Is the 12-item General Health Questionnaire (GHQ-12) confounded by scoring method in individuals with facial disfigurement?

Abstract

The GHQ-12 has been recommended as a reliable screening instrument for psychological distress in all clinical groups. The usefulness of the GHQ-12 was evaluated in individuals with significant facial disfigurement by examination of the impact of alternative scoring methods on case detection rates. The type of scoring method used had a significant impact on the relative prevalence of ‘cases’. However, examination of the receiver operating characteristics (ROC) of the alternative scoring methods revealed a good fit between methods. The use of the GHQ-12 as a screening instrument to determine psychological distress in individuals with facial disfigurement may be enhanced by inclusion of an appearance-specific measure in the screening schedule and by the adoption of one scoring method; the GHQ method.

Keywords:

• Facial disfigurement
• screening
• GHQ-12

Acknowledgments

We would like to thank all those individuals who participated in the study. We would also like to thank two anonymous referees for their extremely lucid and helpful comments on an earlier version of the manuscript.

Notes

Cut-point is standard convention in GHQ-12 scoring irrespective of scoring method. In this example scores up to and including 2 denote a non-case. Scores of 3 and greater denote a ‘case’.

Internal consistency is an estimate of how consistently individuals respond to the items within a scale. Values close to 1.00 are desirable in measures used clinically and non-clinically.

Reference test refers to the use of the scoring method as the ‘true’ index score.

Gold standard is generally referred to the comparison of a measure with a ‘true’ or ‘best’ judgement such as diagnostic investigation or clinical interview.