The General Health Questionnaire: reliability and validity for Australian youth

General Health Questionnaire (GHQ) results are given for a large (N = 1013) sample of South Australian young people (average age 19.6 years), to compare the usefulness of the 12-, 28-, and 30-item forms of the GHQ. Internal reliabilities are generally adequate and the Likert scoring method produces significant correlations with psychological measures such as self-esteem. The case-prevalence rate using the binary scoring method was comparable with other studies, but misclassification rates were unacceptably high when DSM-III Axis I diagnosis was used as the criterion for the presence of any psychiatric disorder.     

The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms

OBJECTIVE: No study has examined the diagnostic validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in the Chinese elderly. This study aims to determine appropriate cutoffs for the 20- (CESD-20) as well as a ten-item (CESD-10) version of the instrument. Data were also provided, based on simulated scoring, for the diagnostic performance of the scales when using dichotomous instead of 4-point rating scales. METHODS: Three hundred and ninety eight persons aged 60 +referred for psychiatric assessment by a physician were administered the CES-D as well as given an independent psychiatric assessment. A spectrum of depression diagnosis as the criterion was used to assess the diagnostic validity of the CES-D. RESULTS: The ten and the 20-item version of the CES-D, regardless of scoring method, produced essentially identical performance indices. The optimal thresholds were 12 and 22 for CESD-10 and CESD-20 respectively, and based on these thresholds, sensitivity, specificity, positive predictive value and negative predictive value were 0.76, 0.55, 0.57 and 0.74 for CESD-10, and 0.75, 0.51, 0.55 and 0.72 for CESD-20. With both ends of the rating scale collapsed to create dichotomous items, the optimal thresholds became 4 for CESD-10 and 7 for CESD-20, and the corresponding performance indices were 0.67, 0.58, 0.56 and 0.69 for CESD-10, and 0.70, 0.58, 0.57 and 0.70 for CESD-20. CONCLUSIONS: The ten-item version can be used in lieu of the 20-item version, and a dichotomous response format would probably work as well as the original four-point format, in order to simplify administration for elderly persons.     

The criterion validity of different versions of the General Health Questionnaire among non-psychiatric inpatients

Purpose  

While the General Health Questionnaire (GHQ) has an excellent screening performance among outpatients and in the community, its accuracy to detect mental disorders among non-psychiatric inpatients was reported to be lower. The aim of the present study was to compare the criterion validity of different scoring methods, i.e. the Bimodal scoring, Likert scoring, Modified Likert scoring and Chronic scoring, of the 30-, 20- and 12-item version of the GHQ.     

Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study

Background: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

Aims: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

Methods: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

Results: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC?=?0.86, GHQ index AUC?=?0.83), and between individuals with current disorder from healthy controls (Likert index AUC?=?0.90, GHQ index AUC?=?0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity?=?81.7 and specificity?=?85.4), and for the Likert index ≥14 (sensitivity?=?85.5 and specificity?=?83.2).

Conclusions: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.     

The validity of the French version of the GHQ-28 and PSYDIS in a community sample of 20 year olds in Switzerland

Summary The 28-item GHQ (General Health Questionnaire) and the 43-item PSYDIS (Psychic Distress) were translated into French and administered to a community sample of 233 young adults. Of the two tests, the GHQ was shown to have the better correlation with the clinical assessment. For PSYDIS, specificity was 72,8, sensitivity was 64.2, but the misclassification rate rose to 29.2. The GHQ misclassified 18.5% of the respondents at the best cut-off point (5/6), with a specificity of 91.1 and a sensitivity of 49.1. The corrections C-GHQ (Goodchild and Duncan-Jones method of scoring) and simple Likert scoring improved sensitivity, although this was still unsatisfactory with males. Considering the lability of troubles in a young population, the GHQ should be applied with caution for epidemiological purposes.     

Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids

OBJECTIVE: Lipid peroxidation (LPO) is involved in oxidative tissue injuries. The present investigation examined the association between LPO and psychological depressive symptoms. METHODS: A cross-sectional study was conducted on 66 female volunteers aged 38-70. Lipid peroxides (LOOH) in serum were evaluated by hemoglobin-methylene blue (Hb-MB) method; additionally, serum antioxidants were also detected. To assess depressive symptoms, the Center for Epidemiologic Studies Depression (CES-D) Scale and a subscale in the 28-item General Health Questionnaire (GHQ) were applied. RESULTS: LOOH concentration displayed a significant positive correlation with CES-D and GHQ depression scores. Multiple regression analysis was performed in which LOOH concentration served as a dependent variable and CES-D scores and antioxidants as independent variables. Consequently, CES-D scores demonstrated significant positive correlation with LOOH. CONCLUSIONS: The positive relationship between depressive symptoms and LPO in a female population may support the hypothesis that LPO may affect depressive symptoms.     

Use of questionnaire infeasibility in order to detect cognitive disorders: Example of the Center for Epidemiologic Studies Depression Scale in psychiatry settings

Aim:  To examine the extent to which cognitive disorders influenced the feasibility and accuracy of both the 20-item and the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).
Methods:  Cross-sectional analyses of 223 first-visit patients in a psychiatric clinic and 108 patients in a psychiatric department in a general hospital were conducted. To assess the influence of age, gender, and the presence of cognitive disorders on the feasibility of both versions of the CES-D, multiple logistic regression was performed with feasibility per se as the dummy dependent variable. In order to assess the accuracy of the CES-D, receiver operating characteristic (ROC) analysis was performed.
Results:  The infeasibility of both types of CES-D were so strongly associated with the presence of cognitive disorders that it can be used as an indicator of cognitive impairment. Moreover, the 10-item CES-D had almost as acceptable an internal consistency reliability as the 20-item CES-D in the study settings.
Conclusions:  Information obtained from both versions of the CES-D could be utilized fully, using infeasibility as an indicator of cognitive disorders, in psychiatry settings. Other screening instruments with as heavy a cognitive load as the CES-D can also be used in the same manner as an indicator of cognitive disorders to save the need for instruments specifically designed for dementia. Such usage can decrease the burden on both the respondent and the clinician in clinical practice.     

A comparison of methods of scoring the General Health Questionnaire

The General Health Questionnaire (GHQ) has been criticized for failing to detect individuals with chronic symptoms due to its focus on recent changes in one's usual state. Using data from a community survey in Edmonton, Canada, in which 3,258 subjects completed the 30-item GHQ and the Diagnostic Interview Schedule (DIS), the traditional method of scoring the GHQ was compared to a revised method proposed by Goodchild and Duncan-Jones. A case was defined to be someone with a history in the preceding month of one or more of the following DIS/DSM-III disorders: major depressive episode, phobia, panic disorder and obsessive-compulsive disorder. A receiver operating characteristic analysis demonstrated no difference in the two methods of scoring the GHQ.     

Practice-based depression screening for psychiatry outpatients: Feasibility comparison of two-types of Center for Epidemiologic Studies Depression Scales

Aims:  The Center for Epidemiologic Studies Depression Scale (CES-D) has been validated to avoid misdiagnoses of major depression in routine psychiatric outpatient settings, but it was reported to be only marginally feasible in these specific settings. A briefer and simpler version, known as the 10-item CES-D, meant to attain adequate feasibility, has been validated in geriatric outpatient settings, but it has not yet been examined in psychiatry outpatient settings. The purpose of the present study was therefore to compare the feasibility, reliability, and validity of the two types of CES-D.
Methods:  A cross-sectional analysis was conducted of 86 consecutive outpatients in a psychiatric department in a general hospital.
Results:  The 10-item CES-D has a higher feasibility than the 20-item CES-D, and its internal consistency, reliability, and validity are almost identical to those of the 20-item CES-D.
Conclusions:  The 10-item CES-D is the better instrument to use because of the higher feasibility than the 20-item CES-D in psychiatric outpatient settings. The different answer format used in each questionnaire (a yes or no format in the former vs a multiple-choice format in the latter) may influence the feasibility, rather than the number of items.     

