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Original Article
February 2003

Screening for Serious Mental Illness in the General Population

Author Affiliations

From the Department of Health Care Policy, Harvard Medical School (Drs Kessler, Howes, Normand, and Zaslavsky and Mss Hiripi and Walters), and the Department of Biostatistics, Harvard School of Public Health (Dr Normand), Boston, Mass; the Office of Applied Studies (Mss Barker and Epstein and Mr Gfroerer) and the Division of State and Community Systems Development (Dr Manderscheid), Substance Abuse and Mental Health Services Administration, Rockville, Md; and the Division of Mental Disorders, Behavioral Research, and AIDS, National Institute of Mental Health, Bethesda, Md (Dr Colpe).

Arch Gen Psychiatry. 2003;60(2):184-189. doi:10.1001/archpsyc.60.2.184

Background  Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI.

Methods  Three SMI screening scales were developed for possible use in the SAMHSA National Household Survey on Drug Abuse: the Composite International Diagnostic Interview Short-Form (CIDI-SF) scale, the K10/K6 nonspecific distress scales, and the World Health Organization Disability Assessment Schedule (WHO-DAS). An enriched convenience sample of 155 respondents was administered all screening scales followed by the 12-month Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning (GAF). We defined SMI as any 12-month DSM-IV disorder, other than a substance use disorder, with a GAF score of less than 60.

Results  All screening scales were significantly related to SMI. However, neither the CIDI-SF nor the WHO-DAS improved prediction significantly over the K10 or K6 scales. The area under the receiver operating characteristic curve of SMI was 0.854 for K10 and 0.865 for K6. The most efficient screening scale, K6, had a sensitivity (SE) of 0.36 (0.08) and a specificity of 0.96 (0.02) in predicting SMI.

Conclusions  The brevity and accuracy of the K6 and K10 scales make them attractive screens for SMI. Routine inclusion of either scale in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.