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International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2010 May 31;19(Suppl 1):88–98. doi: 10.1002/mpr.315

Estimating prevalence of serious emotional disturbance in schools using a brief screening scale

Fan Li 1, Jennifer Greif Green 2, Ronald C Kessler 2,✉, Alan M Zaslavsky 2
PMCID: PMC3572832  NIHMSID: NIHMS424040  PMID: 20527007

Abstract

Information about the prevalence of serious mental illness (SMI) among adults or serious emotional disturbance (SED) among youth in small domains such as counties, states, or schools is valuable for mental health policy planning purposes, but prohibitively expensive to collect with semi‐structured surveys. Commonly used synthetic estimation methods yield imprecise estimates. An improved method is described here that combines information about socio‐demographic covariates with screening scale scores obtained from a sample of individuals, using a prediction equation derived from a Bayesian multilevel regression model with bivariate outcomes fitted to a larger population survey. This method is illustrated using K6 screening scale scores to predict school‐level prevalence of SED in the sample of 282 schools that participated in the National Comorbidity Survey Replication Adolescent Supplement. Respondents completed a diagnostic interview that was used to define DSM‐IV SED. SED prevalence varied significantly across schools and was strongly correlated with aggregate K6 scores (ρ = 0.70). Calculations suggest that near‐maximum precision of school‐level SED prevalence estimates could be attained with K6 samples of 200 students per school. This modeling approach holds great promise for generating accurate estimates of SMI/SED in small‐area planning units based on K6 scores collected in ongoing health tracking surveys. Copyright © 2010 John Wiley & Sons, Ltd.

Keywords: K6 screening scale, psychiatric epidemiology, serious emotional disturbance, small‐area estimation

