Skip to main content Accessibility help

A hierarchy of distress: Mokken scaling of the GHQ-30

  • R. Watson (a1), I. J. Deary (a2) and B. Shipley (a2)



Hierarchical cumulative scales are common and informative in psychology. The General Health Questionnaire (GHQ) does not appear to have been subjected to an analysis that examines the hierarchical and cumulative nature of its items. We report an analysis of data from the 30-item GHQ (GHQ-30) as part of the Health and Lifestyle Survey (HALS).


Data from 6317 participants who completed the GHQ-30 as part of the HALS were analysed using the Mokken Scaling Procedure (MSP), which is a computer program that searches polychotomous data for hierarchical and cumulative scales on the basis of a range of diagnostic criteria.


A final scale consisting of nine items from the GHQ-30 was obtained that, according to the criteria for a Mokken scale, was a reliable and very strong scale. The least difficult item in the scale is ‘been (un)able to face up to your problems?’ and the most difficult item is ‘felt that life isn't worth living?'


Items from the GHQ-30 form a short hierarchical and cumulative scale. The majority of these items also appear in the GHQ-12. The nine-item GHQ shows better distribution properties than the GHQ-30 and compares very favourably with the GHQ-12.


Corresponding author

*Address for correspondence: Dr R. Watson, School of Nursing and Midwifery, The University of Sheffield, Sheffield S10 2TN, UK. (Email:


Hide All
Barkow, K, Heun, R, Üstün, TB, Maier, W (2001). Identification of items which predict later development of depression in primary care. European Archives of Psychiatry and Clinical Neuroscience 251 (Suppl. 2), II21II26.
Cox, BD, Blaxter, M, Buckle, ALJ, Fenner, NP, Golding, JF, Gore, M, Huppert, FA, Nickson, J, Roth, M, Stark, J, Wadsworth, MEJ, Whichelow, M (1987). The Health and Lifestyle Survey: A Preliminary Report. Health Promotion Trust: London.
Goldberg, DP, Hillier, VF (1979). A scaled version of the General Health Questionnaire. Psychological Medicine 9, 139145.
Hosenfeld, B, van den Boom, DC, Resing, WCM (1997). Constructing geometric analogies for the longitudinal testing of elementary school children. Journal of Educational Measurement 34, 367372.
Kempen, GIJM, Suurmeijer, ThPBM (1991). Factors influencing professional home care utilization among the elderly. Social Science and Medicine 32, 7781.
Kingsott, R, Douglas, N, Deary, I (1998). Mokken scaling of the Epworth Sleepiness Scale items in patients with sleep apnoea/hypopnoea syndrome. Journal of Sleep Research 7, 293294.
Mergl, R, Seidscheck, I, Allgaier, A-K, Möller, H-J, Hegerl, U, Henkel, V (2007). Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Depression and Anxiety 24, 185195.
Mokken, RJ, Lewis, C (1982). A nonparametric approach to the analysis of dichotomous item responses. Applied Psychological Measurement 6, 417430.
Molenaar, IW, Sijtsma, K (2000). MSP5 for Windows. Groningen: iec ProGAMMA.
Moorer, P, Suurmeijer, TPBM (1994). A study of the unidimensionality and cumulativeness of the MOS Short-Form General Health Survey. Psychological Reports 74, 467470.
Moorer, P, Suurmeijer, ThPBM, Foets, M, Molenaar, IW (2001). Psychometric properties of the RAND-36 among three chronic diseases (multiple sclerosis, rheumatic diseases and COPD) in the Netherlands. Quality of Life Research 10, 637645.
Niemöller, K, van Schuur, W (1983). Stochastic models for unidimensional scaling: Mokken and Rasch. In Data Analysis and the Social Sciences (ed. McKay, D., Schofield, N. and Whiteley, P.), pp. 120170. Francis Pinter: London.
Ringdall, GI, Jordhøy, MS, Kaasa, S (2003). Measuring quality of palliative care: psychometric properties of the FAMCARE Scale. Quality of Life Research 12, 167176.
Sijtsma, K, Debets, P, Molenaar, IW (1990). Mokken scale analysis for polychotomous items: theory, a computer program and an empirical application. Quality and Quantity 24, 173188.
Sijtsma, K, Junker, BW (1996). A survey of theory and methods of invariant item ordering. British Journal of Mathematical Statistics and Psychology 49, 79105.
Stouffer, SA, Guttman, L, Suchman, EA, Lazarsfeld, PF, Star, SA, Clausen, JA (1950). Measurement and Prediction, vol. 4. Princeton University Press: Princeton, NJ.
Watson, R (1996). The Mokken scaling procedure (MSP) applied to the measurement of feeding difficulty in elderly people with dementia. International Journal of Nursing Studies 33, 385393.
Watson, R, Deary, IJ, Austin, E (2007). Are personality trait items reliably more or less ‘difficult’? Mokken scaling of the NEO-FFI. Personality and Individual Differences 43, 14601469.


A hierarchy of distress: Mokken scaling of the GHQ-30

  • R. Watson (a1), I. J. Deary (a2) and B. Shipley (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed