General Health Questionnaire (GHQ-28)

## **What does it mean to be psychologically distressed?** When one is psychologically distressed, it means that a person is overwhelmed by their negative emotions and feelings to the point that their daily lives, and possibly their relationships, have been affected. It's possible for a person to be psychologically distressed due to not coping healthily with everyday stressors, such as dealing with work, having problems with family, and having health issues (Cardiac College, n.d.). Psychological distress is also considered the umbrella term for a wide variety of psychological/psychiatric disorders, post-traumatic stress disorder, severe depression, anxiety, chronic mental health conditions, somatic symptoms, post-stroke depressive disorders, social dysfunction, and other psychiatric illnesses. Studies in psychological medicine, psychiatric epidemiology, social psychiatry, psychiatric morbidity, and similar fields have discovered the link between psychological distress and adverse physical health outcomes, including cardiometabolic diseases, accelerated aging, cognitive decline, and even mortality (ScienceDirect, n.d.). Those who have psychological distress will likely have the following signs and symptoms: being moody, feeling fatigued, feeling anxious, having isolationist tendencies, or feeling unusually uncomfortable in social situations, feeling fearful about things, and being prone to anger, just to mention a few. If you specialize in mental health and often deal with patients or clients experiencing psychological distress, there are several tools you can use to assess the severity of their distress. One such tool is the General Health Questionnaire (GHQ-28).

## **What is the General Health Questionnaire (GHQ-28)?** The General Health Questionnaire (GHQ-28) is a valuable mental health instrument created by British psychologist David Goldberg. This particular tool was designed to be a screening tool for patients consulting with professionals about their mental health. This tool specifically assesses a patient's overall well-being, detecting psychiatric morbidity, the inability to carry out normal functions, new and distressing phenomena, and the level of psychological distress they are experiencing, and screens them to see how at risk they are of developing psychiatric disorders. The General Health Questionnaire (GHQ-28) is often used by psychologists, psychiatrists, counselors, primary care physicians, and other mental healthcare professionals. It is often used early as part of a comprehensive examination, and it can be used as a monitoring tool. ### **What to expect from this measure** This questionnaire is a scaled version of the General Health Questionnaire (GHQ-60). The GHQ-60 version has sixty items while the GHQ-28 has twenty-eight. The questions for both versions focus on a patient's recent experiences and feelings that may be the result of mental health problems like the loss of confidence and self-worth, depression, anxiety, and stress. The GHQ-28 also asks about physical issues that may be the result of their psychological distress, like feeling headaches and hot or cold spells. All of this will serve to assess if the patient or client's current state differs from his or her usual state. The GHQ-28 is not able to pinpoint the specific factors that contribute to a patient's psychological distress. Rather, the patient's answers on the test should serve as points for discussion in later sessions. Having them expand on their answers should help you identify what is causing and/or contributing to their distress, as well as other mental health-related issues they might have. The GHQ-28, just like the GHQ-12, is not a diagnostic tool, so do not use it to diagnose patients with specific mental illnesses. Once you (or a specialist) have officially diagnosed a patient after conducting comprehensive examinations, you may use this questionnaire to monitor them down the line to check for any changes in their condition. ### **Is it reliable?** The GHQ-28 is considered to be reliable and is widely used globally. The tool has been translated into numerous languages (Sterling, 2011). It even has cross-cultural applicability (Kilic et al., 1997). The GHQ-28 is available in 38 languages (Sterling, 2011) and has cross-cultural applicability (Kilic et al., 1997). Factor analysis of this tool has determined that the tool can examine four specific factor structures: somatic symptoms for Items 1 to 7, anxiety and insomnia for Items 8 to 14, social dysfunction for Items 15 to 21, and severe depression for Items 22 to 28. Despite this, these subscores should not be used to diagnose specific mental health issues, all the more so if this tool is used in non-psychiatric clinical settings. It's only meant to check for the presence of symptoms (McDermott, 2015). When it comes to stroke patients, Robinson and Price (1982) have found that the GHQ-28 has great 2-month test-retest reliability. Please note that this tool is simply a screening tool, not a diagnostic one. Given this, nothing is known about the tool's responsiveness in terms of minimal detectable change (MDC) and minimally clinically important difference (MCID) (Sterling, 2011).

