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

  • A. M. Van Hemert (a1), M. Den Heijer (a1), M. Vorstenbosch (a1) and J. H. Bolk (a1)


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.


Corresponding author

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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