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Heliyon. 2019 Mar 21;5(3):e01387. doi: 10.1016/j.heliyon.2019.e01387. eCollection 2019 Mar.

Further evidence that item responses on the Kessler Psychological Distress Scale exhibit the characteristic pattern in the general population.

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Department of Mental Health, Panasonic Health Center Tokyo, Japan.
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Clinical Research Center, Chiba University Hospital, Chiba, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.
Department of Drug Evaluation and Informatics School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan.



Previous studies suggested that item responses on the 6-item Kessler Psychological Distress Scale (K6) exhibit characteristic distributions among the general population. To confirm the reproducibility of these findings, we conducted a pattern analysis of the K6 item responses using large-scale data from a US representative survey.


Data were drawn from the 2016, and 2017 National Health Interview Survey in the United States (33,028, and 26,742 individuals, respectively). We analyzed the patterns of item responses for the six items using normal and logarithmic scales and proposed a model of item responses.


The lines for item responses showed the same pattern among the six items, characterized by crossing at a single point between "none" and "a little," and parallel patterns from "a little" to "all of the time" on a logarithmic scale. The ratio of "some" to "a little," "most" to "some," and "most" to "all of the time" were similar across the six items. The model of item responses, which was based on the findings that the decreasing ratios of "some" to "a little," "most" to "some," and "all of the time" to "most" were similar across the six items, explained the characteristic patterns of item responses.


These results provide further evidence that item responses on the K6 follow a particular distribution pattern among the general population.


Clinical psychology; Epidemiology; Psychiatry; Public health

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