Abstract
The psychometric properties of the ten-item Kessler Psychological Distress scale (K10) have been extensively explored in civilian populations. However, documentation of its psychometric properties in military populations is limited, and there is no universally accepted cut-off score on the K10 to distinguish clinical vs. sub-clinical levels of distress. The objective of this study was to examine the psychometric properties of the K10 in Canadian Armed Forces personnel. Data on 6700 Regular Forces personnel were obtained from the 2013 Canadian Forces Mental Health Survey. The internal consistency and factor structure of the K10 (range, 0–40) were examined using confirmatory factor analysis (CFA). Receiver Operating Characteristic (ROC) analysis was used to select optimal cut-offs for the K10, using the presence/absence of any of four past-month disorders as the outcome (posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, and panic disorder). Cronbach’s alpha (0.88) indicated a high level of internal consistency of the K10. Results from CFA indicated that a single-factor 10-item construct had an acceptable overall fit: root mean square error of approximation (RMSEA) = 0.05; 90% confidence interval (CI):0.05–0.06, comparative fit index (CFI) = 0.99, Tucker-Lewis Index (TLI) = 0.99, weighted root mean square residual (WRMR) = 2.06. K10 scores were strongly associated with both the presence and recency of all four measured disorders. The area under the ROC curve was 0.92, demonstrating excellent predictive value for past-30-day disorders. A K10 score of 10 or greater was optimal for screening purposes (sensitivity = 86%; specificity = 83%), while a score of 17 or greater (sensitivity = 53%; specificity = 97%) was optimal for prevalence estimation of clinically significant psychological distress, in that it resulted in equal numbers of false positives and false negatives. Our results suggest that K10 scale has satisfactory psychometric properties for use as a measure of non-specific psychological distress in the military population.
Highlights
Military personnel are known to have a significant risk of exposure to occupational trauma, which increases their risk of many mental disorders and psychological distress, a phenomenon underlined by the past fifteen years of armed conflict in southwest Asia [1]
The particular analysis in the present paper was approved through Statistics Canada‘s Federal Research Data Centre Program, which is responsible for ensuring the scientific merit and compliance with ethical and other standards
WMH-Composite International Diagnostic Interview (CIDI) identified individuals who had ever met criteria for mental disorders in their lifetime or during the past 12 months. We have identified those with a WMH-CIDI diagnosed lifetime disorder but no past-year disorder, those with past-year disorder but no past-month mood and anxiety disorder, and those with past-month mood and anxiety disorder
Summary
Military personnel are known to have a significant risk of exposure to occupational trauma, which increases their risk of many mental disorders and psychological distress, a phenomenon underlined by the past fifteen years of armed conflict in southwest Asia [1]. One of the key approaches for this crucial task is to administer surveys that include disorder-specific instruments, with a primary focus on conditions of particular concern in the military, notably PTSD, depression, and alcohol use disorders [3]. Focusing only on the prevalence of specific disorders may underestimate the extent of impaired mental health, given that it is challenging to reliably assess each and every possible disorder in prevalence surveys. Given the practical constraints of assessing many different disorders in health surveys, using brief proxy measures, such as general psychological distress [6], is appealing
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