The factor structure of the GHQ: a scaled version for a hospital's general practice service in Mexico

Meta-Analysis of Factor Analyses of the General Health Questionnaire – Short Forms GHQ-28 and GHQ-30

Abstract. Two meta-analyses of exploratory factor analyses of the General Health Questionnaire short forms, GHQ-28 ( N = 26,848, k = 40) and GHQ-30 ( N = 43,151  k = 25), were conducted to determine the consistent factors found in each test and any common factors across them. Five databases (PsycINFO, PubMed, BASE, Semantic, and Google Scholar) were searched in 2021. Reproduced correlations derived from the original studies’ factor matrices and aggregated across studies were factor analyzed for the meta-analyses. For the GHQ-28, the standard four subscales of somatic, anxiety, social dysfunction, and depression were clearly identified and strongly supported by a four-factor structure. For the GHQ-30, a four-factor solution identified factors of anxiety, depression, social dysfunction, and social satisfaction, the first three factors shared a number of items with the same scales found in the GHQ-28. These shared factors appear similar across tests and should help bridge research using the GHQ-30 and the GHQ-28. Confirmatory factor analyses supported the four-factor models in both tests. The four standard subscales of GHQ-28 were strongly supported and can be recommended. The three similar factors in the GHQ-30, as well as the social satisfaction factor, appear reasonable to use.

Predictors associated with the mental health of Japanese male registered nurses: focusing on environments with many female registered nurses and female patients' refusal to accept nursing services from male registered nurses

Objective: To study the improvement of the mental health of Japanese male registered nurses, we investigated the predictors associated with the Japanese version of the 12-item General Health Questionnaire (GHQ-12). For those predictors, we focused on environments with many female registered nurses and female patients’ refusal to accept nursing services from male registered nurses.

Materials and Methods: This study was conducted in 93 hospitals in the Aichi, Gifu, and Mie prefectures of Japan. The analyzed subjects were 1,216 full-time male registered nurses. The average age (standard deviation) was 34.5 (9.2) years. Multiple logistic regression analysis was conducted. A GHQ-12 score of ≤3 indicated good mental health, and a score of ≥4 indicated poor mental health. “Mental health” was a dependent variable. The independent variables were: “Age”, “Male registered nurses as important partners on the job”, “Female registered nurses’ good manners toward male registered nurses”, “Fairness regarding male registered nurses’ promotions”, and “Female patients’ refusal to accept nursing services from male registered nurses”.

Results: There were 728 (59.9%) full-time male registered nurses with good mental health and 488 (40.1%) with poor mental health. The mental health of the male registered nurses who had negative feelings regarding, “Male registered nurses as important partners on the job” was significantly worse, and that of those who had negative feelings regarding, “Female registered nurses’ good manners toward male registered nurses” was also significantly worse.

Conclusion: Female registered nurses must recognize that their attitudes toward male registered nurses influence the mental health of male registered nurses. Hospital managers should provide male registered nurses who cannot establish appropriate relations with female registered nurses with consultation opportunities. Such organizational action by managers is necessary.

Validity of the effort/reward imbalance questionnaire in health professionals from six Latin-American countries

BACKGROUND

This study tests the validity and the invariance of ERI questionnaire (ERIQ) data from health professionals in six different Latin-American countries.

METHODS

One thousand two hundred ninety-two (1292) participants who worked in hospitals in Argentina, Chile, Colombia, Mexico, Peru and Venezuela completed the ERI and GHQ questionnaires. Partial correlations were carried out as well as reliability statistics and confirmatory factor analyses to examine factor structure and invariance of ERIQ in each subsample.

RESULTS

Overall confirmatory factor analyses confirmed the theoretical structure of the ERIQ. The effort and overcommitment scales were invariant (equivalent) across the six countries, but the reward scale was only partially invariant. Several associations between ERIQ and mental health remain significant after controlling for sociodemographic variables.

CONCLUSIONS

Although the validity of the ERIQ' scales were generally satisfactory in most Latin-American samples, future research should examine in depth the equivalence of reward scale across Latin-American cultures.