The factor structure of the General Health Questionnaire in a Japanese high school and university student sample

Factor structures of the 60- and 30-item versions of the General Health Questionnaire (GHQ) were explored, using data collected from 236 Japanese high-school and university students. The 60-item version produced factors interpretable as social functioning, anxiety, somatic symptoms, and severe depression; the 30-item version produced general dysphoria, social functioning, depressive thoughts, difficulty in concentration and insomnia. Although the two versions of the GHQ produced the same number of factors, their structures differed in content. Thus it may be necessary to examine the factor structures of the GHQ when using it in a study of a population containing subjects with different cultural backgrounds.     

Which version of the General Health Questionnaire should be used in community studies?

Literature pertinent to the use of the various versions of the General Health Questionnaire (GHQ) is briefly surveyed. The literature indicates that the 60-item version has the highest reliability and validity coefficients, the lowest misclassification rate, and the highest sensitivity and specificity. Using data from a previously published community survey in Perth using the 60-item GHQ, comparisons are made between use of the 60-, 30-, 20- and 12-item versions, including community prevalence rates, simultaneous identification of cases, disagreement rates and patterns of community rates with age. The 60-item version gives the lowest prevalence rates. It is argued that the 60-item GHQ is probably the best as it gives the lowest misclassification rates, the smallest standard error of estimated prevalence rates and allows measurement of certain subscales not contained within the shorter versions.     

Detecting depression in Chinese adults with mild dementia: findings with two versions of the Center for Epidemiologic Studies Depression Scale

This study investigates the extent to which the diagnostic performance of the Center for Epidemiologic Studies Depression Scale (CES-D; both 20- and 10-item versions) varies with cognitive status, and whether the same threshold can be applied regardless of cognitive status. Three hundred and ninety-six persons aged 60+ referred for psychiatric assessment were broken down into four groups depending on age (< 70 and ≥ 70) and dementia status (mild vs. none). All were independently interviewed using the CES-D before their first evaluation by a psychiatrist. Receiver operating characteristic curves showed that both versions of the CES-D produced essentially identical results, regardless of age and dementia status. Both versions were more or less robust to the effect of mild dementia but were vulnerable to the effect of age itself. Furthermore, the optimal threshold for the 20-item version varied somewhat across the different age–dementia groups, and no clear-cut threshold existed in old-old persons with dementia. On the contrary, the same threshold of 12 can be adopted for the 10-item version, regardless of age and dementia status. Compared with the full 20-item scale, the 10-item version has the added advantage of an identical threshold across age and cognitive status.     

Comparison of the General Health Questionnaire and the Cornell Medical Index Health Questionnaire

This study compares the 30-item version of the General Health Questionnaire (GHQ) and the psychiatric section of the Cornell Medical Index Health Questionnaire (CMI-MR) using normative data from a sample of the general population and data from general practice patients where clinical assessment by a psychiatrist is used as a criterion of psychiatric caseness. In this study the CMI-MR has a slightly better overall performance as a screening test. It appears that the CMI-MR errs in the direction of false negatives when the symptoms are recent and related to situational stress, but the GHQ has a tendency to miss cases with symptoms of long standing.     

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.     

流产后抑郁障碍调查

目的：主要调查香港地区中国妇女流产后精神疾病的患病率。方法：对282名妇女在流产后6周用30项一般健康问卷（GHQ）、Edinburgh产后抑郁量表（EPDS）和Beck抑郁量表（BDI）进行评定,以DSM－Ⅲ-R定式检查（SCID）建立诊断,检验GHQ、EPDS与DSM－Ⅲ-R诊断间效标效度,以及和BDI间的平行效度。结果：29名妇女（10．3％）符合DSM-Ⅳ-R重症抑郁诊断,GHQ、EPDS具有良好的效标效度和平行效度。结论：中国香港妇女流产后精神障碍患病率降低,EPDS、GHQ适合用于综合性医院中流产后抑郁障碍的筛查。     

The validity of the 28-item general health questionnaire in a Nigerian antenatal clinic

Summary The 28-item General Health Questionnaire (GHQ-28) was validated against the Psychiatric Assessment Schedule (PAS) using data collected during a prospective study of psychiatric disorders associated with childbirth among 277 Nigerian women attending an antenatal clinic. Using the results of correlational analyses of the total scores on the GHQ and on the PAS and the traditional validity coefficients of sensitivity, specificity, and misclassification rate, the instrument was shown to be a valid tool for the detection of psychiatric morbidity in this population. With a sensitivity of 82% and a specificity of 85%, the revised scoring method devised by Goodchild and Duncan-Jones performed better in discriminating cases from non-cases than the conventional scoring method, which values respectively, of 75% and 83%. In a discriminant function analysis, only three of the four subscales of the instrument contributed to its discriminating power.     

