Validation of the K6 and its depression and anxiety subscales for detecting nonspecific psychological distress and need for treatment

Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement

AIMS

By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.

METHODS

Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.

RESULTS

Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.

CONCLUSIONS

The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.

The performance of K6 as a screening tool for mood disorders: A population-based study of the São Paulo metropolitan area

AIM

The use of screening instruments allows the detection of psychological and behavioural manifestations there are often not identified in users of health services. We evaluated the performance of the Kessler Psychological Distress Scale (K6) in identifying mood disorders (MD), using the Composite International Diagnostic Interview (CIDI) as gold-standard, in a population-based sample (n = 5037) of adult residents of metropolitan São Paulo.

METHODS

Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated to assess the performance of K6 in detecting 30-day CIDI MD. All cut-points for each disorder were analysed using the Youden index and the area under the receiver operating characteristic curve (AUC), and the best cut-points were identified. Cronbach's alpha was calculated to assess internal consistency.

RESULTS

In total, 5.5% respondents screened positive for any MD (95% IC 4.84-6.14). A good detection performance was observed for all MD, with AUC values for any MD of 0.91 (95% IC 0.89-0.92), ranging from 0.80 (95% CI 0.71-0.98) for minor depression to 0.93 (95% CI 0.87-0.98) for bipolar I disorder. Best cut-points for each MD were identified, with overall sensitivity and specificity of 88.8% and 80.2%, respectively. Cronbach's alpha was 0.83.

CONCLUSIONS

K6 is a good screening tool for MD in the Brazilian population. It is a brief and easy to use instrument that can promote the early identification and treatment of MD, reducing the burden of mental illness.

Deportation threat predicts Latino US citizens and noncitizens' psychological distress, 2011 to 2018

The national context of deportation threat, defined as the federal government's approach to deportation and/or deportation's salience to the US public, fluctuated between 2011 and 2018. US Latinos across citizenship statuses may have experienced growing psychological distress associated with these changes, given their disproportionate personal or proximal vulnerabilities to deportation. Drawing on 8 y of public- and restricted-access data from the National Health Interview Survey (2011 to 2018), this article examines trends in psychological distress among Latinos who are US-born citizens, naturalized citizens, and noncitizens. It then seeks to explain these trends by considering two theoretical pathways through which the national context of deportation threat could distress Latinos: 1) through discrete dramatic societal events that independently signal a change to the country's approach to deportation and/or that render deportation temporarily more salient to the public or 2) through more gradual changes to the country's everyday institutional (i.e., quotidian efforts to detain and deport noncitizens) and social (i.e., deportation's ongoing salience to a concerned public) environment of deportation threat. We find that, though both pathways matter to some degree, there is more consistent evidence that the gradual changes are associated with Latino US citizens and noncitizens' overall experiences of psychological distress. The article highlights how, even absent observable spillover effects of dramatic societal events bearing on deportation threat, the institutional and social environment in which they occur implicates Latinos' well-being.

Development of the Delusional Interpretation Scale and examination of related variables

Aim

Delusions are a common symptom in schizophrenia. Some scales have been developed to measure delusional tendencies in healthy people, and nonpathological delusional thinking can occur even among these individuals. The existing scales measure the presence and frequency of delusional thoughts, distress levels, and confidence levels. However, these scales are limited because they do not consider the context of the delusions (i.e., where, with whom, and when). In this study, we developed a new scale that presents detailed scenes using illustrations and sentences and measures the tendency toward delusional interpretations.

Methods

Factor analysis was conducted to confirm the factor structure of the new scale. To examine the validity of the scale, we analyzed the correlations between delusional tendencies and related variables and verified the consistency between the current scale and previously developed tools.

Results

Factor analysis confirmed that the new scale has a two-factor structure, including "internal attribution and paranoid tendency" and "external attribution tendency." The new scale was found to have acceptable reliability and validity. The internal attribution and paranoid tendency factor was negatively correlated with self-esteem and decentering. Furthermore, the internal attribution and paranoid tendency factor showed a moderate positive correlation with depressive state and anxiety tendency and a very weak positive correlation with experiences of bullying or harassment.

Conclusion

The correlations between the new scale and related variables confirmed the construct validity and replicated the results reported in previous studies. This new scale enables the measurement of delusional tendencies in healthy subjects based on the social context.

