Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study
Sammanfattning
Background: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a
proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably
between studies. The agreement between the GHQ-12 score and having a clinical disorder in
the study population is usually unknown.
Aims: This study aimed to assess the criterion validity and to determine the sensitivity and specificity
of the GHQ-12 in the Swedish population.
Methods: This study used 556 patient cases surveyed in specialized psychiatric care outpatient ageand
sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring
methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area
Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric
care and (2) current depression, anxiety or adjustment disorder.
Results: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals
using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index
AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index
AUC= 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was 4 (sensitivity = 81.7
and specificity = 85.4), and for the Likert index 14 (sensitivity = 85.5 and specificity = 83.2).
Conclusions: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure
of affective disorders in public mental health surveys.