Handbook of Modern Item Response Theory , 1997 .

[49]  R. J. Mokken,et al.  Handbook of modern item response theory , 1997 .

[50]  R. Kessler,et al.  Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. , 1996, Archives of general psychiatry.

[51]  K Kroenke,et al.  Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. , 1994, JAMA.

[52]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[53]  R. G. Cornell,et al.  Integrating Stratum-specific Likelihood Ratios with the Analysis of ROC Curves , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[54]  F. Goodwin,et al.  Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council. , 1993, The American journal of psychiatry.

[55]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[56]  R. Bland Psychiatric Disorders in America: The Epidemiologic Catchment Area Study , 1992 .

[57]  A. Farmer,et al.  The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. , 1988, Archives of general psychiatry.

[58]  L. Tondo,et al.  Comparison between clinician-rated and self-reported depressive symptoms in Italian psychiatric patients. , 1988, Neuropsychobiology.

[59]  D. Rubin Multiple imputation for nonresponse in surveys , 1989 .

[60]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[61]  Bruce G. Link,et al.  Mental Illness in the United States: Epidemiological Estimates. , 1982 .

[62]  M. Lieberman,et al.  The stress process. , 1981, Journal of health and social behavior.

[63]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[64]  P. Shrout,et al.  Nonspecific psychological distress and other dimensions of psychopathology. Measures for use in the general population. , 1980, Archives of general psychiatry.

[65]  B. Dohrenwend,et al.  Formulation of Hypotheses about the True Prevalence of Demoralization in the United States , 1980 .

[66]  G. Gurin,et al.  Americans View Their Mental Health , 1979 .

[67]  Jae-On Kim,et al.  Factor Analysis: Statistical Methods and Practical Issues , 1978 .

[68]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[69]  J. Fleiss,et al.  The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. , 1976, Archives of general psychiatry.

[70]  J. Myers,et al.  Life events, social integration and psychiatric symptomatology. , 1975, Journal of health and social behavior.

[71]  L. H. Seiler The 22-item scale used in field studies of mental illness: a question of method, a question of substance, and a question of theory. , 1973, Journal of health and social behavior.

[72]  Marvin K. Opler,et al.  Mental Health in the Metropolis: The Midtown Manhattan Study. , 1965 .

[73]  S. Fleck My Name is Legion , 1962 .

[74]  T. Langner A twenty-two item screening score of psychiatric symptoms indicating impairment. , 1962, Journal of health and human behavior.

[75]  A. Macmillan The Health Opinion Survey: Technique for Estimating Prevalence of Psychoneurotic and Related Types of Disorder in Communities , 1957 .