A cross-disasters comparison of psychological distress: Symptoms network analysis

Large-scale traumatic events have the potential to trigger psychological distress, particularly among those in the affected areas. However, the manifestation of psychological distress may vary across different types of disasters. This study thus aimed to compare the symptoms network structure of psychological distress as assessed by the Kessler Psychological Distress Scale across three types of disasters: Terror (n = 5842), COVID-19 (n = 2428), and a nature-related disaster (n = 1001). Across disasters, two communities representing depression and anxiety symptoms were revealed. However, while after a nature-related disaster and the COVID-19 pandemic depression and anxiety items were interconnected via hopelessness, a terror attack resulted in more separated manifestations of anxiety and depression. Examination of symptom centrality showed that while in the Terror and the COVID-19 networks "depressed/no cheering up" was most connected to other symptoms, for the nature-related disaster network, two items were most central: "depressed/no cheering up" and "restless or fidgety". The results may point to different mechanisms of psychological distress structures after different disasters. Depending on the type of disaster, trauma-focused interventions may require targeted support and treatment.

Psychological distress during the COVID-19 pandemic: An integrative perspective

Informed by socio-ecological psychology and the conservation of resources model, the present study proposes an integrative perspective on the association between psychological distress and a constellation of factors, during the COVID-19 outbreak in Israel. Our sample, comprised of 991 adult participants, was measured for psychological distress, locus of control (internal/ external), resilience, loneliness, social support, dimensions of citizens' trust in government organizations (perceived competence, benevolence, and integrity), and demographic characteristics. The findings showed that women, non-religious people, and the unemployed reported higher levels of psychological distress. Internal locus of control, resilience, social support, and the extent to which citizens perceive government organizations as benevolent were negatively associated with psychological distress. Self-reported loneliness and external locus of control positively predicted the level of respondent psychological distress. No association was detected between age, competence and integrity and psychological distress. An overview of the research findings indicates that individuals with greater resources were less likely to suffer from psychological distress during the COVID-19 outbreak. These findings call upon mental health care practitioners to help as well as to enable clients to attain resources in order to lower their levels of psychological distress. Policies developed by policymakers during periods of acute crisis should consider the specific needs and vulnerabilities of certain population groups, including women and the unemployed who may be more susceptible to psychological distress. It is also important for policymakers to be aware that the perception of democratic governments as benevolent can serve as a buffer against psychological distress during times of crisis.

Assessing the Smallest Detectable Change of the Kessler Psychological Distress Scale Score in an Adult Population in Japan

Background

Psychological distress is prevalent worldwide and can lead to the development of mental conditions such as major depression and anxiety disorders. It is essential to assess the severity of patient-reported outcomes to provide effective treatment for psychological distress. The Kessler Psychological Distress Scale (K6) is one of the most widely used psychological distress scales. However, the smallest detectable change (SDC) of the K6 score has not been elucidated. Therefore, the current study aimed to determine the SDC of the K6 score in a Japanese adult population.

Methods

Participants aged 20-59 years who are native Japanese speakers were recruited from the panel list of a web research firm. The K6 score was assessed at baseline (T1) and at 2-week follow-up (T2). SDCs were calculated at the individual (SDC_ind) and group (SDC_group) levels. Intraclass correlation coefficient agreement (ICC_agreement) was calculated to assess test-retest reliability and Cronbach's alpha to evaluate internal consistency.

Results

A total of 3254 (1627 [50%] female) responded at T1 and T2. The mean (standard deviation) K6 scores were 5.71 (5.84) at T1 and 5.65 (5.83) at T2. The SDC_ind and SDC_group of the K6 score were 8.47 (35.31%) and 0.15 (0.63%), respectively. The ICC_agreement was 0.73, and the Cronbach's alpha was 0.94.

Conclusion

Our study provided evidence on the reliability and interpretation of the K6 score. Calculating the SDC of the K6 score can help identify the significance of changes in psychological distress over time and can determine the efficacy of interventions for psychological distress.

