A Brief Mental Health Outcome Scale - Reliability and Validity of the Global Assessment of Functioning (GAF)

Institute of Psychiatry, London.
The British Journal of Psychiatry (Impact Factor: 7.99). 06/1995; 166(5):654-9. DOI: 10.1192/bjp.166.5.654
Source: PubMed


The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations.
Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period.
Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating.
GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.

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    • "Presence and severity of affective symptoms were rated using the Montgomery– Asberg Depression Rating Scale (MADRS) (Montgomery and Asberg , 1979) and the Young Mania Rating Scale (YMRS) (Young et al., 1978). The Clinical Global Impressions Scale for Bipolar Disorders (CGI-BP) (Spearing et al., 1997), the Global Assessment of Functioning Scale (GAF) (Jones et al., 1995) and the National Institute of Mental Health's prospective Life Chart Method (NIMH life-chart) (Robins et al., 1981) were used to cover course and severity of illness. For health-related quality of life the Medical Outcome Studies (MOS) short-Form General health Survey (SF-12) (Stewart et al., 1988) and the WHO-Five Well-being Index (WHO- 5) (Bech et al., 1996) were used. "
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    • "Three FESZ patients had additional diagnoses as follows: posttraumatic stress disorder (1); major depressive disorder (1); and specific phobia (1). All participants were evaluated with the Global Assessment of Functioning scale (GAF) (Jones et al., 1995). Handedness was assessed using the Annett Handedness Questionnaire (Annett, 1970). "
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    • "The Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1989) and the Calgary Depression Scale for Schizophrenia (CDSS; Addington et al., 1993) were, in addition to the PANSS, applied to assess negative and depressive symptoms. Social and global functioning were rated using the scale for the General Assessment of Functioning (GAF; Jones et al., 1995) and the Personal and Social Performance Scale (PSP; Patrick et al., 2009). "
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