A brief history

Since Goldberg [1] introduced the General Health Questionnaire (GHQ), it has been translated into 38 different languages, testament to the validity and reliability of the questionnaire.

Description

Results obtained from assessments of psychological well-being can be useful in understanding various sources of distress for workers, as well as any predisposing factors. It is recommended that results of such assessments not be used in isolation, but rather in combination with other information which is indicative of distress or psychological problems such as sickness absence, poor productivity or increased turnover. Possibly, the most common assessment of mental well-being is the GHQ. Developed as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders, it is a measure of the common mental health problems/domains of depression, anxiety, somatic symptoms and social withdrawal. Available in a variety of versions using 12, 28, 30 or 60 items, the 28-item version is used most widely. This is not only because of time considerations but also because the GHQ28 has been used most widely in other working populations, allowing for more valid comparisons.

Items

Examples of some of the items in use include ‘Have you found everything getting on top of you?’; ‘Have you been getting scared or panicky for no good reason?’ and ‘Have you been getting edgy and bad tempered?’. Each item is accompanied by four possible responses, typically being ‘not at all’, ‘no more than usual’, ‘rather more than usual’ and ‘much more than usual’, scoring from 0 to 3, respectively. The total possible score on the GHQ 28 ranges from 0 to 84 and allows for means and distributions to be calculated, both for the global total, as well as for the four sub-scales. Using the alternative binary scoring method (with the two least symptomatic answers scoring 0 and the two most symptomatic answers scoring 1), the 28- and 30-item versions classify any score exceeding the threshold value of 4 as achieving ‘caseness’. Any score exceeding the threshold value of 4 is classed as achieving ‘psychiatric caseness’. The caseness threshold is 3 for the 12-item version. Psychiatric caseness is a probabilistic term—whereby, if such respondents presented in general practice, they would be likely to receive further attention. It should be noted that the GHQ is not usually used for predictive purposes. If the GHQ score were compared with the results of independent psychiatric assessment, it would be more likely than not (0.51) to state that the individual would be assessed as being a ‘case’ once the threshold is exceeded.

Validity

Reliability coefficients have ranged from 0.78 to 0.95 in various studies.

Key research

The GHQ is simple to administer, easy to complete and score and widely used in many studies of (occupational) well-being [2–4]. The GHQ can be scored in a variety of ways which is useful in providing multiple outcome measures. A further advantage of the GHQ is that it is widely used in occupational research, which allows simple comparisons with results obtained in other studies. In using this tool with postgraduate students conducting research in many areas of occupational health, the GHQ rarely fails to provide reliable and effective measures of well-being that usually correlate very highly with other measures of working environments or organizations.

References

1.
Goldberg
DP
, et al.  . 
Manual of the General Health Questionnaire
 , 
1978
Windsor, England
NFER Publishing
2.
Feyer
AM
Herbison
P
Williamson
AM
, et al.  . 
The role of physical and psychological factors in occupational low back pain: a prospective cohort study
Occup Environ Med
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2000
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116
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120
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3.
Jones
M
Rona
RJ
Hooper
R
Wesseley
S
The burden of psychological symptoms in UK Armed Forces
Occup Med (Lond)
 , 
2006
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56
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322
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328
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4.
Stansfeld
SA
Fuhrer
R
Shipley
MJ
Marmot
MG
Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study
Occup Environ Med
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1999
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56
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302
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307
)