Testing Psychometric Properties of the 30-Item General Health Questionnaire

This study aimed to evaluate the psychometric properties of the General Health Questionnaire (GHQ-30) given conflicting findings in the literature. A cross-sectional, nonexperimental research was used with a convenience sample of 271 American female health care professionals. Data were collected by using self-reported questionnaires. A series of exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and structural equation modeling (SEM) were performed to examine underlying dimensions of the GHQ-30.Results from EFAs and CFAs revealed the three-factor composition (positive affect, anxiety, and depressed mood). All factor loadings were statistically significant, and one pair of error variance was allowed to be correlated. All factors contained questionnaire items with acceptable face validity and demonstrated good internal consistency reliability. Results from SEM further confirmed underlying constructs of the scale. To our knowledge, this is the first study that extensively tested the psychometric properties of the GHQ-30, taking both statistical and substantive issues into consideration.

A Confirmatory Factor Analysis of the GHQ12 Using a Large Australian Sample

The GHQ12 has become a popular screening instrument used by both clinicians and researchers. To date there have been a number of studies investigating the factor structure of the GHQ12. Most have identified a factorial structure to the instrument but there has been little consistency in the factors identified. One reason for this may be that different investigators are using different scoring methods and this could impact the structure identified. This study used structured equation modeling (LISREL 8.7) to carry out a confirmatory factor analysis, with a large sample of 8,732 university staff, on four 3-factor and one unitary model solutions using the three most common scoring methods (Classical, Corrected, and Likert). It was found that the method of scoring substantially affects model estimation and suggestions were made as to the best scoring method for future use.

The factor structure of the General Health Questionnaire (GHQ): a scaled version for general practice in Spain

BACKGROUND

The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values.

METHODS

We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting.

RESULTS

Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items.

CONCLUSIONS

The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.

Confirmatory factor analysis of the GHQ-12: can I see that again?

OBJECTIVE

This paper reviews research relating to the factor analysis of the GHQ-12. We explore the question of whether there is a consistent replicable structure to the GHQ-12 using: (i) a comparative analysis of fit between identified factor models; and (ii) a confirmatory factor analysis of GHQ-12 data from our own study.

METHOD

The factor models proposed from the literature were reviewed. The published factor loadings were used to carry out a factor matching analysis to identify similarities between the various factor models that have been identified. In addition, 490 patients visiting their general practitioner completed the General Health Questionnaire (GHQ-12) in the first phase of a longitudinal study evaluating service delivery to rural Tasmania. Three different methods for scoring the GHQ-12 were utilized and each resultant data set was analysed using a Confirmatory Factor Analysis (CFA) to establish which of the various factor models provided the most consistent description of the data.

RESULT

None of the complete factor models that have been proposed have been consistently replicated across studies. Isolated factors were replicated between some studies but no single factor structure was replicated across all studies. All of the models had adequate fit to the Tasmanian data when the usual scoring was used. However, only one model had a consistently high 'goodness of fit' across scoring methods.

CONCLUSION

It was concluded that the 'best fit' was achieved by a model based on an early factor analytic study using an Australian sample. It was suggested that researchers wanting to extract scales from the GHQ-12 could use this model.

Suicide attempts in a sample of patients from a general hospital

BACKGROUND

Suicide in Mexico has risen steadily in recent years, increasing by 156% in the last two decades. The study of suicide precursors, such as suicide attempts, has also become an important public health topic. The aim of this study is to establish the prevalence of suicide attempts in a general hospital setting and its association with alcohol, depression, and other factors.

METHODS

A cross-sectional survey of a sample of patients was carried out in all three service units (inpatient, outpatient, and the emergency room) of a general hospital in Mexico City. All patients were randomly selected to participate regardless of the reason for initial hospital admission. Each patient was administered a series of psychological and demographic scales including the Beck Depression Inventory, the Beck Hopelessness Inventory, the General Health Questionnaire, a suicide assessment scale, a scale for alcohol consumption, and several measurements of alcohol-related problems.

