Construct validity and factor structure of the Kessler-10 in South Africa

Abstract

Background The Kessler Psychological Distress Scale (K-10) is a short screening tool developed to identify, with good sensitivity, non-specific psychological distress in the general population. Sensitivity and specificity of the K-10 have been examined in various clinical populations in South Africa; however, other psychometric properties, such as construct validity and factor structure, have not been evaluated. We present evidence of the prevalence and severity of psychological distress in an outpatient setting in South Africa and evaluate the internal reliability, construct validity, and factor structure of the K-10 in this population. Methods We explored prevalence estimates of psychological distress using previously established cutoffs and assessed the reliability (consistency) of the K-10 by calculating Cronbach’s alpha, item-total correlations and omega total and hierarchical coefficients. Construct validity and factor structure of the K-10 were examined through split-sample exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA), comparing several theoretical models and the EFA. Results Overall, there was low prevalence of psychological distress in our sample of 2591 adults, the majority of whom were between the ages of 18–44 (77.7%). The K-10 showed good construct validity and reliability, with a Cronbach’s alpha of 0.84 and omega total of 0.88. EFA yielded a four-factor solution with likely measurement artifacts. CFA showed that the four-factor model from EFA displayed the best comparative fit indices, but was likely overfitted. The unidimensional model with correlated errors was deemed the best fitting model based on fit indices, prior theory, and previous studies. Conclusion The K-10 displays adequate psychometric properties, good internal reliability, and good fit with a unidimensional-factor structure with correlated errors. Further work is required to determine appropriate cutoff values in different populations and clinical subgroups within South Africa to aid in determining the K-10’s clinical utility.

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“…Responses were averaged, with a higher score indicating more psychological distress, Cronbach's α = .93. The validity of the K10 has been supported in a range of samples (Donker et al, 2010; Hoffman et al, 2022).…”

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“…The Kessler Psychological Distress Scale, 10-item version-10 (K-10), has been widely used in assessing psychological distress among general and clinical populations from different cultural background 7 , 8 , 9 including sub-Saharan countries such as South Africa. 10 , 11 …”

“…The Kessler Psychological Distress Scale, 10-item version-10 (K-10), has been widely used in assessing psychological distress among general and clinical populations from different cultural background 7,8,9 including sub-Saharan countries such as South Africa. 10,11 The K-10 is a tool that identifies symptoms of psychological distress, specifically anxiety and depression. Responses to the instrument's 10 items are added, with the total score ranging between 10 and 50.…”

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“…The K10 has robust psychometric properties for the detection of distress in the general population [ 26 ]. The instrument has been used in outpatient settings in SA and showed good construct validity and reliability, with a Cronbach’s alpha of 0.84 and omega total of 0.88 [ 33 ].…”