School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada.
PLoS One. 2018 Apr 26;13(4):e0196562. doi: 10.1371/journal.pone.0196562. eCollection 2018.
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.
十项 Kessler 心理困扰量表（K10）的心理测量特性已在平民人群中得到广泛探讨。然而，其在军事人群中的心理测量特性的文献记载有限，并且 K10 上没有普遍接受的分界值来区分临床和亚临床水平的困扰。本研究的目的是检验 K10 在加拿大武装部队人员中的心理测量特性。2013 年加拿大部队心理健康调查获得了 6700 名常规部队人员的数据。使用验证性因素分析（CFA）检验 K10（范围为 0-40）的内部一致性和因子结构。使用四个过去一个月障碍的存在/不存在（创伤后应激障碍、重度抑郁发作、广泛性焦虑障碍和惊恐障碍）作为结果，进行 K10 的接收者操作特征（ROC）分析，以选择最佳的 K10 截止值。Cronbach 的 alpha（0.88）表明 K10 的内部一致性很高。CFA 的结果表明，单一因素 10 项结构具有可接受的总体拟合度：均方根误差近似值（RMSEA）= 0.05；90%置信区间（CI）：0.05-0.06，比较拟合指数（CFI）= 0.99，塔克-刘易斯指数（TLI）= 0.99，加权均方根残差（WRMR）= 2.06。K10 分数与所有四种测量障碍的存在和最近发生情况密切相关。ROC 曲线下的面积为 0.92，表明过去 30 天障碍的预测值非常好。K10 得分为 10 或更高分是筛查目的的最佳选择（灵敏度=86%；特异性=83%），而 K10 得分为 17 或更高分（灵敏度=53%；特异性=97%）是用于估计临床上显著的心理困扰的患病率的最佳选择，因为它导致了相同数量的假阳性和假阴性。我们的结果表明，K10 量表在军事人群中作为非特异性心理困扰的测量工具具有令人满意的心理测量特性。