RESULTS

The final sample was made up of 1,094 patients of both genders (68% women), aged 18-65 years. A lifetime prevalence of suicide attempts of 6.1% (95% confidence interval [CI] of 4.7-7.7%) was found. Multiple logistic regression was used to obtain estimations of the association between lifetime suicide attempt and other factors. Marital status, age, depressed mood, hopelessness, Goldberg's 30-item version of the General Health Questionnaire, and high levels of alcohol consumption were all associated with the suicide attempt.

CONCLUSIONS

Prevalence of lifetime suicide attempts was mainly related to being young, divorced, or widowed, and to feeling depressed, hopeless, and under undesirable psychological distress.

General Health Questionnaire (GHQ12 & GHQ28): psychometric properties and factor structure of the scales in a Turkish primary care sample

The General Health Questionnaire is a widely used screening instrument. It detects a wide range of psychological disorders, mainly the anxiety/depression spectrum, and has been shown to be a valid and reliable instrument across cultures. This study reports the psychometric properties of the 12- and 28-item versions of the questionnaire among Turkish primary care attenders, focusing mainly on the factor structures. Both questionnaires were found to be reliable and they had factor structures consistent with the original studies.

Factor structure of the 28-item general health questionnaire in a sample of antenatal women

OBJECTIVE

The factor structure of responses to the twenty-eight-item General Health Questionnaire (GHQ-28) in a sample of 277 Nigerian antenatal women was examined.

METHOD

Principal Component Analysis (PCA) and Varimax rotation were used.

RESULTS

A four factor structure interpretable as social dysfunction, somatic-anxiety, depression-anxiety, and severe depression was obtained.

CONCLUSION

Although the factor structure in this sample is similar to that previously reported with this instrument, the factor loadings particularly for the anxiety subscale differed. Thus, the factor structures of the GHQ may differ depending on the cultural background of the sample.

The two scaled versions of the Chinese General Health Questionnaire: a comparative analysis

The four scales of the Chinese 28-item General Health Questionnaire (GHQ-28), and the five scales of the Chinese GHQ-20 were separately subjected to confirmatory factor analysis (in individual sample analyses and simultaneous multi-sample analyses) based on four Chinese samples of 150 general psychiatric patients, 549 school teachers, 653 university undergraduates, and 1082 secondary school students. While the two scaled versions were comparable in discriminating patients from nonpatients, the five scales of the GHQ-20 assessing five correlated dimensions were interpreted as mapping salient symptom areas in the Hong Kong Chinese population as they were empirically derived in the Chinese setting. The need for using samples from different cultural settings in multi-sample confirmatory analysis was discussed.

The factor structure of the general health questionnaire (GHQ-30) in Japanese middle-aged and elderly residents

We conducted Goldberg's 30-item General Health Questionnaire (GHQ) on 1,216 Japanese general population aged 40-92. Among them, 9.8% of males and 13.7% of females scored over the cut-off point which is used to indicate minor psychiatric disorders. Factor analysis was carried out using the Likert method and eight factors labelled as follows were selected: depression, anxiety and tension, anergia, interpersonal dysfunction, difficulty in coping, insomnia, anhedonia and social avoidance. The mean value of the standardized scores for each age-sex group indicated that changes in sex-age social roles with age affect the mental health of the general population.

Is the General Health Questionnaire (12 item) a culturally biased measure of psychiatric disorder?

There have been suggestions that some self-administered questionnaires designed to assess psychiatric disorder tend to overestimate prevalence in samples from Latin America. This phenomenon may be obscured when the General Health Questionnaire (GHQ) is used, as it is recommended that researchers determine the threshold in each setting by comparing the GHQ with a standardised interview. Reports in the literature suggest that Latin American samples have a higher threshold for case definition using the GHQ than that found in British samples. The present study confirmed this finding when comparing the 12-item GHQ in a Chilean primary care sample with a sample of primary care attenders from the United Kingdom. The increase in GHQ scores in the Chilean sample persisted after adjustment for age, sex, marital status and the score on the Revised Clinical Interview Schedule (CIS-R). The increase in scores seen in the Chilean sample was only found in that half of the GHQ that asks about negative aspects of mental health.