Screening for depression in African American and Caucasian older women

Objective: To assess the performance of a two-choice (yes/no), 10-item shortened form of the CES-D in both African American (AA) and Caucasian (CA) older women. The CES-D is a widely used screening instrument, but its use has been questioned for routine screening because of its length and the complexity of its four-choice format. There is also little data available about its suitability low-income AA respondents.

Method: Telephone screening for depression followed by in-home diagnostic interviews were conducted in a community sample of 256 CA and 186AA low-income older women who ranged in age from 64 to 94 years. Standard receiver operator curves were plotted to determine the sensitivities and specificities of the screening instrument at different cut-scores against a criterion of SCID-based diagnoses of current major depressive episode (CMDE).

Results: Sensitivity and specificity of the 10-item scale and an even shorter 5-item version was slightly higher for AA than for CA women. While both short forms produced significant numbers of false positives against a criterion of CMDE, many of the women identified by the screen did have significant depressive symptomatology. Significantly, fewer AA women received a diagnosis of CMDE primarily because they did not show diminution of functioning associated with their depressive symptoms.

Conclusion: Short, easy to administer forms of the CES-D can provide useful information in working with older patients. Clinicians should be aware of ethnic differences in symptom expression and levels of functional impairment that are likely to occur in follow-up medical and psychiatric exams.     

Is the GDS-30 better than the GHQ-12 for screening depression in elderly people in the community? The Bambui Health Aging Study (BHAS)

BACKGROUND: Two-phase diagnostic surveys are popular in psychiatric epidemiology. The Geriatric Depression Scale (GDS) and the General Health Questionnaire (GHQ) are commonly used to screen in older and younger populations, respectively. METHOD: In Phase I, in this Brazilian population-based study, we screened 392 participants aged >or= 75 years. In Phase II, half of those scoring >or= 11 in the GDS and >or= 4 in the GHQ and 20% of others were selected for detailed evaluation with ICD-10 diagnoses assessed by the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 126). RESULTS: Internal consistencies were good for all scales. At the optimal cut-off points GDS-30 (14/15) yielded 73% sensitivity and 65% specificity, while classical GHQ (4/5), Likert (15/16) and c-GHQ (5/6) yielded 66-75% sensitivity and 57-62% specificity. Receiver operating characteristic (ROC) curve analysis against SCAN indicated only moderate screening potential [area under the ROC curve (AUROC): GDS = 0.76; classical GHQ = 0.74; Likert = 0.76; c-GHQ = 0.73], with no statistically significant differences. All measures were biased by disability and self-reported health. CONCLUSIONS: In this study, neither screen was sufficiently predictive of SCAN ICD-10 diagnosis to recommend their use in two-phase surveys. Despite its theoretical advantages, the GDS-30 performed no better than the GHQ-12, and was biased in similar ways.     

The GHQ-12 as a screening tool in a primary care setting

Summary The performance of the 12-item General Health Questionnaire (GHQ) was tested against a modified version of a structured diagnostic interview for making DSM III-4 diagnoses, the Composite International Diagnostic Interview (CIDI), in a population of 787 primary care patients, 214 of whom were interviewed. The Yoruba versions of both instruments were found to be feasible in this setting and the inter-rater reliability of the CIDI was good. The GHQ-12 showed a sensitivity of 68% and a specificity of 70% when only cases meeting the criteria for specific DSM III-R disorders were considered. The sensitivity was better for certain individual disorders and the overall performance was marginally improved when scoring was made according to the revised method proposed by Goodchild and Duncan-Jones.