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Detecting psychiatric disorders in medical practice using the General Health Questionnaire. Why do cut-off scores vary?

Published online by Cambridge University Press:  09 July 2009

A. M. Van Hemert ,
M. Den Heijer ,
M. Vorstenbosch  and
J. H. Bolk
A. M. Van Hemert*
Affiliation:
Departments of Psychiatry and Internal Medicine, University Hospital, Leiden; Department of Psychiatry, Dijkzigt University Hospital, Rotterdam, The Netherlands
M. Den Heijer
Affiliation:
Departments of Psychiatry and Internal Medicine, University Hospital, Leiden; Department of Psychiatry, Dijkzigt University Hospital, Rotterdam, The Netherlands
M. Vorstenbosch
Affiliation:
Departments of Psychiatry and Internal Medicine, University Hospital, Leiden; Department of Psychiatry, Dijkzigt University Hospital, Rotterdam, The Netherlands
J. H. Bolk
Affiliation:
Departments of Psychiatry and Internal Medicine, University Hospital, Leiden; Department of Psychiatry, Dijkzigt University Hospital, Rotterdam, The Netherlands
*
1Address for correspondence: Dr Albert M. van Hemert, Department of Psychiatry, Out-patient Clinic, University Hospital Leiden, Building 1, B1-P, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Synopsis

In this study we assessed the accuracy of the General Health Questionnaire in detecting psychiatric disorders in general medical out-patients. A total of 290 newly referred patients were interviewed with the Present State Examination. Prior to the interview, 112 patients completed the full GHQ-60, 100 completed the GHQ-30 and 78 completed the GHQ-12. Data from the first group were used to study the full GHQ-60, together with the GHQ-30 and and GHQ-12, when disembedded from the full questionnaire. In a comparison between the disembedded and the separate versions of the GHQ-30 and GHQ-12 we observed considerable variation in the cut-off scores where a certain sensitivity and specificity was attained. In ROC-analysis, the versions were not materially different in their discriminatory capacity (area under the curve). The use of different criteria to define a ‘case’ demonstrated that case severity was another source of increasing cut-off scores. Our data demonstrate that the use of disembedded or separate versions of the questionnaire, together with variation in the case criteria can be a major explanation for variation in cut-off scores that was observed in previous studies.

Type
Research Article
Information
Psychological Medicine , Volume 25 , Issue 1 , January 1995 , pp. 165 - 170
Copyright
Copyright © Cambridge University Press 1995

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