General Health Questionnaire

The General Health Questionnaire (GHQ) was developed to assess the extent of psychiatric illness in general practice. Contrary to what the name suggests, this questionnaire does not assess general health but mental healthLewin Group. Read more ... ». The GHQ is considered to be a significant advancement in psychiatric epidemiology since general practitioners did not diagnose their patients with significant psychiatric illness in the 1970s. Recognizing the need for physicians to test and assess their patients and make a tentative diagnosis of mental illness, David Goldberg at the Institute of Psychiatry, LondonSackett, David L.. Read more ... », developed and published the GHQ.

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, psychophysiologic 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 resultacupuncture. Read more ... », disorders with less than 2 weeks’ duration are included. In contrast, the Diagnostic and Statistical Manual of Mental Disorders (DSMMental Health Epidemiology. Read more ... »-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 whoWorld Health Organization. Read more ... » 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.

Versions
Several versions of the GHQ are available. These include the GHQ-60, the fully detailed 60-item questionnaire; the GHQ-30, a short form without items relating to physical illness; the GHQ-28, a 28-item scaled version that assesses somatic symptoms, anxiety, insomnia, social dysfunction, and severe depression; and the GHQ-12, a quick, reliable, and sensitive short form, which is ideal for research studies.

In terms of validity, reliability, and prediction, the 60-item version has been shown to outperform the shorter counterparts. The 12-item and the 30-item versions have been more widely used in community samples because they are brief and take less time to complete. Over the past 10 years, the GHQ-28 has become a widely used questionnaire in epidemiological studies.

The GHQ has also been adapted for different populations and cultures. There are three main reasons that account for the interest in adapting this instrument to different samples and languages. First, the GHQ-28 has the advantage of being shorter, with approximately 3 to 5 minutes required for the full questionnaire to be filled out. Additionally, it can be applied to primarycare settings, where the majority of minor psychiatric disorders arise. Furthermore, apart from providing an overall assessment, the GHQ-28 contains four scales that furnish additional information.

Use
The GHQ has been used in different settings for various purposes, including within clinical-practice settings for research studies and clinical trials and in population-based epidemiological studies. The use of GHQ and its versions is protected by copyrights held by David Goldberg and the Institute of Psychiatry, London. The GL Assessment acts on behalf of the original copyright holders, and it allows researchers to use the GHQ after paying user fees and signing various legal agreements. Based on the study design and the context of use, there is also a provision to use GHQ free of cost.

Future ImplicationsCommunity-Based Participatory Research. Read more ... »
The GHQ has been used to assess the mental health statusRAND Health Insurance Experiment. Read more ... » of individuals and populations for more than three decades. The GHQ has also been translated and validated across many languages and cultures. A general note of caution should be exercised in using the GHQ or in interpreting the results from this survey in the clinic setting, because it does not differentiate between different types of mental illness. Among all the different versions of the GHQ, the 12-item short form remains a quick, reliable, and sensitive questionnaire, making it ideal for research studies. In addition, it has been shown that the use of GHQ by general practitioners can increase their ability to recognize hidden psychiatric morbidity and a new episode of illness.

Vikrant Vats

See also Diagnostic and Statistical Manual of Mental Disorders (DSM); Health Surveys; Measurement in Health Services ResearchU.S. Department of Veterans Affairs. Read more ... »; Mental Health; Mental Health Epidemiology; Short-Form Health Surveys (SFRAND Corporation. Read more ... »-36, -12, -8)

Further Readings
Hankins, Matthew. “The Reliability of the Twelve-Item General Health Questionnaire Under Realistic Assumptions,” BMC Public HealthCommunity-Based Participatory Research. Read more ... » 8(1): 355–61, October 14, 2008.
Hu, Yongjian, Sarah Stewart-Brown, Liz Twigg, et al. “Can the 12-Item General Health Questionnaire Be Used to Measure Positive Mental Health?” Psychological Medicine 37(7): 1005–13, July 2007.
Ouimette, Paige, Michael Wade, Annabel Prins, et al. “Identifying PTSDMedicalization. Read more ... » in Primary CareNational Guideline Clearinghouse. Read more ... »: Comparison of the Primary Care-PTSD Screen and the General Health Questionnaire-12,” Journal of Anxiety Disorders 22(2): 337–43, March 2008.
Picardi, Angelo, Damiano Abeni, Eva Mazzotti, et al. “Screening for Psychiatric Disorders in Patients With Skin Diseases: A Performance Study of the 12-item General Health Questionnaire,” Journal of Psychosomatic Research 57(3): 219–33, September 2004.
Willmott, Sasi A., Jed A. P. Boardman, Carol A. Henshaw, et al. “The Predictive Power and Psychometric Properties of the General Health Questionnaire (GHQ-28),” Journal of Mental Health 17(4): 435–42, August 2008.

Web Sites
American Psychiatric Association (APA): http://www.psych.org
GL Assessment: http://www.gl-assessment.co.ukUnited Kingdom’s National Institute for Health and Clinical Excellence. Read more ... »
National Institute of Mental Health (NIMHNational Institutes of Health. Read more ... »): http://www.nimh.nihHealth Services Research, Origins. Read more ... ».gov