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General Health Questionnaire

Identify minor psychiatric disorders

Identify

Screen for non-psychotic and minor psychiatric disorders

Inform

Help to inform further intervention

Four versions

Enabling researchers and clinicians to select the version most appropriate to their individual requirements

HADS Quick Reference Guide
  • Suitable for: Psychiatrists
  • Test duration: untimed
  • Test format: Paper

General Health Questionnaire

The General Health Questionnaire (GHQ) is a screening device for identifying minor psychiatric disorders in the general population and within community or non-psychiatric clinical settings such as primary care or general medical out-patients. Suitable for all ages from adolescent upwards – not children, it assesses the respondent’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term psychiatric disorders but not to long-standing attributes of the respondent.

The self-administered questionnaire focuses on two major areas:

  • The inability to carry out normal functions
  • The appearance of new and distressing phenomena.

It is available in the following versions:

  • GHQ-60: the fully detailed 60-item questionnaire
  • GHQ-30: a short form without items relating to physical illness
  • GHQ-28: a 28 item scaled version – assesses somatic symptoms, anxiety and insomnia, social dysfunction and severe depression
  • GHQ-12: a quick, reliable and sensitive short form – ideal for research studies.

Why use the GHQ?

  • The self-administered questionnaire is an ideal screening device for identifying non-psychotic and minor psychiatric disorders to help inform further intervention
  • GHQ is available in four different versions, enabling researchers and clinicians to select the version most appropriate to their individual requirements
  • For researchers intending to set-up their own localised validation studies – the GHQ User’s Guide provides guidance and advise.

FAQs

The GHQ is used to detect psychiatric disorder in the general population and within community or non-psychiatric clinical settings such as primary care or general medical out-patients. It assesses the respondent’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term psychiatric disorders but not to long-standing attributes of the respondent.

 

The GHQ is very widely used by researchers in various fields (occupational health, medicine, psychology) and clinicians who wish to screen individuals for psychiatric disorder.

 

This version of the GHQ is very quick to administer and score as it contains only 12 questions. It has comparable psychometric properties to the longer versions even though it only takes around two minutes to complete. Given its speed of administration, it is often used in research studies where it is impractical to administer a longer form.

The GHQ-12 was prepared by removing the items endorsed by ‘physically ill’ respondents from the GHQ-60. Items were then divided into those in which agreement indicated either health or illness. Within each group, items were selected which had the highest slopes in the original item analysis. For further information on the design of the GHQ-12, please refer to the User’s Guide (1988), p.21. The GHQ-12 yields only an overall total score.

It is often of more interest to be able to examine a profile of scores rather than a single score, making this version of the GHQ particularly useful. It contains 28 items that, through factor analysis, have been divided into four sub-scales. The GHQ-28 is the most well-known and popular version of the GHQ. For further information on the design of the GHQ-28, please refer to the User’s Guide (1988), p.37.

This ‘scaled’ version of the GHQ has been developed on the basis of the results of principal components analysis. The four sub-scales, each containing seven items, are as follows:

  • A – somatic symptoms (items 1-7)
  • B – anxiety/insomnia (items 8-14)
  • C – social dysfunction (items 15-21)
  • D – severe depression (items 22-28)

There are no thresholds for individual sub-scales. Individual sub-scales are used for providing individual diagnostic or profile information. For identifying caseness with GHQ-28, the total of the sub-scales is used.

An important paper on the GHQ-28 is that which reports the WHO study of mental illness in general health care. Goldberg, D.P. et al (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care.
Psychological Medicine, 27, 191-197.

The GHQ-28 has been advocated by Easton & Turner for use in trauma research and is included in the 1998 GL Assessment ‘Measures in Post-traumatic Stress Disorder: A Practitioner’s Guide’ mini-portfolio edited by Stuart Turner and Deborah Lee.

This version contains 30 items and is excellent as a quick screener to help detect caseness. It produces an overall score that can be compared with a prescribed cut-off score.

The GHQ-30 is the most widely validated version and 29 validity studies are outlined in the User’s Guide. It was developed from the GHQ-60 and involved removing all questions related to somatic symptoms. For further information on the design of the GHQ-30, please refer to the User’s Guide (1988), p.21. The fact that this version is so well-validated is a good reason for choosing to use the GHQ-30.

The GHQ-30 yields only an overall total score.

This version contains 60 items and is ideal if it is to be used to identify potential cases for more intensive examination. However, there is undoubtedly some redundancy in the GHQ-60 and this must explain how versions as short as the GHQ-12 still do a good job of discriminating between cases and non-cases. In places where time is strictly limited or respondents have poor reading skills and the questions must be read out to them, there are obvious advantages in using a shorter version of the questionnaire. The GHQ-60 produces an overall score that can be compared with a prescribed cut-off score. For further information on the development and design of the GHQ-60, please refer to: Goldberg, D. (1972) The Detection of Psychiatric Illness by Questionnaire. Maudsley Monograph No. 21, Oxford University Press.

