A scaled version of the General Health Questionnaire
TL;DR: In this article, a shorter, 28-item General Health Questionnaire (GHQ) consisting of four subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression was proposed.
Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
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TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
35,518 citations
TL;DR: A 36-item short-form survey designed for use in clinical practice and research, health policy evaluations, and general population surveys to survey health status in the Medical Outcomes Study is constructed.
Abstract: A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
33,857 citations
TL;DR: The Multidimensional Scale of Perceived Social Support (MSPSS) as discussed by the authors is a self-report measure of subjectively assessed social support, which has good internal and test-retest reliability as well as moderate construct validity.
Abstract: The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
8,983 citations
Dresden University of Technology1, Centre for Addiction and Mental Health2, Karlstad University3, Stockholm School of Economics4, University of Copenhagen5, Karolinska Institutet6, University of Florence7, University of Basel8, University of Zurich9, Maastricht University10, University of Lausanne11, European Monitoring Centre for Drugs and Drug Addiction12, Aarhus University Hospital13
TL;DR: The true size and burden of disorders of the brain in the EU was significantly underestimated in the past, and Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research and policy decisions.
3,079 citations
TL;DR: In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy, and Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects.
Abstract: Background Randomized trials of surgery for epilepsy have not been conducted, because of the difficulties involved in designing and implementing feasible studies. The lack of data supporting the therapeutic usefulness of surgery precludes making strong recommendations for patients with epilepsy. We conducted a randomized, controlled trial to assess the efficacy and safety of surgery for temporal-lobe epilepsy. Methods Eighty patients with temporal-lobe epilepsy were randomly assigned to surgery (40 patients) or treatment with antiepileptic drugs for one year (40 patients). Optimal medical therapy and primary outcomes were assessed by epileptologists who were unaware of the patients' treatment assignments. The primary outcome was freedom from seizures that impair awareness of self and surroundings. Secondary outcomes were the frequency and severity of seizures, the quality of life, disability, and death. Results At one year, the cumulative proportion of patients who were free of seizures impairing awarenes...
2,923 citations
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TL;DR: It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.
Abstract: A self-administered questionary (the General Health Questionnaire) aimed at detecting current psychiatric disturbance was given to 553 consecutive attenders to a general practitioner9s surgery. A sample of 200 of these patients was given an independent assessment of their mental state by a psychiatrist using a standardized psychiatric interview. Over 90% of the patients were correctly classified as “well” or “ill” by the questionary, and the correlation between questionary score and the clinical assessment of severity of disturbance was found to be +0·80. The “conspicuous psychiatric morbidity” of a suburban general practice assessed by a general practitioner who was himself a psychiatrist and validated against independent psychiatric assessment was found to be 20%. “Hidden psychiatric morbidity” was found to account for one-third of all disturbed patients. These patients were similar to patients with “conspicuous illnesses” in terms both of degree of disturbance and the course of their illnesses at six-month follow-up, but were distinguished by their attitude to their illness and by usually presenting a physical symptom to the general practitioner. When 87 patients who had been assessed as psychiatric cases at the index consultation were called back for follow-up six months later, two-thirds of them were functioning in the normal range. Frequency of attendance at the surgery in the six months following index consultation was found to have only a modest relationship to severity of psychiatric disturbance. It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.
1,002 citations
TL;DR: A standardized psychiatric interview has been constructed to meet the following requirements: Psychiatric assessment should be made by an experienced psychiatrist in a realistic ciinical setting and the interview should be acceptable to indi viduals who may not see themselves as psychiatrically disturbed.
Abstract: Surveys of psychiatric illness in the community are at present handicapped by the lack of valid and reliable methods of case-identification. The widely varying estimates of psychiatric prevalence made by different workers in this field (Lin and Standley, 1962) emphasize the urgent need for such tech niques, which could be used both in field surveys and in the screening of general practice populations. In large-scale psychiatric surveys, the use of a two-stage screening procedure is desirable and may, indeed, be essential for economic reasons. The first stage entails the selection of possible or 'potential' cases by means of a rapid and simply administered screening test; the second comprises detailed clinical examination of such potential cases in order that they may be confirmed as actual cases (Blum, 1962) and given an accurate diagnostic assessment. The present paper is concerned only with the second of these stages, namely, the development of a standard ized psychiatric interview and rating technique suitable for application to potential cases in a com munity setting. A number of standardized psychiatric interviews, including some which are highly reliable, have been developed in recent years, but for various reasons all are unsuitable for field surveys. In the United States, Lorr, Klett, and McNair (1963) have de scribed an assessment based on the Inpatient Multi dimensional Psychiatric Scale (IMPS), and Overall and Gorham (1962) have used a psychiatric assess ment derived from a shortened version of the Lorr scale; both these scales heavily emphasize psychotic phenomena which are relatively uncommon in the general population. The interview described by Spitzer, Fleiss, Burdock, and Hardesty (1964), although in some ways more suitable, is still in sufficiently flexible and contains many items which would make it unacceptable to normal individuals. In this country, Wing, Birley, Cooper, Graham, and Isaacs (1967) and Kendell, Everitt, Cooper, Sar torius, and David (1968) have published accounts of the 'Present State Examination' which has been designed primarily for use in international studies. This very comprehensive 500-item schedule was designed for administration to known psychiatric patients and again does not readily lend itself in its present form for use in community surveys. With these considerations in mind, a standardized psychiatric interview has been constructed to meet the following requirements: (1) Psychiatric assessment should be made by an experienced psychiatrist in a realistic ciinical setting; (2) The interview should be acceptable to indi viduals who may not see themselves as psychiatrically disturbed; (3) The content of the interview should be appro priate to the types of psychiatric disturbance com monly encountered in the community; (4) The interview should generate information about individual symptoms and signs of illness as well as an overall diagnostic assessment;
868 citations
TL;DR: A comparison is made between the General Health Questionnaire (GHQ) and the Symptom Checklist (SCL) as psychiatric screening tests in community-based research projects, which revealed high correlations between the symptoms of anxiety and depression.
Abstract: A comparison is made between the General Health Questionnaire (GHQ) and the Symptom Checklist (SCL) as psychiatric screening tests in community-based research projects. Both are shown to correlate equally well with independent clinical assessment, and the differences between them mainly reside in the form of their response scales. The GHQ works best as a screening test, since it has fewer false positives associated with its use, but it may miss those with long-standing disorders. The SCL tends not to miss long-standing disorders and furnishes diagnostic sub-scales if these are required. Both tests function better with men than with women and with whites than with blacks, but neither is affected by social class or age of the respondent. The study revealed high correlations between the symptoms of anxiety and depression, and indicated some possible differences between the symptom clusters seen in whites and in blacks.
417 citations
TL;DR: The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality, and there are wide variations in morbidity between practices.
Abstract: This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: 'conspicuous morbidity' by the doctor's own assessments, and 'probable prevalence' by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was + 0.36, but the range was very wide (0.09-0.60). The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death. The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67% of the variance of correlation coefficient mainly in terms of 2 dimensions: 'interest and concern' and 'conservatism'. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.
412 citations