Screening performance of K6/K10 and other screening instruments for mood and anxiety disorders in Japan
01 Aug 2011-Psychiatry and Clinical Neurosciences (Psychiatry Clin Neurosci)-Vol. 65, Iss: 5, pp 434-441
TL;DR: This study aimed to establish the screening performance and optimal cut‐off points for the Japanese version of Kessler (K)6, K10 and the Depression and Suicide Screen (DSS).
Abstract: Aims: This study aimed to establish the screening performance and optimal cut-off points for the Japanese version of Kessler (K)6, K10 and the Depression and Suicide Screen (DSS).
Methods: A self-report questionnaire including K6, K10 and DSS, as well as the Center for Epidemiologic Studies – Depression Scale (CES-D), was administered to a random sample of community residents in Japan (non-cases, n = 147) and psychiatric outpatients diagnosed with mood or anxiety disorders according to DSM-IV (cases, n = 17). A receiver–operator characteristics (ROC) curve was drawn to estimate the area under the curve (AUC), the sensitivity, and specificity with the optimal cut-off points for K6, K10, and DSS, which were then compared with those of CES-D. The community sample was also asked to rate each measure on a scale from ‘very easy’ to ‘very hard’ to use.
Results: K6 and K10 showed a high AUC (0.93–0.94), which was comparable to that of CES-D (0.95), but DSS showed a significantly smaller AUC (0.89) than CES-D (P < 0.05). The optimal cut-off points were estimated as 4/5 for K6, 9/10 for K10, and 1/2 for DSS. The sensitivity of these three scales was similar, but the specificity was lower for DSS than for the other two. K6, K10 and DSS were rated as being ‘very easy’ or ‘easy to use’ significantly more than CES-D (P < 0.01).
Conclusion: The screening performance of the Japanese versions of K6 and K10 was comparable with that of CES-D, and better than that of DDS. K6/K10, particularly K6, might have an advantage, even over the CES-D, because of its similar screening performance and better acceptability.
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TL;DR: Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive, and it is important to strengthen efforts to align depression care with each patient's clinical needs.
Abstract: Importance Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity. Objective To characterize the treatment of adult depression in the United States. Design, Setting, and Participants Analysis of screen-positive depression, psychological distress, and depression treatment data from 46 417 responses to the Medical Expenditure Panel Surveys taken in US households by participants aged 18 years or older in 2012 and 2013. Main Outcome and Measures Percentages of adults with screen-positive depression (Patient Health Questionnaire-2 score of ≥ 3) and adjusted odds ratios (AORs) of the effects of sociodemographic characteristics on odds of screen-positive depression; percentages with treatment for screen-positive depression and AORs; percentages with any treatment of depression and AORs stratified by presence of serious psychological distress (Kessler 6 scale score of ≥13); and percentages with depression treatment by health care professional group (psychiatrists, other health care professionals, and general medical providers); and type of depression treatment (antidepressants, psychotherapy, and both) all stratified by distress level. Results Approximately 8.4% (95% CI, 7.9-8.8) of adults screened positive for depression, of which 28.7% received any depression treatment. Conversely, among all adults treated for depression, 29.9% had screen-positive depression and 21.8% had serious psychological distress. Adults with serious compared with less serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% vs 17.3%, P P P P P Conclusions and Relevance Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient’s clinical needs.
248 citations
TL;DR: The earthquake and tsunami followed by the nuclear accident caused psychological distress among residents in Fukushima prefecture, as revealed by the present mental health survey.
