The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BMC Public Health

Sandra Brouwer²  Jac JL van der Klink²  Johan W Groothoff²  Bert LR Cornelius¹ 

[1] Social Security Institute, Amsterdam, The Netherlands;Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

关键词: Predictive value;    Psychometric;    GHQ-12;    K6;    K10;    CIDI;    Screening;    Mental disorder;    Disability;   

Others  :  1162551
DOI  :  10.1186/1471-2458-13-128

 received in 2012-05-20, accepted in 2013-02-06,  发布年份 2013

【 摘 要 】

Background

Screening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4^thEdition (DSM-IV) among disability claimants.

Methods

All scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach’s α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.

Results

Cronbach’s alpha’s were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC’s for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).

Conclusions

The K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

【 授权许可】

   
2013 Cornelius et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]OECD: Sickness, disability and work: Keeping on track in the economic downturn - background paper. Geneva: OECD; 2009.
• [2]Knowledge Center UWV: Quarterly Report 2007-III (in Dutch: Kwartaalverkenning 2007-III). Amsterdam: UWV; 2007.
• [3]Ellen SR, Norman TR, Burrows GD: MJA practice essentials. 3. Assessment of anxiety and depression in primary care. Med J Aust 1997, 167:328-33.
• [4]Olfson M, Guardino M, Struening E, Schneier FR, Hellman F, Klein DF: Barriers to the treatment of social anxiety. Am J Psychiatry 2000, 157:521-7.
• [5]Gilbody SM, House AO, Sheldon TA: Routinely administered questionnaires for depression and anxiety: systematic review. BMJ 2001, 322:406-9.
• [6]Gilbody S, House AO, Sheldon TA: Screening and case finding instruments for depression. Cochrane Database Syst Rev 2005., 19CD002792
• [7]Lecrubier Y: Widespread underrecognition and under treatment of anxiety and mood disorders: results from 3 European studies. J Clin Psychiatry 2007, 68(Suppl 2):36-41.
• [8]Donker T, Comijs H, Cuijpers P, Terluin B, Nolen W, Zitman F, Penninx B: The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Res 2010, 176:45-50.
• [9]Stansfeld S, Feeney A, Head J, Canner R, North F, Marmot M: Sickness absence for psychiatric illness: The Whitehall II study. Soc Sci Med 1995, 40:189-97.
• [10]Hensing G, Spak F: Psychiatric disorders as a factor in sick-leave due to other diagnoses. A general population-based study. Br J Psychiatry 1998, 172:250-6.
• [11]Laitinen Krispijn S, Bijl RV: Mental disorders and employee sickness absence: the NEMESIS study. Netherlands Mental Health Survey and Incidence study. Soc Psychiatry Psychiatr Epidemiol 2000, 35:71-7.
• [12]Laitinen-Krispijn S, Bijl R: Werk, psyche en ziekteverzuim. aard en omvang van psychische stoornissen, ziekteverzuim en zorggebruik in de beroepsbevolking (in Dutch). Utrecht: Institute of Mental Health and Addiction (Trimbos-instituut); 2002.
• [13]Langerak W, Langeland W, Draijer N, Draisma S, van Balkom T: Diagnostics and classification of psychiatric disorders in a cohort of long-term work disabled persons due to mental health problems (article in Dutch; abstract in English). Tijdschr Bedrijfs Verzekeringsgeneeskd 2011, 19:14-21.
• [14]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington D.C: American Psychiatric Association; 1994.
• [15]Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004, 13:93-121.
• [16]Kessler RC, Mroczek DK: Final versions of our non-specific psychological distress scale. Ann Arbor: Ann Arbor Mi. Survey Research Center for Social Research, University of Michigan; 1994.
• [17]Goldberg D, Williams P: A user's guide to the General Health Questionnaire. Windsor: NFER-NELSON; 1998.
• [18]Andrews G, Slade T: Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health 2001, 25:494-7.
• [19]Furukawa TA, Kessler RC, Slade T, Andrews G: The performance of the K6 and K10 screening scales for psychological distress in the Australian national survey of mental health and well-being. Psychol Med 2003, 33:357-62.
• [20]Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, Tachimori H, Iwata N, Uda H, Nakane H, Watanabe M, Naganuma Y, Hata Y, Kobayashi M, Miyake Y, Takeshima T, Kikkawa T: The performance of the Japanese version of the K6 and the K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res 2008, 17:152-8.
• [21]Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SL, Manderscheid RW, Walters EE, Zaslavsky AM: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003, 60:184-9.
• [22]WHO World Mental Health (WMH) Survey Initiative: Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) Survey Initiative. Int. J. Methods Psychiatr Res 2010, 19(1):4-22.
• [23]Fassaert T, De Wit MA, Tuinebreijer WC, Wouters H, Verhoeff AP, Beekman AT, Dekker J: Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress Scale (K10) among Dutch, Moroccan and Turkish respondents. Int J Methods Psychiatr Res 2009, 18:159-68.
• [24]Schmitz N, Kruse J, Tress W: Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample. Acta Psychiatr Scand 1999, 100:462-8.
• [25]OECD: Sick on the Job? Myths and Realities about Mental Health and Work. Geneva: OECD; 2011.
• [26]Flach PA, Groothoff JW, Krol B, Bültmann U: Factors associated with first return to work and sick leave durations in workers with common mental disorders. Eur J Public Health 2011.
• [27]Blank L, Peters J, Pickvance S, Wilford J, Macdonald E: A systematic review of the factors which predict return to work for people suffering episodes of poor mental health. J Occup Rehabil 2008, 18:27-34.
• [28]Cornelius LR, van der Klink JJ, Groothoff JW, Brouwer S: Prognostic factors of long term disability due to mental disorders: a systematic review. J Occup Rehabil 2011, 21:259-74.
• [29]Ouwehand P, Wouters PHM: ICD-10 classificaties voor Arbo en SV. Classificatie van klachten, ziekten en oorzaken voor bedrijfs- en verzekeringsartsen (in Dutch. Utrecht: TICA; 1997.
• [30]Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002, 32:959-76.
• [31]ESEMeD: Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004, 109(1):8-20.
• [32]Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C: The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997, 27:191-7.
• [33]Kessler RC, Üstün TB: The World Health Organization Composite International Diagnostic Interview. In World Mental Health surveys: Global perspectives on the epidemiology of mental disorders. Edited by The WHO. Cambridge: Cambridge University Press; 2008:58-90.
• [34]Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson SA, Kessler RC: Concordance of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006, 15:167-80.
• [35]Wittchen HU: Reliability and validity studies of the WHO–Composite International Diagnostic Interview (CIDI): A critical review. J Psychiatr Res 1994, 28:57-84.
• [36]Andrews G, Peters L: The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 1998, 33:80-8.
• [37]Zweig MH, Campbell G: Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clin Chem 1993, 39:561-77.
• [38]Smits N, Smit F, Cuijpers P, De Graaf R: Using decision theory to derive optimal cut-off scores of screening instruments: an illustration explicating costs and benefits of mental health screening. Int J Methods Psychiatr Res 2007, 16:219-29.
• [39]ESEMeD: Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004, 109(1):21-7.
• [40]Hensing G, Wahlstrom R: Sickness absence and psychiatric disorders. Scand J Public Health 2004, 63(Suppl):152-80.
• [41]Leeflang MMG, Bossuyt PMM, Irwig L: Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis. J Clin Epi 2009, 62:5-12.