Occupational Medicine 2007 57(1):79; doi:10.1093/occmed/kql169
© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The General Health Questionnaire
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A brief history
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Since Goldberg [
1] introduced the General Health Questionnaire
(GHQ), it has been translated into 38 different languages, testament
to the validity and reliability of the questionnaire.
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Description
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Results obtained from assessments of psychological well-being
can be useful in understanding various sources of distress for
workers, as well as any predisposing factors. It is recommended
that results of such assessments not be used in isolation, but
rather in combination with other information which is indicative
of distress or psychological problems such as sickness absence,
poor productivity or increased turnover. Possibly, the most
common assessment of mental well-being is the GHQ. Developed
as a screening tool to detect those likely to have or be at
risk of developing psychiatric disorders, it is a measure of
the common mental health problems/domains of depression, anxiety,
somatic symptoms and social withdrawal. Available in a variety
of versions using 12, 28, 30 or 60 items, the 28-item version
is used most widely. This is not only because of time considerations
but also because the GHQ28 has been used most widely in other
working populations, allowing for more valid comparisons.
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Items
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Examples of some of the items in use include ‘Have you
found everything getting on top of you?’; ‘Have
you been getting scared or panicky for no good reason?’
and ‘Have you been getting edgy and bad tempered?’.
Each item is accompanied by four possible responses, typically
being ‘not at all’, ‘no more than usual’,
‘rather more than usual’ and ‘much more than
usual’, scoring from 0 to 3, respectively. The total possible
score on the GHQ 28 ranges from 0 to 84 and allows for means
and distributions to be calculated, both for the global total,
as well as for the four sub-scales. Using the alternative binary
scoring method (with the two least symptomatic answers scoring
0 and the two most symptomatic answers scoring 1), the 28- and
30-item versions classify any score exceeding the threshold
value of 4 as achieving ‘caseness’. Any score exceeding
the threshold value of 4 is classed as achieving ‘psychiatric
caseness’. The caseness threshold is 3 for the 12-item
version. Psychiatric caseness is a probabilistic term—whereby,
if such respondents presented in general practice, they would
be likely to receive further attention. It should be noted that
the GHQ is not usually used for predictive purposes. If the
GHQ score were compared with the results of independent psychiatric
assessment, it would be more likely than not (0.51) to state
that the individual would be assessed as being a ‘case’
once the threshold is exceeded.
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Validity
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Reliability coefficients have ranged from 0.78 to 0.95 in various
studies.
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Key research
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The GHQ is simple to administer, easy to complete and score
and widely used in many studies of (occupational) well-being
[
2–
4]. The GHQ can be scored in a variety of ways which
is useful in providing multiple outcome measures. A further
advantage of the GHQ is that it is widely used in occupational
research, which allows simple comparisons with results obtained
in other studies. In using this tool with postgraduate students
conducting research in many areas of occupational health, the
GHQ rarely fails to provide reliable and effective measures
of well-being that usually correlate very highly with other
measures of working environments or organizations.
Craig Jackson
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References
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- Goldberg DP, et al. (1978) Manual of the General Health Questionnaire(NFER Publishing, Windsor, England).
- Feyer AM, Herbison P, Williamson AM, et al. (2000) The role of physical and psychological factors in occupational low back pain: a prospective cohort study. Occup Environ Med 57:116–120.[Abstract/Free Full Text]
- Jones M, Rona RJ, Hooper R, Wesseley S. (2006) The burden of psychological symptoms in UK Armed Forces. Occup Med (Lond) 56:322–328.
- Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG. (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med 56:302–307.[Abstract/Free Full Text]
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A brief history
Description