Psychometric Evaluation of GHQ-12 as a Screening Tool for Psychological Impairment of Healthcare Workers Facing COVID-19 Pandemic

Main Article Content

Anna Comotti
Alice Fattori
Francesca Greselin
Lorenzo Bordini
Paolo Brambilla
Matteo Bonzini

Keywords

General Health Questionnaires (GHQ-12), Occupational stress, Health-care workers, Item response theory

Abstract

Background: The General Health Questionnaire (GHQ) is a widely used tool, both in clinical and research settings, due to its brevity and easy administration. Researchers often adopt a dichotomous measurement method, considering a total score above or below a certain threshold. This leads to an extreme simplification of the gathered data and therefore to the loss of clinical details.


In a multi-step evaluation study aimed at assessing health care workers’ mental health during the Covid-19 pandemic, GHQ-12 proved to be the most effective tool to detect psychological distress compared to other scales adopted. These results led to deepen the understanding of GHQ-12 properties through a statistical study by focusing on items’ properties and characteristics.


Methods: GHQ-12 responses were analyzed using Item Response Theory (IRT), a suitable method for scale assessment. Instead of considering the single overall score, in which each item accounts equally, it focuses on individual items’ characteristics. Moreover, IRT models were applied combined with the latent class (LC) analysis, aiming to the determination of subgroups of individuals according to their level of psychological distress.


Results: GHQ-12 was administered to 990 health-care workers and responses were scored using the binary method (0-0-1-1). We applied the two-parameter logistic (2-PL) model, finding that the items showed different ways of responses and features. The latent class analysis classified subjects into three sub-groups according to their responses to GHQ-12 only: 47% of individuals with general well-being, 38% expressing signs of discomfort without severity and 15% of subjects with a high level of impairment. This result almost reproduces subjects’ classification obtained after administering the six questionnaires of the study protocol.


Conclusions: Accurate statistical techniques and a deep understanding of the latent factors underlying the GHQ-12 resulted in a more effective usage of such psychometric questionnaire – i.e. a more refined gathering of data and a significant time and resource efficiency.


We underlined the need to maximize the extraction of data from questionnaires and the necessity of them being less lengthy and repetitive.