Reliability and validity of the Cambodian version of the 28-item General Health Questionnaire

This study confirmed the reliability and validity of a Cambodian version of the 28-item General Health Questionnaire (GHQ-28). The GHQ-28 was tested on 223 adult Cambodians living in Dunedin, New Zealand, who were examined independently by a psychiatrist (P.C.) using the short Present State Examination (PSE). There were satisfactory internal consistencies for the whole scale and the subscales except the C scale. It correctly identified 84.4% of cases with a 3/4 cut-off (sensitivity 87.5%, specificity 82.8%), suggesting a discriminative power as good as its English version when used among Caucasian women in Dunedin. The four subscales were by no means independent, and concurrent validity tests with the PSE suggested that they provided additional information regarding somatic symptoms and anxiety, but not about social dysfunction and depression.

The Chinese General Health Questionnaire in a psychiatric setting: the development of the Chinese scaled version

The development of the Chinese scaled GHQ-20 was based on the factor analysis of the item responses of 150 general psychiatric patients with the Chinese GHQ-60. The five subscales assessing the symptom areas of dysphoric functioning, health concern, anxious coping, sleep problems, and suicidal ideas were found to discriminate significantly the sample of patients from another sample of 653 nonpatients. As a scale, the Chinese GHQ-20 was also found to be comparable to the full Chinese GHQ-60 in screening for individuals who might benefit from psychiatric consultation. The implications for its use as a refined instrument to monitor therapeutic change of patients in different symptom areas are discussed.

The factor structure of the Turkish version of the General Health Questionnaire

The 60-item General Health Questionnaire (GHQ) was translated into Turkish and administered to a community sample of 437 Turkish-speaking immigrants resident in Melbourne, Australia. The factor structures of the 60-item and 28-item versions of the GHQ were examined to determine the cross-cultural validity of the four subscales of the 28-item GHQ "anxiety/insomnia", "social dysfunction", "severe depression" and "somatic complaints". Four-factor principal components analyses yielded factors which corresponded to similar underlying traits, but the pattern of symptom loadings differed in several ways. Insomnia was less closely associated with anxiety, and general illness ratings such as "not feeling perfectly well" were not uniquely associated with somatic symptoms. The "anxiety/insomnia" and "severe depression" factors overlapped, with many symptoms partially correlated with both factors. These factors appeared to be due to variations in the frequency of occurrence of these symptoms rather than a qualitative distinction between anxiety and depression.

The validity of the 28-item General Health Questionnaire in a Nigerian antenatal clinic

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.

Comparison of two self administered psychiatric questionnaires (GHQ-12 and SRQ-20) in primary care in Chile

The General Health Questionnaire (GHQ-12) and the Self Report Questionnaire (SRQ-20) were simultaneously validated against the criterion of the Revised Clinical Interview Schedule (CIS-R) in a primary care clinic in Santiago, Chile. A Relative Operating Characteristic (ROC) analysis was used to determine the optimal threshold point for case definition and to compare the performance of these two questionnaires. The validation coefficients for the GHQ-12 and the SRQ-20 were, respectively: sensitivity 76% and 74%; specificity 73% and 77%; overall misclassification rate: 26% and 25%. Misclassification by these questionnaires was significantly associated with education and sex, males being more likely than females to be misclassified as false negatives and poorly educated respondents as false positives. The symptom response profile of both questionnaires showed that the most prevalent items were psychological complaints of anxiety and depression. Both instruments seem to have a similar ability to identify minor psychiatric disorders in primary care in Chile.

