A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

Abstract

BackgroundPsychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.MethodsThis study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).ResultsHigher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.ConclusionsThis study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.

Epidemiology of Psychological Distress

“…Several studies showed no substantial bias for the K10 in relation to gender, education (Baillie 2005) or age (OConnor and Parslow 2010). The K6 also achieves an adequate level of measurement invariance across gender and age groups and over a 12-year period (Drapeau et al 2010). The K6 was validated with teens ).…”

Psychological Distress and Emergency Department Utilization in the United States: Evidence from the Medical Expenditure Panel Survey

“…The K6 measure was developed specifically for use in population-based surveys, 24,25 it has been validated on populations in the United States and around the world as a measure of psychological distress, and it is used in many population-based surveys to estimate the public health effects and prevalence of mental illness. 4,[24][25][26][27][28][29][30][31][32][33] While measures of psychological distress do not identify a specific mental illness, it is most closely associated with mood and anxiety disorders, and increasing levels are associated with increased symptom severity 2 and a higher likelihood of mental illness. 3 The K6 asks about the frequency of six symptoms: "During the past 30 days, how often did you feel .…”

An Ecosystems and Vulnerable Populations Perspective on Solastalgia and Psychological Distress After a Wildfire

“…The K10 (and it's six item abbreviated version, the K6), is a well validated instrument used to screen for psychological distress in large, epidemiological surveys (R. C. Kessler et al, 2003). It has been administered in annual government health surveys in the United States, Canada, and Australia (Drapeau et al, 2010;Furukawa, Kessler, Slade, & Andrews, 2003;Kessler et al, 2002) and is also used by the World Health Organization in their World Mental Health Surveys (Kessler et al, 2010). The scale consists of 10 questions regarding level of psychological distress experienced in the past four weeks.…”