Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Int J Methods Psychiatr Res. 2010 Jun;19 Suppl 1(Suppl 1):23-35. doi: 10.1002/mpr.314.
Effective screening for emotional and behavioral disorders among youth requires brief screening scales with good validity to identify youth requiring further evaluation and to estimate prevalence of target disorders in populations of interest such as schools or neighborhoods. This paper examines the psychometric properties of a very short (six-item) screening scale, the K6, to assess serious emotional disturbance (SED) among youth. The K6, which is made up of symptoms of depression and anxiety, has been shown in previous research to be a strong predictor of serious mental illness (SMI) in adults, but no information is available on the ability of the scale to screen for SED among youth. The current report examines the K6 as a screen for SED in a national survey of US adolescents, the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The K6 is shown to provide fairly good prediction of SED [area under curve (AUC) = 0.74] that is somewhat higher for internalizing (AUC = 0.80) than behavior (AUC = 0.75) disorders. Based on this result, we augmented the K6 with questions about symptoms of behavior disorders. This improved prediction of SED (from AUC = 0.74 to AUC = 0.83) as well as of SED associated with pure behavior disorders (from AUC = 0.53 to AUC = 0.78). These results show that although the symptoms of depression and anxiety in the K6 are sufficient to detect SMI among adults, high rates of behavior disorders among adolescents require indicators of behavior disorders to be added to the K6 to screen adequately for adolescent SED.
有效筛查青少年的情绪和行为障碍需要使用具有良好效度的简短筛查量表来识别需要进一步评估的青少年，并估计学校或社区等感兴趣人群中目标障碍的流行率。本文研究了一个非常简短的（六项目）筛查量表 K6 的心理测量学特性，用于评估青少年的严重情绪困扰（SED）。K6 由抑郁和焦虑症状组成，先前的研究表明它是成年人严重精神疾病（SMI）的强有力预测指标，但关于该量表在青少年中筛查 SED 的能力尚无信息。本报告在一项对美国青少年的全国性调查（国家共病调查复制青少年补充调查，NCS-A）中，考察了 K6 作为 SED 的筛查工具。结果表明，K6 对 SED 有较好的预测能力[曲线下面积（AUC）=0.74]，对内部障碍（AUC=0.80）的预测能力略高于行为障碍（AUC=0.75）。基于这一结果，我们在 K6 中增加了关于行为障碍症状的问题。这提高了对 SED 的预测（从 AUC=0.74 到 AUC=0.83）以及与纯行为障碍相关的 SED 的预测（从 AUC=0.53 到 AUC=0.78）。这些结果表明，尽管 K6 中的抑郁和焦虑症状足以检测成年人中的 SMI，但青少年中较高的行为障碍率需要在 K6 中增加行为障碍的指标，以充分筛查青少年的 SED。
