title: Screening for serious mental illness in the general population.
abstract: 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.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Suite 215, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Peggy R
authors.initials: PR
authors.lastname: Barker
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Colpe
authors.forename: Joan F
authors.initials: JF
authors.lastname: Epstein
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gfroerer
authors.forename: Eva
authors.initials: E
authors.lastname: Hiripi
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Howes
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Manderscheid
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Walters
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
mesh_terms: D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014482:United States Substance Abuse and Mental Health Services Administration