Dynamic contributions of socioeconomic status to mental health with the resettlement process among refugees

Socioeconomic status (SES) is shown to be associated with refugees' mental health, but few studies have considered that these associations may vary over time. This study aimed to examine the dynamic contributions of SES to refugees' mental health during resettlement. We used five waves of data from a cohort study in Australia; 2399 refugees completed the interview in Wave 1, and the remaining waves had 2009, 1894, 1929, and 1881 participants, respectively. SES, high risk of severe mental illness (HR-SMI), and post-traumatic stress disorder (PTSD) were assessed in each wave. Weighted multilevel regression models were performed, and analyses were stratified by sex. For both sexes, financial hardships were consistently positively associated with HR-SMI and PTSD across all five waves. However, time or sex differences were more pronounced for associations between other SES factors and mental health. For males, there were negative associations of current paid jobs with HR-SMI and PTSD in Waves 3-5. For females, the current paid job was negatively associated with HR-SMI only in Wave 5. Our findings highlight the dynamic associations and sex differences between SES and refugees' mental health. We recommend interventions focusing on increasing employment opportunities, particularly for male refugees in the later resettlement stages.

Psychological distress is more common in some occupations and increases with job tenure: a thirty-seven year panel study in the United States

BACKGROUND

Workers in certain occupations may have elevated risks of psychological distress. However, research is limited. For example, researchers often measure distress that may have existed before occupational exposures. We studied occupations and the development of psychological distress using national data from the United States.

METHODS

We reviewed relevant research to identify occupations with low and high risks of mental health problems. We confirmed those individual low and high risk occupations using 1981-2017 data from the Panel Study of Income Dynamics (n = 24,789). We measured new cases of distress using the Screening Scale for Psychological Distress (Kessler K6) and compared distress in the low and high risk groups, adjusted for factors associated with occupational selection and non-occupational distress risks. A subset of participants described their jobs (n = 1,484), including factors such as job demands, social support, and control over work. We examined associations of those factors with psychological distress.

RESULTS

Workers in high risk occupations had 20% higher adjusted odds of developing distress than those in low risk occupations (odds ratio, OR 1.20, 95% confidence interval, CI 1.13-1.28). Distress increased with time in a high risk occupation: ≥5 years OR 1.38 (CI 1.18-1.62), ≥ 10 years OR 1.46 (CI 1.07-1.99), and ≥ 15 years OR 1.77 (CI 1.08-2.90; p-trend = 0.0145). The most common positive participant descriptions of their jobs indicated social support (34%), sense of accomplishment (17%), and control over work (15%). Participants reporting such descriptions were significantly less likely to have a high risk occupation (OR 0.66, CI 0.46-0.94, p = 0.0195). The most common negative descriptions were excessive job demands (43%), low social support (27%), and lack of control (14%). Participants reporting such descriptions were significantly more likely to have a high risk occupation (OR 1.49, CI 1.03-2.14, p = 0.0331).

CONCLUSION

Certain occupations may have high risks of psychological distress, which may be due to characteristics of the occupations rather than employee characteristics, or in addition to them. Results were consistent with theoretical models of psychosocial work environments. Providers of health care and social services should ask patients or clients about work-related distress.

Factors Related to Psychological Distress in Suicide Prevention Supporters during the COVID-19 Pandemic

PURPOSE

Psychological distress and related factors in suicide prevention supporters during the COVID-19 pandemic were clarified.

METHODS

A web-based survey for supporters from helplines or psychiatric institutions was conducted from May to July 2021. It included items about profession, stress and anxiety, and the Kessler Psychological Distress Scale.

RESULTS

818 participants were analyzed. Psychological distress was significantly higher among healthcare workers in psychiatric institutions than among helpline volunteers. The factor most related to psychological distress in both professions was insufficient rest with overwork. Distress in helpline volunteers was related to their lack of ability to support people with suicidal thoughts and suicide attempts, excessive media coverage related to COVID-19, and trouble dealing with complainers. Distress in healthcare workers was related to their lack of ability to provide sufficient support to their clients due to infection prevention measures.

CONCLUSION

Psychological distress among suicide prevention supporters during the pandemic has been affected by overwork, the fact that helpline volunteers cannot be trained in suicide prevention, and the fact that healthcare workers can only provide insufficient support to their clients due to infection prevention measures. To maintain suicide prevention during pandemics, it is necessary to implement measures that are tailored to the factors of psychological distress in supporters.