Abstract: Background On 11 March 2011, the Great East Japan Earthquake followed by a gigantic tsunami hit the Pacific coast of Northeast Japan (Tohoku) and damaged Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, causing a radiation hazard in the entire Fukushima Prefecture. The radiation dose exposed either externally and internally in Fukushima residents have been evaluated to be low so far and it is hardly believed that they may have any direct radiation risk on physical condition. The purpose of this report is, therefore, to describe results of a mental health and lifestyle survey intended to facilitate adequate care for residents who are at a higher risk of developing mental health problems after the complicated accident. Participants and methods The target population of this survey is the residents of evacuation zones including Hirono Town, Naraha Town, Tomioka Town, Kawauchi Village, Okuma Town, Futaba Town, Namie Town, Katsurao Village, Minamisoma City, Tamura City, Yamakiya district of Kawamata Town, and Iitate Village. The targeted population was 210,189 in fiscal year 2011 (FY2011) and 211,615 in fiscal year 2012 (FY2012). Questionnaires have been mailed since January 2012, and subsequently, January 2013, 10 and 22 months after the disaster. Among of them, children 63.4%, adults 40.7% for FY2011, and children 41.0%, adults 29.7% for FY2012 responded to the questionnaires mailed. Results Sociodemographic data showed that many evacuee households were separated after the disaster and had to move several times. K6 was used in this survey to estimate general mental health. The proportion (14.6% in FY2011 and 11.9% inFY2012) of adults who scored above the K6 cut-off (≥13) for general mental health was higher than usual, indicating severe mental health problems among evacuees. The proportion (21.6% in FY2011 and 18.3% inFY2012) of adults who scored above the cut-off (≥44) of PTSD checklist (PCL), reflecting traumatic symptoms, was almost equal to that of the workers after the 9.11 World Trade Center attacks. These results also indicate the presence of severe traumatic problems among evacuees. The proportions of children (4-6 years old) and children of primary school age (6-12 years old) who scored above the cut-off (≥16) of Strengths and Difficulties Questionnaire (SDQ) reflecting the mental health status in children, 24.4% and 22.0% in the survey of FY2011, were double the usual state respectively, whereas 16.6% in children of 4-6 years old and 15.8% in children of 6-12 years old in FY2012 were 1.5 times. These findings also disclosed the presence of severe mental difficulties in children, with relative improvement year by year. Conclusion As revealed by the present mental health survey, the earthquake and tsunami followed by the nuclear accident caused psychological distress among residents in Fukushima prefecture. Continuous survey and mental care programs are required.
168 citations
TL;DR: Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress, and associations between psychological distress and risk perception in logistic regression models were examined.
Abstract: Objective To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster. Methods We analysed cross-sectional data from a survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders. Findings Out of the 180 604 people who received the questionnaire, we included 59 807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, CI: 1.42-1.89) for immediate effects; OR: 1.48 (99.9% CI: 1.32-1.67) for delayed effects and OR: 2.17 (99.9% CI: 1.94-2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors. Conclusion Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress.
145 citations
TL;DR: This work was supported by Health and Labour Sciences Research Grants (Research on Occupational Safety and Health H24-001) from the Ministry of Health Labour and Welfare of Japan.
Abstract: Author Affiliations: Department of Psychiatry, National Defense Medical College, Saitama, Japan (Drs Shigemura and Nomura); and Department of Public Health, Ehime University Graduate School of Medicine, Ehime, Japan (Drs Tanigawa [tt9178tt9178@gmail.com] and Saito). Author Contributions: Drs Shigemura and Tanigawa had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Shigemura, Tanigawa, Nomura. Acquisition of data: Shigemura, Tanigawa. Analysis and interpretation of data: Shigemura, Tanigawa, Saito. Drafting of the manuscript: Shigemura, Tanigawa, Saito. Critical revision of the manuscript for important intellectual content: Shigemura, Tanigawa, Nomura. Statistical analysis: Shigemura, Tanigawa, Saito. Obtained funding: Shigemura, Tanigawa, Nomura. Administrative, technical, or material support: Tanigawa. Study supervision: Tanigawa, Nomura. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Shigemura and Nomura provided voluntary mental health assistance to Tokyo Electric Company Fukushima Daiichi and Daini nuclear power plant employees according to official requests from Daini and a Japanese government cabinet order to the Ministry of Defense. Dr Tanigawa is a Daini part-time occupational physician. Dr Saito reported no conflict of interest disclosures. Funding/Support: This work was supported by Health and Labour Sciences Research Grants (Research on Occupational Safety and Health H24-001) from the Ministry of Health Labour and Welfare of Japan. Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Disclaimer: The views expressed in this article are those of the authors and do not reflect the position or policy of Tokyo Electric Company, Ehime University, National Defense Medical College, the Ministry of Defense, or the Japanese government. Additional Contributions: We thank Tomoko Yamamoto, RN (Tokyo Electric Company [TEPCO] Fukushima Daini nuclear power plant), the medical team employees of Daiichi and Daini plants, and Yoshiko Kage (TEPCO R&D Center) for their invaluable cooperation. We also thank the plant workers for their study participation and dedicated recovery efforts. No compensation was received for their services.