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REFERENCES

  1. Browne W.J. (2005). MCMC Estimation in MLwiN (Version 2.0), University of Bristol, Centre for Multilevel Modeling. [Google Scholar]
  2. Burns B.J., Costello E.J., Angold A., Tweed D., Stangl D., Farmer E.M., Erkanli A. (1995). Children's mental health service use across service sectors. Health Affairs (Millwood), 14, 147–159, DOI: 10.1377/hlthaff.14.3.147.58 [DOI] [PubMed] [Google Scholar]
  3. Colpe L.J., Barker P.R., Karg R.S., Batts K.R., Morton K.B., Gfroerer J.C., Stolzenberg S.J., Cunningham D.B., First M.B., Aldworth J. (2010). The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures. Int J Methods Psychiatr Res, 19(Suppl. 1), 36–48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ghosh M., Rao J.N.K. (1994). Small area estimation: an appraisal. Stat Sci, 9, 55–93, DOI: 10.1214/ss/1177010647 [Google Scholar]
  5. Goldsmith H.F., Holzer C.E., Manderscheid R.W. (1998). Neighborhood characteristics and mental illness. Eval Program Plann, 21, 211–225, DOI: 210.1016/S0149‐ 7189(1098)00012‐00013 [Google Scholar]
  6. Green J.G., Gruber M.J., Sampson N.A., Zaslavsky A.M., Kessler R.C. (2010). Improving the K6 short scale to predict serious emotional disturbance in adolescents in the USA. Int J Methods Psychiatr Res, 19(Suppl. 1), 23–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hudson C. (2009). Validation of a model for estimating state and local prevalence of serious mental illness. Int J Methods Psychiatr Res, 18, 251–264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kaufman J., Birmaher B., Brent D., Rao U., Flynn C., Moreci P., Williamson D., Ryan N. (1997). Schedule for Affective Disorders and Schizophrenia for School‐Age Children‐Present and Lifetime Version (K‐SADS‐PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry, 36, 980–988, DOI: 10.1097/00004583‐199707000‐00021 [DOI] [PubMed] [Google Scholar]
  9. Kessler R.C., Andrews G., Colpe L.J., Hiripi E., Mroczek D.K., Normand S.L., Walters E.E., Zaslavsky A.M. (2002). Short screening scales to monitor population prevalences and trends in non‐specific psychological distress. Psychol Med, 32, 959–976, DOI: 10.1017/S0033291702006074 [DOI] [PubMed] [Google Scholar]
  10. Kessler R.C., Avenevoli S., Costello E.J., Green J.G., Gruber M.J., Heeringa S., Merikangas K.R., Pennell B.E., Sampson N.A., Zaslavsky A.M. (2009a). Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS‐A). Int J Methods Psychiatr Res, 18, 69–83, DOI: 10.1002/mpr.279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kessler R.C., Avenevoli S., Costello E.J., Green J.G., Gruber M.J., Heeringa S., Merikangas K.R., Pennell B.E., Sampson N.A., Zaslavsky A.M. (2009b). National Comorbidity Survey Replication Adolescent Supplement (NCS‐A): II. Overview and design. J Am Acad Child Adolesc Psychiatry, 48, 380–385, DOI: 10.1097/CHI.0b013e3181999705 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kessler R.C., Avenevoli S., Green J., Gruber M.J., Guyer M., He Y., Jin R., Kaufman J., Sampson N.A., Zaslavsky A.M. (2009c). National Comorbidity Survey Replication Adolescent Supplement (NCS‐A): III. Concordance of DSM‐IV/CIDI diagnoses with clinical reassessments. J Am Acad Child Adolesc Psychiatry, 48, 386–399, DOI: 10.1097/CHI.0b013e31819a1cbc [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kessler R.C., Barker P.R., Colpe L.J., Epstein J.F., Gfroerer J.C., Hiripi E., Howes M.J., Normand S.L., Manderscheid R.W., Walters E.E., Zaslavsky A.M. (2003). Screening for serious mental illness in the general population. Arch Gen Psychiatry, 60, 184–189. [DOI] [PubMed] [Google Scholar]
  14. Kessler R.C., Berglund P.A., Walters E.E., Leaf P.J., Kouzis A.C., Bruce M.L., Friedman R.M., Grosser R.C., Kennedy C., Kuehnel T.G., Laska E.M., Mandersheid R.W., Narrow W.E., Rosenheck R.A., Schneier M. (1999). Population‐based analyses: a methodology for estimating the 12‐month prevalence of serious mental illness In: Mental Health, United States 1998 (eds Manderscheid RW, Henderson MJ.), pp. 99–109, U.S. Government Printing Office. [Google Scholar]
  15. Kessler R.C., Green J.G., Gruber M.J., Sampson N.A., Bromet E., Cuitan M., Furukawa T.A., Gureje O., Hinkov H., Hu C., Lara C., Lee S., Mneimneh Z., Myer L., Oakley‐Brown M., Posada‐Villa J., Sagar R., Viana M.C., Zaslavsky A.M. (2010). Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) Survey Initiative. Int J Methods Psychiatr Res, 19(Suppl. 1), 4–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kessler R.C., Merikangas K.R. (2004). The National Comorbidity Survey Replication (NCS‐R): background and aims. Int J Methods Psychiatr Res, 13, 60–68, DOI: 10.1002/mpr.166 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kessler R.C., Üstün T.B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res, 13, 93–121, DOI: 10.1002/mpr.168 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Leaf P.J., Alegria M., Cohen P., Goodman S.H., Horwitz S.M., Hoven C.W., Narrow W.E., Vaden‐Kiernan M., Regier D.A. (1996). Mental health service use in the community and schools: results from the four‐community MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry, 35, 889–897, DOI: 10.1097/00004583‐199607000‐00014 [DOI] [PubMed] [Google Scholar]
  19. Leon A.C., Olfson, M. , Portera, L. , Sheehan, D.V. (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med, 27, 93–106, DOI: 10.2190/T8EM‐C8YH‐373N‐1UWD [DOI] [PubMed] [Google Scholar]
  20. Rao J.N.K. (2003). Small Area Estimation, John Wiley and Sons. [Google Scholar]
  21. Shaffer D., Gould M.S., Brasic J., Ambrosini P., Fisher P., Bird H., Aluwahlia S. (1983). A children's global assessment scale (CGAS). Arch Gen Psychiatry, 40, 1228–1231. [DOI] [PubMed] [Google Scholar]
  22. Sheehan D.V. (1983). The Anxiety Disease, Scribner. [Google Scholar]
  23. Slade E.P. (2003). The relationship between school characteristics and the availability of mental health and related health services in middle and high schools in the United States. J Behav Health Serv Res, 30, 382–392. [DOI] [PubMed] [Google Scholar]
  24. Substance Abuse and Mental Health Services Administration . (1993). Final notice establishing definitions for (1) children with a serious emotional disturbance, and (2) adults with a serious mental illness. Fed Register, 58, 29422–29425. [Google Scholar]
  25. Thomas K.C., Ellis A.R., Konrad T.R., Holzer C.E., Morrissey J.P. (2009). County‐level estimates of mental health professional shortage in the United States. Psychiatr Serv, 60, 1323–1328, DOI: 10.1176/appi.ps.60.10.1323 [DOI] [PubMed] [Google Scholar]

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