Healthcare-related correlates of preoperative psychological distress among a mixed surgical and cancer-specific sample

OBJECTIVE

Preoperative distress is commonly experienced by surgical patients and is associated with adverse health-related outcomes. Research suggests preoperative distress may be elevated among cancer surgery patients relative to other surgical groups and there appears to be greater recognition of the adverse impacts of distress for these patients. This study examined associations between preoperative distress and postoperative healthcare-related correlates (e.g., length of stay, re-hospitalization) among a large, mixed surgical sample, and separately among cancer surgery patients with active cancer.

METHODS

We analyzed secondary data from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study - Mental Health Supplement (N = 997; n = 370 active cancer/cancer surgery). The Kessler 6-item Psychological Distress Scale assessed preoperative distress on the day of surgery. Multivariable regressions examined associations between distress and healthcare-related correlates. For significant relationships, we examined associations between anxiety and depressive subscales of distress with the correlates of interest.

RESULTS

Among the full surgical sample, after adjustment, preoperative distress was associated with a greater length of stay (b = 0.01, 95% CI [0.00-0.02], R² = 0.15, f² = 0.18) and increased odds of re-hospitalization (AOR = 1.07, 95%CI [1.01-1.13]). Results were comparable among cancer surgery patients (length of stay: b = 0.02, re-hospitalization: AOR = 1.11). Post-hoc analyses revealed associations between anxiety symptoms and re-hospitalization (AOR range: 1.13-1.26) and between depressive symptoms and length of hospital stay (b range: 0.02-0.04, R² range: 0.07-0.15, f² range: 0.07-0.18).

CONCLUSIONS

Findings suggest preoperative distress may be associated with greater postoperative healthcare needs. Results support the importance of screening for distress in the perioperative period.

Exploring Social Media Rumination: Associations With Bullying, Cyberbullying, and Distress

In this study, we examined students' perceptions of peer aggression occurring within their school environment and how these perceptions are interconnected with both social media rumination and distress. Social media usage is associated with a range of negative mental health and interpersonal outcomes for adolescents. Social media use can increase youth's vulnerability to peer victimization and psychosocial difficulties. In addition, ruminating when sad or stressed has been linked to elevated distress for youth experiencing peer aggression. Yet rumination specifically regarding social media activities has not been investigated in relation to peer aggression and distress, nor has the degree to which students perceive peer aggression occurring at school been included in these investigations. Participants were 169 high school students (age, M = 15.89, SD = .87), largely identifying as Black/African American and female, who completed surveys as part of a larger program working with at-risk youth in a Midwestern, urban city. We found that social media rumination mediated the relationship between perceptions of bullying at school and feelings of distress, but mediation was not supported when examining student perceptions of cyberbullying frequency and youth distress. In the case of bullying, rumination may disrupt other forms of coping-such as positive cognitive distractions-that would ameliorate symptoms of distress. Furthermore, we present evidence that social media rumination is experienced by, and has different influences on, youth. We highlight the need for differentiated intervention and prevention efforts regarding these two forms of peer aggression. Future research may be justified to examine these possibilities.

Preventative diabetes self-care management practices among individuals with diabetes and mental health stress

BACKGROUND

The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress.

METHODS

Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors.

RESULTS

Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior.

LIMITATIONS

Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional.

CONCLUSIONS

Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.

A National Study to Assess Validity and Psychometrics of the Short Kessler Psychological Distress Scale (K6)

This study aimed to test the validity and reliability of the Kessler Psychological Distress Scale-6 (K6) with a nationally representative clinical sample with various mental health disorders. The cross-sectional, nationally representative, and publicly available data were extracted from the 2014 Health Center Patient Survey (HCPS), which was sponsored by the Health Resources and Services Administration (HRSA). After excluding certain individuals for the purpose of this study, we had a total of 1,863 participants. The highest and lowest psychological distress weighted scores were reported by individuals with bipolar disorder (M = 17.16) and individuals with schizophrenia (M = 16.09), respectively, although psychological distress interference was highest in individuals with schizophrenia (M = 2.44). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results yielded a unidimensional factor solution for K6 scale in all subgroups. The K6 is a brief, reliable, and valid measure of psychological distress in adults with panic disorder, generalized anxiety disorder, bipolar disorder, and schizophrenia.