118 citations
TL;DR: It is suggested that mental health problems were prevalent in survivors of the Great East Japan Earthquake and Tsunami and for men and women, health complaints, severe economic status, relocations, and lack of social network may be important risk factors of poor mental health.
Abstract: Mental health is one of the most important issues facing disaster survivors. The purpose of this study is to determine the prevalence and correlates of mental health problems in survivors of the Great East Japan Earthquake and Tsunami at 6–11 months after the disaster. The questionnaire and notification were sent to the survivors in three municipalities in the Tohoku area of the Northern part of Honshu, Japan’s largest island, between September 2011 and February 2012. Questionnaires were sent to 12,772, 11,411, and 18,648 residents in the Yamada, Otsuchi, and Rikuzentakata municipalities, respectively. Residents were asked to bring the completed questionnaires to their health check-ups. A total of 11,124 or (26.0%) of them underwent health check-ups, and 10,198 were enrolled. We excluded 179 for whom a K6 score was missing and two who were both 17 years of age, which left 10,025 study participants (3,934 male and 6,091 female, mean age 61.0 years). K6 was used to measure mental health problems. The respondents were classified into moderate (5–12 of K6) and serious mental health problems (13+). A total of 42.6% of the respondents had moderate or serious mental health problems. Multivariate analysis showed that women were significantly associated with mental health problems. Other variables associated with mental health problems were: younger male, health complaints, severe economic status, relocations, and lack of a social network. An interaction effect of sex and economic status on severe mental health problems was statistically significant. Our findings suggest that mental health problems were prevalent in survivors of the Great East Japan Earthquake and Tsunami. For men and women, health complaints, severe economic status, relocations, and lack of social network may be important risk factors of poor mental health. For men, interventions focusing on economic support may be particularly useful in reducing mental health problems after the disaster.
112 citations
References
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TL;DR: The CES-D scale as discussed by the authors is a short self-report scale designed to measure depressive symptomatology in the general population, which has been used in household interview surveys and in psychiatric settings.
Abstract: The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
48,339 citations
TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
35,518 citations
8,687 citations
TL;DR: The general depression scales used were felt to be insufficient for the purpose of this research project and the more specific scales were also inadequate.
Abstract: The fact that there is a need for assessing depression, whether as an affect, a symptom, or a disorder is obvious by the numerous scales and inventories available and in use today. The need to assess depression simply and specifically as a psychiatric disorder has not been met by most scales available today. We became acutely aware of this situation in a research project where we needed to correlate both the presence and severity of a depressive disorder in patients with other parameters such as arousal response during sleep and changes with treatment of the depressive disorder. It was felt that the general depression scales used were insufficient for our purpose and that the more specific scales were also inadequate. These inadequacies related to factors such as the length of a scale or inventory being too long and too time consuming, especially for a patient
8,413 citations
TL;DR: 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.
Abstract: 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 fl 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N fl 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 fl 1000 telephone screening interviews in the first stage followed by N fl 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 fl 36116) and 1998 (N fl 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N fl 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.
7,570 citations
"Screening performance of K6/K10 and..." refers methods in this paper
...Using item response theory (IRT), self-administered or intervieweradministered K6/K10 questionnaires were developed to detect general psychological distress.(15) Because of their brevity (six and ten questions for K6 and K10, respectively, to be completed within 2–3 min), K6 and K10 have a great advantage over other well-known scales....
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...Short screening questionnaires, such as the K6 and K10 (hereafter referred as K6/K10), which contain six or ten items of the same set of questions on depression and anxiety, respectively, have been increasingly used in community settings.(15) K6 and K10 were also used in national surveys in the USA, Canada, Australia, and Japan....
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