Screening for depression in the medically ill. The future of paper and pencil tests

Paper and pencil screening tests for depression have never become widely used in the medically ill, despite consensus that a sizeable pool of depression exists in this population. The performance of several self-rating scales in these patients is reviewed, demonstrating that satisfactory screening of depression as defined by standard case criteria can be achieved. It is proposed that it is primarily the absence of clear guidelines for treatment to be used in conjunction with these scales which will make clinicians sceptical of their value. Treatment validation of case criteria is required to demonstrate that screening for depression in medical patients is worthwhile.

The factor structure of the 28-item General Health Questionnaire when used in Japanese early adolescents and adult employees: age- and cross-cultural comparisons

The principal-component analysis (PCA) with varimax rotation on the 28-item General Health Questionnaire (GHQ-28) in Japanese translation was performed separately for two samples of the Japanese population: early adolescents (junior high school students) and adult employees. The initial PCA yielded different number of components across sub-samples. The later PCA, however, with restriction of the number of components four generally produced a similar structure across sub-samples by means of visual inspection and the coefficient of factor similarity between the components calculated by using the loadings matrices, while a slight different structure emerged for the employees aged 40-49 years. Then, based on these two ways of comparison, the factor structure of GHQ-28 was compared between the present Japanese samples and the European and Turkish school-aged adolescent populations with three ethnic backgrounds. The results showed that its structure was highly stable across age (generation) and several cultural backgrounds, at least among these nations. The internal consistency reliability of the GHQ-28 was at a high level among the present sample of Japanese.

Greek version of the General Health Questionnaire: accuracy of translation and validity

The purpose of this study was to examine the accuracy of translation and to test the validity of the Greek version of the General Health Questionnaire (GHQ). In the translation study, the English and the Greek versions of the GHQ were administered to a sample of 50 bilingual respondents. The internal consistency, item-by-item and the subject-by-subject analysis have shown that the 2 versions are equivalent and therefore the Greek translation is highly accurate. In the validity study, 100 consecutive patients attending an internal medicine outpatient clinic completed the Greek version of the GHQ-60 and were interviewed independently using the Present State Examination (PSE). The validity of the shorter forms of the questionnaire (GHQ-30 and GHQ-28) was tested by disembedding the relevant items from the larger set. The correlations obtained between the scores of the questionnaire and the PSE ratings, as well as all the validity indices (sensitivity, specificity, positive predictive value, negative predictive value and overall misclassification rate) were quite satisfactory for all the GHQ forms, thus confirming the validity of the questionnaire in its Greek version. The best cut-off points as found by receiver-operating characteristics analysis were 11/12 for the GHQ-60, 5/6 for the GHQ-30 and 4/5 for the GHQ-28. The revised (CGHQ) scoring system for the GHQ-30 has not been proved superior to the conventional scoring method. The above results are discussed in relation to the pertinent literature and especially the studies carried out in similar settings and in countries with similar cultural backgrounds.

Reliability and the factor structure of the Yoruba version of the 12-item General Health Questionnaire

The reliability and the factor structure of the Yoruba translation of the General Health Questionnaire (GHQ) were investigated using data collected during a study of psychiatric morbidity among a sample of 787 primary care attendees. The instrument was shown to have a high degree of internal consistency. A two-factor solution provided the best description of the GHQ in this setting. Using subsamples selected on the basis of sex and age, these two factors were shown to be stable. Also, using data collected on a second-stage sample of 214 patients who were given a structured clinical interview, both factors discriminated "cases" from "non-cases" and one of the factors discriminated between depressed from non-depressed "cases".

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.

Psychiatric morbidity among Punjabi medical patients in England measured by General Health Questionnaire

The 28-item GHQ was administered to 282 Punjabi and white British patients visiting two Health Centres in Bedford. We discovered that ethnicity is not significantly correlated with GHQ 'caseness', but that differences exist in somatic and depressive symptomatology. The discussion relates these findings to debates about the psychiatric morbidity of Asian immigrants and somatization.

