General Health Questionnaire

Overview

The GHQ was designed as a self-administered screening instrument with the ability to differentiate psychiatric patients from healthy individuals within a community. However, the GHQ is not concerned with making a specific psychiatric diagnosis. The GHQ was originally developed as a 60-item instrument. Currently, there are four shortened versions available. In addition, the GHQ has been translated into 38 languages, and it has been extensively used in both research and clinical practice. Furthermore, this survey instrument has been validated cross-culturally in many adult populations across the world.

Rating Scale

Each item on the GHQ is rated on a 4-point scale: less than usual, no more than usual, rather more than usual, or much more than usual. For example, the GHQ-12 gives a total score of 36 or 12 based on the selected scoring methods. One of the most common scoring methods used is the bimodal method, where the responses are assigned the numeric values of 0-0-1-1. Another method is the Likert scoring style, which assigns the values as 0-1-2-3.

The areas of mental health that are assessed by the original version of the GHQ include depression and anxiety, social functioning, psychophys-iologic symptoms, general health, and vague aches and pains. The internal consistency of the GHQ is reported to be in the range of 80% to 90%, which indicates the high reliability of the instrument. Additionally, the coefficients of correlation with global clinical assessments of psychopathology are in the range of .55 to .83, indicating high validity. The overall sensitivity has been reported to be about 68% with a specificity of about 81%.

Factors Assessed

The GHQ assessment focuses on breaks in normal functioning rather than lifelong traits. The GHQ is based on two major classes of phenomenon that occur in patients with psychiatric illness. First, it assumes that patients with psychiatric illness are not able to carry out normal healthy functions. Furthermore, it assumes that such patients have episodes of distress. The items in the GHQ concentrate on the specific spectrum between psychiatric disturbance and normal functioning, rather than ranging over the whole array of mental health from normality to severe disturbance. Respondents are not asked how long they have experienced symptoms. As a result, disorders with less than 2 weeks' duration are included. In contrast, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), another diagnostic instrument for assessing the severity of depression requires that symptoms be present in a respondent for at least 2 weeks to be included as a positive symptom of depression. Certain demographic variables also affect the GHQ scores, while some do not. For example, females who are divorced or separated, unemployed, or living in urban areas generally have higher scores than women who are not in the same situation. Age and social class, however, do not have a strong effect on the GHQ score.

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