Psychological Medicine

Short screening scales to monitor population prevalences and trends in non-specific psychological distress

R. C.  KESSLER  a1 c1, G.  ANDREWS  a1, L. J.  COLPE  a1, E.  HIRIPI  a1, D. K.  MROCZEK  a1, S.-L. T.  NORMAND  a1, E. E.  WALTERS  a1 and A. M.  ZASLAVSKY  a1
a1 From the Department of Health Care Policy, Harvard Medical School, Division of Mental Disorders, Behavioral Research and AIDS, National Institute of Mental Health, Department of Psychology, Fordham University and Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA; and Clinical Research Unit for Anxiety Disorders, School of Psychiatry, University of New South Wales, NSW, Australia


Background. A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS).

Methods. Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being.

Results. Both the K10 and K6 have good precision in the 90th–99th percentile range of the population distribution (standard errors of standardized scores in the range 0·20–0·25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0·87–0·88 for disorders having Global Assessment of Functioning (GAF) scores of 0–70 and 0·95–0·96 for disorders having GAF scores of 0–50.

Conclusions. The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

c1 Address for correspondence: Dr R. C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.