Sex difference in prevalence of minor psychiatric morbidity: a social epidemiological study in Taiwan

The female excess in prevalence of minor psychiatric morbidity (MPM) evident in a community study in Taiwan (n = 1023) was further investigated in terms of demographic variables, socioenvironmental risk factors and psychosocial stresses. It was suggested that a stronger effect of chronic psychosocial stressors accounted for the higher prevalence of MPM in women. Further analysis has revealed a longer mean duration of MPM in women and an incidence ratio close to unity between the sexes. These retrospective findings were further examined in a small one-year prospective outcome study; a poorer outcome was found among older subjects and female subjects. It is suggested that more females have MPM because chronic psychosocial stressors more adversely affect the course of such morbidity. These results are discussed in a cross-cultural context.

Validity of the GHQ-28 in New Zealand women

The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Goodchild and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearson's correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.

Validity of the Japanese version of the GHQ among antenatal clinic attendants

The validity of the Japanese version of the 30-item General Health Questionnaire (GHQ) was examined against the semi-structured interview-based Research Diagnostic Criteria (RDC) as external criteria. The GHQ total score discriminated 'cases' and 'non-cases' satisfactorily but its recommended cut-off point was higher (7/8) than that of the original English version (4/5). Discriminant function analysis revealed that only 13 items contributed to the discriminatory power and that their discriminant function score was better than a simple summation of the 30 GHQ item scores in terms of validity.

A comparative investigation of the principal component structure of the 28 item version of the General Health Questionnaire (GHQ). 15-year-old schoolgirls in England, Greece, Turkey and West Germany

The 28-item version of the General Health Questionnaire of 15-year-old schoolgirls obtained under identical conditions in two separate studies was subjected to principal component analysis (PCA). Varimax rotation produced different numbers of components for the different groups, but restricting the number of components to be rotated to four produced similar component structures, as supported by the coefficient of factor similarity, for both Turkish and Greek groups in their home countries and a heterogeneous non-British group in London in comparison to British girls. Different structures were obtained in schoolgirls from Greece, in Munich, and from the Indian subcontinent in London. Analysis of variance of the factor scores of a combined PCA produced significant overall group differences for all components and specific group differences for anxiety and insomnia, social dysfunction, and severe depression. Somatic symptoms and anxiety and insomnia subscales, either alone or in combination with other subscales, contributed most frequently to morbidity.

The factor structure of the GHQ-60 in a community sample

The factor structure of the 60-item version of the General Health Questionnaire was explored, using data collected in a community study in a rural area of northern Spain. Six principal components, similar to those previously reported with this instrument, were found to provide a good description of the data structure. The 30-item and 12-item versions of the GHQ were then disembedded from the parent version, and further principal components analyses carried out. Again, the results were similar to previous studies: in each of the three versions analysed here, the two most important components represented a disturbance of mood ('general dysphoria')--including aspects of anxiety, depression and irritability--and a disturbance of social performance ('social function/optimism'). The principal component structure of the GHQ-60 was then utilized to calculate factor scores, and these were compared with PSE ratings using Relative Operating Characteristic (ROC) analysis. While four of the six factors discriminated well (area under the ROC curve 0.75 or more) between PSE 'cases' and 'non-cases', only one, depressive thoughts, was a good discriminator between depressed and non-depressed PSE 'cases'.

Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness

The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.

Assessment of psychological morbidity in primary care: explorations with the General Health Questionnaire

The 30-item version of the General Health Questionnaire (GHQ) was completed by 1649 new adult enrollees in a Health Maintenance Organization (HMO). Factor analysis of responses disclosed six factors (Anxiety/Strain, Confidence, Depression, Energy, Social Function, and Insomnia) and a strong tendency for items of similar wording (positive phrasing) to cluster together. Elevations of GHQ scores, especially when persistent over two administrations of the GHQ separated by 7 months, were strongly associated with the probability of both mental health and non-mental health care within 12 months of enrollment. Anxiety/Strain, Depression, and Social Function scores were associated with the probability of use; Confidence and Energy factors were not. Once in care a member's rate of use of service was relatively independent of the response pattern to the GHQ at enrollment.

