The 10-Item Kessler Psychological Distress Scale (K10) as a Screening Instrument in Older Individuals

Objective: To provide population-based Kessler Psychological Distress Scale (K10) normative data for older adults and cut scores for screening. Participants: Adults age >= 65 years who participated in either the 1997 or 2007 Australian National Surveys of Mental Health and Well-being (N = 3,697). Measurements: The proportion of respondents who reported psychological distress, and the correspondence of K10 scores with diagnosis of mental disorder, disability, and service use. Results: Scores on the K10 corresponded well with rates of mental disorder. Higher K10 scores were associated with increased levels of internalizing disorder, comorbidity, functional disability, and service use. Receiver operating characteristic curve analysis revealed an area under the curve score of 0.86, suggesting good predictive power. For screening purposes, a cut score of 15 was found to be associated with the best balance between sensitivity (0.77) and specificity (0.78). Similar levels of predictive power were observed across various subgroups of the population. Score ranges for groups who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition affective or anxiety disorder showed that for those age 65-75, a score of 20 or greater and a score of 17 or greater for those older than 75 years warrant heightened clinical interest. Conclusions: The K10 exhibits sensitivity to internalizing disorders as they occur across the lifespan and can be used with confidence when assessing psychological distress in old-age community dwellers. The significant association between higher K10 scores and disability suggests that the presence of psychological distress, regardless of diagnostic status, requires clinician attention.