Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization
Open accessAbstract
The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ≥ 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.
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Psychological distress poses risk for subsequent mental disorders and causes marked impairment.
“Psychological distress poses risk for subsequent mental disorders and causes marked impairment. 13,14”
From Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomised trial (2020) · cites this paper as [14]
The Discussion (page unavailable) reports that moderate mental distress affected work, household, social, and other functioning, supporting the impairment portion. The paper does not establish that distress increases the risk of subsequent mental disorders, and its findings on impairment do not establish causation. (LLM, conf=0.87)
Experimental — accuracy not yet measuredScoring 13 or higher on the K6 indicates a high likelihood of having a serious mental disorder causing functional limitations requiring treatment.
“scoring 13 or higher on the K6, which in studies done in other settings 14 indicates a high likelihood of having a serious mental disorder causing functional limitations requiring treatment”
From Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomised trial (2020) · cites this paper as [14]
The Abstract defines the K6 cutoff of 13 as a screen for serious mental illness involving a DSM-IV disorder and significant impairment. It does not establish that a person scoring 13 or higher has a high likelihood of that diagnosis or necessarily requires treatment; the Discussion addresses treatment need chiefly when evaluating a lower cutoff for moderate distress. The cited passages have no page numbers in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measured
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- Authors
- Prochaska, J. J., Sung, H., Max, W., Shi, Y., & Ong, M.
- Affiliations
- University of California, San Francisco (US)
- University of California, Los Angeles (US)
- Venue
- International Journal of Methods in Psychiatric Research
- Publisher
- Wiley
- Published
- 2012-02-20
- Volume
- 21
- Issue
- 2
- Pages
- 88-97
- ISSN
- 1049-8931 (ISSN-L)
- 1557-0657
- PMC
- PMC3370145
- OpenAlex
- W1722711020
- Cited by
- 942
- References
- 23
- Citations by year
- 2026: 93 · 2025: 119 · 2024: 131 · 2023: 110 · 2022: 110 · 2021: 106 · 2020: 89 · 2019: 53 · 2018: 41 · 2017: 28 · 2016: 22 · 2015: 19 · 2014: 15 · 2013: 4 · 2012: 2
- FWCI
- 19.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Methods in Psychiatric Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (R01MH083684, P30MH082760)
- National Institute on Drug Abuse (K23DA018691, P50DA009253)
- National Cancer Institute (U54CA153499)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- mental health service utilization, functional disability, substance use, risk-taking, California Health Interview Survey
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Mental Disorders, Female, Health Services Needs and Demand, Humans, Male, Mental Health, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, ROC Curve, Sensitivity and Specificity, Sex Factors, Substance-Related Disorders, Young Adult
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