## **How to use the General Health Questionnaire (GHQ-28)** Here are some steps you can follow to make the most out of this resource: ### **Step 1: Obtain a copy of the questionnaire measure** If you want to add this tool to your roster of tools, just click "Use Template" or "Download" to obtain a copy of our PDF file. You can print it out or use it digitally since it has interactive segments. ### **Step 2: Administer the questionnaire to your patient** Administering this questionnaire is easy, and you can choose between two ways to do so! The simplest way is to hand the patient a copy of an unanswered questionnaire and have them answer it. You can do this during an actual appointment or as something for them to take home/do on their own time. Or, you can conduct it like an interview, where you can ask them these questions and provide them with the set answers they can give per question. Whichever you choose as your preferred way to administer it, all the patient has to do is answer each item by selecting one out of four possible answers. They simply need to select based on how the answer applies to them in the context of what is being asked. The answer sets are usually the following: - Not at all - No more than usual - Rather more than usual - Much more than usual Some questions are framed positively, so the answer sets for those are the inverse of what is listed above. ### **Step 3: Calculate the scores** The traditional scoring method for this is the Likert scale of 0 to 3, meaning each question can score between 0 to 3. The answer sets for each question are arranged by severity from left to right, with the leftmost answer (the first choice) being equivalent to 0 and the rightmost answer (the last choice) being equivalent to 3 points. Given that there are twenty-eight questions and the highest possible score per question is 3, the maximum score for this questionnaire is 84. Unlike other assessments that are used to gauge patients, there are no specific score ranges to refer to. What you need to keep in mind is that the higher the patient's score is, the more likely they are to be experiencing psychological distress at a level that is concerning. Even if there is no score range to refer to, you have their specific answers to look at. If their answers score a 2 or 3, and they answered a lot of questions that got those same scores, well, they definitely need to undergo a more comprehensive examination. You may even use their answers as points of discussion so they can elaborate on what they feel during subsequent sessions. If they are able to expand on their answers, you will be able to get a better picture of them, which should help you make more informed decisions as you go about treatment. ### **Step 4: What to do after using the GHQ-28** Remember, the GHQ-28 and its other variants are not diagnostic tools. They're just meant to be used as screening tools. After assessing the results of this test, we recommend conducting a more comprehensive examination of your patients to narrow down their specific mental health problems and determine the root cause. Diagnosing whichever psychiatric problem will require consistent results from various tests, information from interviews concerning the patient, and cross-checking everything with the current edition of the DSM, at least for the psychiatric problems. Down the line, you can use this as a monitoring tool to check if there are any changes to the patient's psychological stress severity.

## **References** Cardiac College. (n.d.). Psychological distress. Health e-University. https://www.healtheuniversity.ca/EN/CardiacCollege/Wellbeing/Stress_And_Sense_Of_Control/Pages/psychological-distress.aspx Kilic, C., Rezaki, M., Rezaki, B., Kaplan, I., zgen, G., Sagduyu, A., & zturk, M. O. (1997). General Health Questionnaire (GHQ12 & GHQ28): Psychometric properties and factor structure of the scales in a Turkish primary care sample. Social Psychiatry and Psychiatric Epidemiology, 32(6), 327–331. https://doi.org/10.1007/bf00805437 McDermott, A. (2015, January 18). General Health Questionnaire – 28 (GHQ-28). Stroke Engine. https://strokengine.ca/en/assessments/general-health-questionnaire-28-ghq-28/ Robinson, R. G., & Price, T. R. (1982). Post-stroke depressive disorders: a follow-up study of 103 patients. Stroke, 13(5), 635–641. https://doi.org/10.1161/01.str.13.5.635 ScienceDirect. (n.d.). Psychological distress. Www.sciencedirect.com. https://www.sciencedirect.com/topics/psychology/psychological-distress Sterling, M. (2011). General Health Questionnaire – 28 (GHQ-28). Journal of Physiotherapy, 57(4), 259. https://doi.org/10.1016/s1836-9553(11)70060-1