General Health Questionnaire (GHQ-12)

What is the General Health Questionnaire (GHQ-12)?

The General Health Questionnaire (GHQ-12) is a widely used screening tool for assessing mental health and psychological distress in various populations. This guide provides an overview of the GHQ-12, its applications, and its psychometric properties, focusing on its utility in clinical settings and public health initiatives.

The GHQ-12 is a shortened version of the original 60-item General Health Questionnaire developed by Goldberg in 1972. It consists of 12 items designed to detect common mental disorders and psychological distress. The questionnaire uses a four-point scale, with respondents indicating the extent to which they have recently experienced particular symptoms or behaviors.

Psychometric properties of the GHQ-12

Numerous studies have examined the factor structure of the GHQ-12 using various statistical analyses, including exploratory factor analysis, confirmatory factor analysis, and principal component analysis (Andrich & Schoubroeck, 2009). Here, the factor structures supported are the two-factor and three-factor model.

The two-factor model typically distinguishes between psychological distress and social dysfunction. In contrast, the three-factor model often includes anxiety and depression, social dysfunction, and loss of confidence as distinct factors.

The GHQ-12 has also demonstrated good psychometric properties across various populations and cultural contexts. It shows high internal consistency and test-retest reliability both in a Spanish and even a German primary care sample (Gómez-Salgado et al., 2020; Schmitz et al., 1999). Research by World Health Organization on psychological disorders in general healthcare also revealed significant differences in factor variation for the GHQ-12 (Montazeri et al., 2003). These validation studies have also confirmed its effectiveness in detecting mental health problems and its correlation with other established measures of psychological distress.

How to use the General Health Questionnaire (GHQ-12)

Here's a step-by-step guide on how healthcare practitioners can use the General Health Questionnaire:

Step 1: Administer the GHQ-12

Begin by providing the patient with the 12-item questionnaire. Ask them to complete their personal details, including name, gender, date of assessment, and contact information. It's crucial to ensure they understand the different response options for questions 1-6 and 7-12, as the scoring method changes between these two sets.

Step 2: Scoring

Employ the binary scoring method (0-0-1-1) for all questions. Once all questions are scored, sum the values to obtain a total score. This total will range from 0 to 12, quantitatively measuring the patient's psychological state.

Step 3: Interpretation

When interpreting the results, use a cut-off point of 3 for the general population. Consider scores of 3 or higher as indicators of potential psychiatric disorders or morbidity. Remember that higher scores suggest a greater likelihood of health issues (Gómez-Salgado et al., 2020). This interpretation framework allows for a quick assessment of the patient's mental health status, serving as a valuable screening tool in various clinical settings.

Step 4: Follow-up

For patients scoring 3 or above, consider implementing further assessment or intervention strategies. Use these results to guide the development of treatment plans or to determine if referrals to specialized mental health services are necessary. Remember that while the GHQ-12 is an effective mental health screening tool, it is not a diagnostic instrument. It primarily identifies individuals who may benefit from more comprehensive mental health evaluation or support.

When should you use the GHQ-12?

The GHQ-12 is a versatile screening tool with applications across various healthcare settings. Understanding when to use this instrument can significantly enhance patient care and research outcomes.

Primary care settings

The GHQ-12 serves as a quick and effective way to screen for mental health symptoms and psychological distress during routine check-ups or when patients present with vague symptoms that might have a psychological component. The questionnaire can help identify primary care patients who may be experiencing mental health issues but haven't explicitly sought psychological support.

Occupational health

The GHQ-12 proves invaluable in occupational health settings, especially for assessing workplace stress and mental well-being. It's particularly relevant in high-stress professions or during periods of organizational change.

Public health research

In public health research and epidemiological studies, the GHQ-12 allows for quick assessment of mental health status across large populations. This application provides valuable insights into community mental health trends and can inform policy decisions.

Pre-intervention screening

The GHQ-12 can serve as an initial screening tool before implementing specific interventions or treatment plans. It helps identify individuals who might benefit from more comprehensive mental health assessments or targeted interventions, allowing for a more efficient allocation of healthcare resources.

What are the benefits of using the General Health Questionnaire (GHQ-12)?

It's quick and easy to use

Healthcare practitioners may find this a nifty tool mainly because of its straightforward nature. The short questionnaire has general questions that can be answered with one answer among a set of four per item. This makes it quick and easy to administer. It should take at most ten minutes to finish, even if each answer is given great thought.

Early identification

Given that this is typically used during the first or any of the early sessions that professionals have with their patients, this tool can help professionals identify the level of psychological distress that their patients are experiencing early. Knowing how the patient feels at first can open up the discussion about what is causing their emotions. This could lead to identifying the factors that drive their distress. The more information you have, the more you are informed about conducting comprehensive examinations and creating treatment plans.

Monitoring patient and treatment plan

You may use this questionnaire again to see if there have been any significant changes in your patient's overall well-being and psychological distress. Hopefully, they are getting better, but if they are not, perhaps that is a sign that you need to evaluate your treatment plan and identify what is working and what is not.

References

Andrich, D. & Schoubroeck, L.V. (2009). The general health questionnaire: A psychometric analysis using latent trait theory. Psychological Medicine, 19(2):469-485. https://doi.org/10.1017/S0033291700012502

Gómez-Salgado, J., Andrés-Villas, M., Domínguez-Salas, S., Díaz-Milanés, D., & Ruiz-Frutos, C. (2020). Related health factors of psychological distress during the COVID-19 pandemic in Spain. International Journal of Environmental Research and Public Health, 17(11), 3947. https://doi.org/10.3390/ijerph17113947

Montazeri, A., Harirchi, A. M., Shariati, M., Garmaroudi, G., Ebadi, M., & Fateh, A. (2003). The 12-item general health questionnaire (GHQ-12): Translation and validation study of the Iranian version. Health and Quality of Life Outcomes, 1, 66. https://doi.org/10.1186/1477-7525-1-66

Schmitz, N., Kruse, J., & Tress, W. (1999). Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample. Acta Psychiatrica Scandinavica, 100(6), 462–468. https://doi.org/10.1111/j.1600-0447.1999.tb10898.x