Factors associated with being a false positive on the General Health Questionnaire

Truda Bell, Margaret Watson, Deborah Sharp, Ita Lyons, Glyn Lewis

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80%. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments.

METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire.

RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 %) (95% CI 27%-32%) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95% CI 1.4-5.3], owner-occupiers (OR 1.6, 95% CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 % CI 1.4-3.5).

CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.
Original languageEnglish
Pages (from-to)402-407
Number of pages6
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume40
Issue number5
DOIs
Publication statusPublished - May 2005

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questionnaire
Health
health
Odds Ratio
mental disorder
Mental Disorders
Surveys and Questionnaires
trend
Demography
demographic factors
Social Support
General Practice
social support
Primary Health Care
Appointments and Schedules
Anxiety
Economics
Interviews
Depression
anxiety

Keywords

  • adolescent
  • adult
  • anxiety disorders
  • bias (epidemiology)
  • decision support systems, Ccinical
  • depressive disorder
  • diagnosis, computer-assisted
  • false positive reactions
  • family practice
  • female
  • great britain
  • humans
  • male
  • middle aged
  • personality inventory
  • psychometrics
  • reproducibility of results
  • risk factors
  • socioeconomic factors

Cite this

Bell, Truda ; Watson, Margaret ; Sharp, Deborah ; Lyons, Ita ; Lewis, Glyn. / Factors associated with being a false positive on the General Health Questionnaire. In: Social Psychiatry and Psychiatric Epidemiology. 2005 ; Vol. 40, No. 5. pp. 402-407.
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title = "Factors associated with being a false positive on the General Health Questionnaire",
abstract = "BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80{\%}. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments.METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire.RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 {\%}) (95{\%} CI 27{\%}-32{\%}) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95{\%} CI 1.4-5.3], owner-occupiers (OR 1.6, 95{\%} CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 {\%} CI 1.4-3.5).CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.",
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Factors associated with being a false positive on the General Health Questionnaire. / Bell, Truda; Watson, Margaret; Sharp, Deborah; Lyons, Ita; Lewis, Glyn.

In: Social Psychiatry and Psychiatric Epidemiology, Vol. 40, No. 5, 05.2005, p. 402-407.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with being a false positive on the General Health Questionnaire

AU - Bell, Truda

AU - Watson, Margaret

AU - Sharp, Deborah

AU - Lyons, Ita

AU - Lewis, Glyn

PY - 2005/5

Y1 - 2005/5

N2 - BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80%. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments.METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire.RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 %) (95% CI 27%-32%) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95% CI 1.4-5.3], owner-occupiers (OR 1.6, 95% CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 % CI 1.4-3.5).CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.

AB - BACKGROUND: The General Health Questionnaire (GHQ) has been used extensively in community and primary care research as an alternative to longer, time-consuming and more expensive assessments of the common mental disorders of depression and anxiety. The sensitivity and specificity of the GHQ compared with longer more detailed assessments is between 70 and 80%. Though satisfactory, this raises the concern about the possibility of bias in relation to longer assessments. We studied socio-demographic factors that were associated with being a false positive on the GHQ in order to investigate any ascertainment bias in relation to more detailed assessments.METHOD: A total of 7,357 consecutive patients aged 16 and over, in five general practices in Cardiff, Bristol and Pontypridd, were invited to complete the 12-item GHQ. Of these, 1,154 patients scored 3 or more, our case definition on the GHQ, and completed a computerised version of the Revised Clinical Interview Schedule (CIS-R) together with a short socio-demographic questionnaire.RESULTS: Of the 1,154 subjects who were cases on the GHQ, 344 (30 %) (95% CI 27%-32%) were false positive and were not cases on the CIS-R. After adjustment for the other variables, including GHQ score, false positive subjects were more likely to be employed [odds ratio (OR) 2.7, 95% CI 1.4-5.3], owner-occupiers (OR 1.6, 95% CI 1.0-2.4) and to have a close friend or relative to talk to about personal problems (OR 2.2, 95 % CI 1.4-3.5).CONCLUSION: Our results suggest that in this study there was an ascertainment bias on the GHQ in relation to the CIS-R. Studies that use the GHQ to study the relationship between socio-economic status and common mental disorder could lead to biased estimates of association compared to studies that use the CIS-R. It is likely that the GHQ will lead to a higher estimate of prevalence than the CIS-R in subjects who are better off financially and who have better social support.

KW - adolescent

KW - adult

KW - anxiety disorders

KW - bias (epidemiology)

KW - decision support systems, Ccinical

KW - depressive disorder

KW - diagnosis, computer-assisted

KW - false positive reactions

KW - family practice

KW - female

KW - great britain

KW - humans

KW - male

KW - middle aged

KW - personality inventory

KW - psychometrics

KW - reproducibility of results

KW - risk factors

KW - socioeconomic factors

U2 - 10.1007/s00127-005-0881-6

DO - 10.1007/s00127-005-0881-6

M3 - Article

VL - 40

SP - 402

EP - 407

JO - Social Psychiatry and Psychiatric Epidemiology

JF - Social Psychiatry and Psychiatric Epidemiology

SN - 0933-7954

IS - 5

ER -