 

The only advantage of using the GHQ-30 over the GHQ-60 is that it can be completed more quickly (3-4 minutes compared with 6-8 minutes). Patients in consultation settings often wait as long as 10 minutes to see their doctor, hence the longer questionnaire seems quite reasonable. If the intention is for GHQ use within a non-consulting setting, then the GHQ-60 is preferable, since the hits-positive rate is much better in settings with low prevalence.

 

We will consider requests for the GHQ to be used in an alternative format (eg: included within a test booklet for research purposes). In such cases a GHQ user guide should be purchased.

You will first need to contact us with details of what you wish to do via: permissions@gl-assessment.co.uk.

Information Required:

  • Brief details of the project, for example, what is the study measuring?
  • How many administrations will you be carrying out? For example, if you will be administering the GHQ-28to 100 people twice, you will be doing 200 administrations.
  • Will you be using the measure as it stands or will you be using the whole scale or some of the items within a larger questionnaire?
  • Are you a student or a clinical practitioner? If you are student please provide details of your supervisor.

This is unfair to the authors and future researchers. The conditions set out for permission to use the GHQ as part of your own research have been put together to protect the use of the questionnaire. Photocopying a record form without abiding by the conditions outlined above is regarded as theft and is a criminal offence. Part of the payment received from permissions is paid as a royalty to the Institute of Psychiatry to fund research.

 

A number of translations are available. However, these have not been validated by GL Assessment. The MAPI Research Trust distributes translated versions on behalf of our Company. You will first need to obtain permission to use the scale through GL Assessment via permissions@gl-assessment.co.uk. Translated versions are available in a range of languages including Czech, Afrikaans and US-Spanish.

Then you will need to contact MAPI, informing them of the translations you require via: PROinformation@mapi-trust.org.

Please see a recent article, and paper, published by the British Psychology Society:
http://www.bps.org.uk/media-centre/press-releases/releases$/division-of-educational-and-child-psychology/children-with-delayed-language-skills$.cfm.

Locke, A, Ginsbourg, J and Peers, I. (2002). Development and Disadvantage: implications for the early years and beyond. International. J. of Language & Communication Disorders, 37(1), 3-15

 

 

that ranges from a 'better/healthier than normal' option, through a 'same as usual' and a 'worse/more than usual' to a 'much worse/more than usual' option. The exact wording will depend upon the particular nature of the item.

There are four possible methods of scoring the questionnaire:

  • GHQ scoring (0-0-1-1). This method is advocated by the test author.
  • Likert scoring (0-1-2-3)
  • Modified Likert scoring (0-0-1-2)
  • C-GHQ scoring (0-0-1-1) for positive items, where agreement indicates health, and 0-1-1-1 for negative items, where agreement indicates illness).

For both GHQ and Likert scoring, the wording of the items mean that they can all be scored in the same direction (no need to reverse score), so the higher the score, the more severe the condition. The Likert scoring method will produce a wider and smoother score distribution if a researcher wishes to assess severity and the C-GHQmethod is more normally distributed than the GHQ scoring method.

The author has stated that ‘… modified Likert is inferior to simple Likert and may therefore be discarded’. C-GHQscoring is a relatively specialised method and is useful only when it is important not to miss cases with long-standing disorders.

GHQ-12/30/60 all yield only an overall total score. The GHQ-28 is a scaled version, yielding four sub-scores, each based on seven items and a total score.

This is not possible. The best advice is to score using the GHQ method and to use threshold scores that have been computed scoring that method. It would be useful to refer to the following reference: Goldberg, D.P. et al

The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 1997, 27, 191-197.

Thresholds are only relevant for screening use of the GHQ, i.e. for identifying ‘caseness’. For this use, the GHQ scoring is advocated by the test author. For GHQ-30 and GHQ-60, the user will need to determine their required threshold value – we have no data on which to base a default threshold for such scoring.

In general, it is best if the user specifies their required threshold value, based on past clinical use or research evidence relevant to their assessment circumstances. The following gives some threshold values that can be entered as default options. These have been derived from information in the original GHQ Manual, the User’s Guide and the following paper: Goldberg, D.P. et al (1997).

The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191-197.

N.B. For people who are physically ill, a higher threshold than the default one will probably be needed for optimal discrimination between cases and non-cases.

Suggested Default Thresholds:
 
GHQ GHQ Scoring Likert
GHQ12 1/2 (max score 12) 11/12 (max score 36)
GHQ28 4/5* (max score 28) 23/24 (max score 84)
GHQ30 4/5 (max score 30) --- (max score 90)
GHQ60 11/12 (max score 60) --- (max score 180)

* advocated in 1978 GHQ Manual; 1997 WHO study (see reference above) had an average threshold, across all centres and languages, of 5/6 and reports a threshold of 6/7 for a Manchester, UK sample. Turner & Lee advocate a cut-off of 12/13 as almost always indicating a positive psychiatric condition in the PTSD context (see Easton, J.A. and Turner, S.W. (1991) Detention of British citizens as hostages in the Gulf – health, psychological, and family consequences. British Medical Journal, 303, 1231-1234).

 

The standard procedure is to count omitted items as low scores. This applies to all four versions of the GHQ.

 

None of the versions of the GHQ are recommended for use with children. However, the User Guide (p63) notes that several researchers appear to have used it successfully with adolescents.