The principal component structure of the General Health Questionnaire among Greek and Turkish adolescents

The 28-item version of the General Health Questionnaire was administered to Greek and Turkish school pupils in their mother country as well as to Greeks in Munich. Principal component analysis with varimax rotation was carried out separately for both the individual populations and sexes separately. Visual inspection of the matrices suggested overall agreement with the sub-scales obtained by Goldberg and Hillier (1979). The coefficient of factor similarity, calculated between matrices, suggested a highly similar principal component structure between the population samples as a whole and separately for the sexes living in their own country, but not between male and female Greek pupils in Germany. Highly similar component matrices were obtained for Greek males living in Greece with those in Germany, but not for females.

The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan

The problems which arise in the use of a psychiatric screening instrument in a language and culture other than that in which it was designed and developed are considered. An account is given of the development of a psychiatric screening questionnaire suitable for use in Chinese community samples. The questionnaire was derived from a Chinese translation of the General Health Questionnaire, with the addition of specially designed, culturally-relevant items. Discriminant function analysis was then used to select a subset of 12 items which discriminated well between 'cases' and 'normals' in the community.

Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a Spanish population

This study confirms the validity of a Spanish version of the General Health Questionnaire in its scaled 28-item version. The screening instrument was tested on a sample of 100 patients attending an internal medicine out-patient clinic, who were examined independently by psychiatrists standardized in the use of the Clinical Interview Schedule (CIS). The questionnaire correctly identified 85% of 'cases' with a cutting score of 6/7 (sensitivity 76.9%, specificity 90.2%), and 83% of cases with a cutting score of 5/6 (sensitivity 84.6%, specificity 82%), suggesting a discriminative power almost as good as the Spanish GHQ-60. It has the important advantage of being considerably shorter and, although the 4 subscales are by no means independent, its concurrent validity with CIS ratings suggests that they provide additional information concerning anxiety and depression.

THE FACTOR STRUCTURE OF THE 60 ITEM GENERAL HEALTH QUESTIONNAIRE

Male school children (N 241), all aged 16 years, and 144 men facing redundancy completed the 60 item version of the General Health Questionnaire. Data from the two groups was analysed separately using unrotated first principal components analysis followed by oblique rotation. The unrotated first principal component accounted for 23% of the variance in the school group, and 13.2% in the group facing redundancy. No subsequent component accounted for more than 6.1% of the variance. For both samples the first five components were subjected to an oblique rotation. Results were discussed in relation to previous findings of the GHQ. The factor structure was found to be unstable across groups. The implications of these findings were considered in the context of proposed subscales of the GHQ.

The Chinese version of the General Health Questionnaire: does language make a difference?

The English and Chinese versions of the General Health Questionnaire (GHQ) were administered to a sample of 72 bilingual respondents for the evaluation of version equivalence by a series of item analyses, reliability analyses and factor analyses. Although certain notable discrepancies were observed at the item level, the two versions were found to be comparable at the scale level. In addition, cogent evidence was provided for the relative robustness of the symptom dimensions as assessed by the two versions of the GHQ.

Propiedades psicométricas del cuestionario general del salud de Goldberd – QHQ-28 – en cuidadores primarios informales de pacientes con cáncer

Objetivo. Determinar las propiedades psicométricas del Cuestionario de Salud General de Goldberg –GHQ-28–, en una muestra de cuidadores primarios mexicanos de pacientes con cáncer. Método. Participaron 276 cuidadores de los cuales 205 fueron mujeres (74.3%) y 71 hombres (25.7%). Los participantes contestaron concurrentemente el GHQ-28 y el Inventario de Depresión de Beck BDI. Resultados. La consistencia interna de la escala global mostró un índice satisfactorio (α= 0,91). Las alfas de Cronbach de las sub-escala tuvieron un valor de α=0,86, a α=0,76 que explican el 53,42% de la varianza. La validez por concurrente con el BDI mostró resultados significativos (r de Pearson de 0,72 a 0,427, p<0,05). Conclusiones. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a presentar afectaciones en la salud en general a lo largo del proceso de cuidado de los pacientes oncológicos.