Abstract
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.
Methods
The GHQ was available from 511 inpatients recruited from surgical, medical, gynaecological and physical rehabilitation wards. The Clinical Interview Schedule was performed for psychiatric case-identification and was used as external care criterion.
Results
Sensitivities of all versions were between 0.612 and 0.701, and specificities between 0.601 and 0.759. The Overall Misclassification Rate (OMR) varied for the Bimodal and the Modified Likert scoring method between 0.257 and 0.281, for the Likert and the Chronic scoring method between 0.325 and 0.386. Overall, the Bimodal and the Modified Likert scoring method showed significantly better specificity and OMR than the Likert and the Chronic scoring method, while we could not find any differences for sensitivity.
Conclusions
Overall, the Bimodal and the Modified Likert scoring method seem to be more accurate than the Likert and the Chronic scoring method. Nevertheless, due to the high misclassification, none of these versions can be recommended for routine screening among non-psychiatric inpatients.
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References
Alexandrowicz R, Weiss M, Marquart B, Wancata J (2008) Zur Validität zweistufigen Screenings am Beispiel Depressionsscreening. Psych Prax 35:29–301
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3 edn, revised. American Psychiatric Association, Washington, DC
Arolt V (1997) Psychische Störungen bei Krankenhauspatienten. Berlin, Springer
Cooper B, Schwarz R (1982) Psychiatric case identification in an elderly population. Soc Psychiatry 17:43–52
Cooper B (1978) Probleme der Falldefinition und Fallfindung. Nervenarzt 49:437–444
Fichter MM (1990) Verlauf psychischer Erkrankungen in der Bevölkerung. Springer, Berlin
Gilbody SM, House AO, Sheldon TA (2001) Routinely administered questionnaires for depression and anxiety: systematic review. BMJ 322:406–409
Goldberg DP (1972) The detection of psychiatric illness by questionnaire. Oxford Univ Press, New York
Goldberg D (1986) Use of the general health questionnaire in clinical work. Br Med J 293:1188–1189
Goldberg DP, Gater R, Sartorius N, Üstün TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197
Goldberg DP, Cooper B, Eastwood MR, Kedward HB, Shepher M (1970) A standardized psychiatric interview for use in community surveys. Br J Prev Soc Med 24:18–23
Goldberg DP, Williams P (1988) A user’s guide to the General Health Questionnaire. NFER-Nelson, Windsor
Goodchild ME, Duncan-Jones P (1985) Chronicity and the general health questionnaire. Br J Psychiatry 146:55–61
Grabe HJ, Baumeister SE, John U, Freyberger HJ, Völzke H (2009) Association of mental distress with health care utilization and costs: a 5-year observation in a general population. Soc Psychiatry Psychiatr Epidemiol 44:835–844
Härter M, Woll S, Wunsch A, Bengel J, Reuter K (2006) Screening for mental disorders in cancer, cardiovascular and musculoskeletal diseases. Soc Psychiatry Psychiatr Epidemiol 41:56–62
Jacob K, Brugha D, Mann A (1997) The validation of the 12-item General Health Questionnaire among ethnic Indian women living in the United Kingdom. Psychol Med 27:1215–1217
Katschnig H, Berner W, Haushofer M, Barfuss M, Seelig P (1980) Psychiatric case identification in general practice: self-rating versus interview. Acta Psychiatr Scand 62(Suppl 285):164–175
Malt UF (1989) The validity of the General Health Questionnaire in a sample of accidentally injured adults. Acta Psychiatr Scand 80(35):103–112
Mayou R, Hawton K (1986) Psychiatric disorder in the general hospital. Br J Psychiatry 149:172–190
Pakesch G, Katschnig H, Dittrich R, Loimer N, Rasinger E, Tutsch G (1993) Prävalenz und soziodemographische Korrelate des Benzodiazepingebrauchs in einer Großstadtbevölkerung. Nervenarzt 64:312–317
Picardi A, Abeni D, Mazzotti E, Fassone G, Lega I, Ramieri L, Sagoni E, Tiago A, Pasquini P (2004) Screening for psychiatric disorders in patients with skin diseases. A performance study of the 12-item General Health Questionnaire. J Psychosom Res 57:219–223
Pignone P, Gaynes B, Rushton J, Burchell C, Orleans C, Mulrow C, Lohr K (2002) Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 136:765–776
Ramsay R, Wright P, Katz A, Bielawska C, Katona C (1991) The detection of psychiatric morbidity and its effects on outcome in acute elderly medical admission. Intern J Geriatr Psychiatry 6:861–868
Schmitz N, Kruse J, Heckrath C, Alberti L, Tress W (1999) Diagnosing mental disorders in primary care: the General Health Questionnaire (GHQ) and the Symptom Checklist (SCL-90-R) as screening instruments. Soc Psychiatry Psychiatr Epidemiol 34:360–366
Sweeting H, Young R, West P (2009) GHQ increases among Scottish 15 year olds 1987–2006. Soc Psychiatry Psychiatr Epidemiol 44:579–586
Üstün TB, Sartorius N (1995) Mental illness in general health care: an international study. John Wiley and Sons, Chichester
Wancata J, Alexandrowicz R, Benda N (2002) 30-item General Health Questionnaire in general hospitals: selecting items using a stepwise hierarchical procedure. Eur J Epidemiol 17:1001–1004
Wancata J, Alexandrowicz R, Marquart B, Weiss M, Friedrich F (2006) The criterion validity of the Geriatric Depression Scale: a systematic review. Acta Psychiatr Scand 114:398–410
Wancata J, Benda N, Windhaber J, Nowotny M (2001) Does psychiatric comorbidity increase the length of stay in general hospitals? Gen Hosp Psychiatry 23:8–14
Wancata J, Weiss M, Marquart B, Alexandrowicz R (2004) Screening instruments for general hospital and primary care patients. In: Diefenbacher A (ed) Consultation-liaison psychiatry in Germany, Austria and Switzerland. Adv Psychosom Med. Karger, Basel 26:74–97
Watanabe N, Stewart R, Jenkins R, Bhugra DK, Furukawa TA (2008) The epidemiology of chronic fatigue, physical illness, and symptoms of common mental disorders: a cross-sectional survey from the second British National Survey of Psychiatric Morbidity. J Psychosom Res 64:357–362
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This research project was supported by the Austrian Ministry of Science and Research.
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Friedrich, F., Alexandrowicz, R., Benda, N. et al. The criterion validity of different versions of the General Health Questionnaire among non-psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 46, 635–641 (2011). https://doi.org/10.1007/s00127-010-0229-8
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DOI: https://doi.org/10.1007/s00127-010-0229-8