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References

REFERENCES

1. Baldwin JA. The Detection of Psychiatric Illness by Questionnaire. By DP Goldberg. Maudsley Monograph No. 21. Oxford University Press. 1972.
2. Goldberg DP. General Health Questionnaire-12. Aust J Psychol. 1978. Doi: https://doi.org/10.1037/t00297-000
3. Goldberg D. GHQ and psychiatric case. Br J Psychiatry. 1979;134:446-447.
4. Goldberg DP. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol. Med. 1997;27(1):191-197.
5. Andrich D, van Schoubroeck L. The General Health Questionnaire: a psychometric analysis using latent trait theory. Psychol Med. 1989;19(2):469-485. Doi:10.1017/s0033291700012502
6. Graetz B. Multidimensional properties of the General Health Questionnaire. Social Psychiatry and Psychiatric Epidemiology. 1991;26(3):132-138. Doi:10.1007/bf00782952
7. Marton G, Vergani L, Mazzocco K, Garassino MC, Pravettoni G. 2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers Dur-ing Italy Phase 1. Front Psychol. 2020;11:588762. Published 2020 Oct 15. Doi:10.3389/fpsyg.2020.588762
8. Dai Y, Hu G, Xiong H, Qiu H, Yuan X. Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. bioRxiv. Published online 2020. Doi:10.1101/2020.03.03.20030874
9. Shoja E, Aghamohammadi V, Bazyar H, et al. Covid-19 effects on the workload of Iranian healthcare workers. BMC Public Health. 2020;20(1):1636. Published 2020 Nov 2. Doi:10.1186/s12889-020-09743-w
10. Del Piccolo L, Donisi V, Raffaelli R, et al. The Psychological Impact of COVID-19 on Healthcare Pro-viders in Obstetrics: A Cross-Sectional Survey Study. Front Psychol. 2021;12:632999. Published 2021 Apr 9. Doi:10.3389/fpsyg.2021.632999
11. Feng J, Xu J, Xu S, et al. Psychological Impact During the First Outbreak of COVID-19 on Frontline Health Care Workers in Shanghai. Front Public Health. 2021;9:646780. Published 2021 May 17. Doi:10.3389/fpubh.2021.646780
12. Mascayano F, van der Ven E, Moro MF, et al. The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study. Soc Psychiatry Psychiatr Epidemiol. 2022;57:633-645. Doi:10.1007/s00127-021-02211-9
13. Mediavilla R, Fernández-Jiménez E, Martínez-Alés G, et al. Role of access to personal protective equipment, treatment prioritization decisions, and changes in job functions on health workers' mental health outcomes during the initial outbreak of the COVID-19 pandemic. J Affect Disord. 2021;295:405-409. Doi:10.1016/j.jad.2021.08.059
14. Tanaka K, Tahara M, Mashizume Y, Takahashi K. Effects of Lifestyle Changes on the Mental Health of Healthcare Workers with Different Sense of Coherence Levels in the Era of COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(6):2801. Published 2021 Mar 10. Doi:10.3390/ijerph18062801
15. Goldberg DP, Gater R, Sartorius N, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997;27(1):191-197. Doi:10.1017/s0033291796004242
16. Smith AB, Fallowfield LJ, Stark DP, Velikova G, Jenkins V. A Rasch and confirmatory factor analysis of the general health questionnaire (GHQ)-12. Health Qual Life Outcomes. 2010;8:45. Published 2010 Apr 30. Doi:10.1186/1477-7525-8-45
17. Böhnke JR, Croudace TJ. Calibrating well-being, quality of life and common mental disorder items: psychometric epidemiology in public mental health research. Br J Psychiatry. 2016;209(2):162-168. Doi:10.1192/bjp.bp.115.165530
18. Nouri F, Feizi A, Roohafza H, Sadeghi M, Sarrafzadegan N. How different domains of quality of life are associated with latent dimensions of mental health measured by GHQ-12. Health Qual Life Outcomes. 2021;19(1):255. Published 2021 Nov 14. Doi:10.1186/s12955-021-01892-9
19. Stochl J, Böhnke JR, Pickett KE, Croudace TJ. An evaluation of computerized adaptive testing for general psychological distress: combining GHQ-12 and Affectometer-2 in an item bank for public mental health research. BMC Med Res Methodol. 2016;16:58. Published 2016 May 20. Doi:10.1186/s12874-016-0158-7
20. Stochl J, Jones PB, Croudace TJ. Mokken scale analysis of mental health and well-being question-naire item responses: a non-parametric IRT method in empirical research for applied health re-searchers. BMC Med Res Methodol. 2012;12:74. Published 2012 Jun 11. Doi:10.1186/1471-2288-12-74
21. Weiss DS, Marmar CR. Impact of event scale--revised. PsycTESTS Dataset. 1997. Doi:10.1037/t12199-000
22. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety dis-order: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097. Doi:10.1001/archinte.166.10.1092
23. Fattori A, Cantù F, Comotti A, et al. Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (It-aly). BMC Med Res Methodol. 2021;21(1):163. Published 2021 Aug 10. Doi:10.1186/s12874-021-01355-1
24. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. Doi:10.1046/j.1525-1497.2001.016009606.x
25. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis. 1986;174(12):727-735. Doi:10.1097/00005053-198612000-00004
26. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary re-port. Psychopharmacol Bull. 1973;9(1):13-28.
27. Bonzini M, Comotti A, Fattori A, et al. One Year Facing COVID. Systematic Evaluation of Risk Factors Associated With Mental Distress Among Hospital Workers in Italy. Front Psychiatry. 2022;13:834753. Published 2022 Mar 10. Doi:10.3389/fpsyt.2022.834753
28. Lazarsfeld PF. Latent Structure Analysis. Boston: Houghton Mifflin Company; 1968.
29. Goodman LA. Exploratory latent structure analysis using both identifiable and unidentifiable mod-els. Biometrika. 1974;61(2):215-231. Doi:10.1093/biomet/61.2.215
30. Bartolucci F. A class of multidimensional IRT models for testing unidimensionality and clustering items. Psychometrika. 2007;72(2):141-157. Doi:10.1007/s11336-005-1376-9
31. Bartolucci F, Bacci S, Gnaldi M. Statistical Analysis of Questionnaires: A Unified Approach Based on R and Stata. Chapman & Hall Book/CRC; 2015.
32. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Doi:10.1016/j.jbi.2019.103208
33. R Core Team. A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria (2020). Available online at: https://www.R-project.org/
34. Prenovost KM, Fihn SD, Maciejewski ML, Nelson K, Vijan S, Rosland AM. Using item response theo-ry with health system data to identify latent groups of patients with multiple health condi-tions. PLoS One. 2018;13(11):e0206915. Published 2018 Nov 26. Doi:10.1371/journal.pone.0206915
35. Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5(9):e475-e483. Doi:10.1016/S2468-2667(20)30164-X