Validity of DSM-IV Axis V Global Assessment of Relational Functioning Scale

Massachusetts General Hospital and Harvard Medical School, Psychology Assessment Center, 1 Bowdoin Square, 7th Floor, Boston, Massachusetts 02114-2919, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 01/2009; 197(1):50-5. DOI: 10.1097/NMD.0b013e3181923ca1
Source: PubMed


We investigate the convergent validity of the DSM-IV Axis V Global Assessment of Relational Functioning Scale (GARF; American Psychiatric Association, 1994). This study included 79 patients at a university-based outpatient treatment clinic. We examined clinician-rated GARF and the relationship to self-reported (Inventory of Interpersonal Problems; IIP-C; Horowitz et al. 2000) and free response themes [Social Cognition and Object Relations Scale: SCORS; Hilsenroth, Stein & Pinsker, 2004; Westen, 1995] of interpersonal functioning. Clinician ratings of the GARF scale and SCORS variables were highly reliable and internally consistent. Convergent Validity among the GARF, SCORS, and IIP scores was calculated using a Principal Components Analysis and Confirmatory Factor Analysis (CFA). Results of the Principal Components Analysis revealed that the GARF, SCORS, and IIP scores converged on a single factor, although findings of the CFA did not fully confirm the 1 factor model originally proposed. Intercorrelations among the GARF, SCORS, and IIP variables were analyzed and a pattern of significant relationships was found between the GARF and SCORS variables. This study helps support the convergent validity GARF as a relational functioning measure and is one of the first investigations to examine this scale multidimensionally.

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Available from: Michelle B Stein, Mar 11, 2015
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    • " and SCORS – G ratings . Past research with adult samples has also reported similar findings ( Pinsker - Aspen , Stein , & Hilsenroth , 2007 ) . We also found that the SCORS – G composite ratings were positively correlated to the patients ' GAF scores . This pro - vides convergent validity as similar results were found in past SCORS – G research ( Stein et al . , 2009 ) . We would expect that those who have healthier self - and interpersonal functioning capacities would lead to better coping capacities and overall"
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    ABSTRACT: The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) is a clinical rating system assessing eight domains of self and interpersonal relational experience which can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943]; early memories narratives) or oral data (e.g., psychotherapy narratives, Relationship Anecdotal Paradigms). In the current study, seventy-two psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating disordered behavior and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of inter-rater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy; history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.
    Journal of Personality Assessment 08/2014; 97(1). DOI:10.1080/00223891.2014.930744 · 2.01 Impact Factor
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    • "These three constructs have been used in other global functioning measures such as the CGAS and the GAF (Bird, 1999; Bird et al., 1987; Winters et al., 2005). In addition, the inclusion of a dimensional assessment of personality functioning into the Overall Functioning Scale (OFS) was supported by work showing how personality pathology affects overall functioning (Kuurmann and Hilsenroth, 2012; Peters et al., 2005; Stein et al., 2009; Westen and Arkowitz- Westen, 1998; Zittel-Conklin and Westen, 2005). Personality pathology in adolescents has also been linked to other psychiatric disorders (for review, see Shiner and Tackett, 2014). "
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    ABSTRACT: The current study looks to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients’ length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning score at admission, and global rating of engagement in individual psychotherapy. Results also showed that the OFS was related to patients’ history of non-suicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being and symtomatology. Hierarchical regressions reveal that the OFS shows incremental validity above the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates inter-rater reliability in the excellent range (ICC 1,2) of .88. Clinical implications of the use of this tool as well as areas of future research are discussed.
    Journal of Nervous & Mental Disease 08/2014; 202(11). DOI:10.1097/NMD.0000000000000200 · 1.69 Impact Factor
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    ABSTRACT: 1 RIASSUNTO. Introduzione. L'Asse V di Kennedy o Asse K è uno strumento alternativo alla Scala per la Valutazione Glo-bale Del Funzionamento (VGF) dell'Asse V del DSM-IV-TR, considerata da alcuni ricercatori di scarse proprietà psicome-triche e di ridotta utilità pratica. L'Asse K, a differenza del VGF, propone un approccio multidimensionale e multiassiale al-la valutazione del funzionamento personale, sociale e interpersonale del paziente psichiatrico. Questo studio intende indaga-re la riproducibilità tra osservatori della versione italiana dell'Asse K attraverso la sua applicazione a un campione psichia-trico. Metodi. L'Asse V di Kennedy e stato somministrato a 180 pazienti in cura presso nove strutture territoriali della Lom-bardia e del Piemonte. I soggetti sono stati raggruppati in quattro categorie diagnostiche, secondo i criteri del DSM-IV-TR. Risultati. L'analisi dei coefficienti delle correlazioni intraclasse (ICC) delle valutazioni effettuate da due giudici indipenden-ti ha permesso di rilevare un'ottima riproducibilità per tutte le sotto-scale dell'Asse K (0,633<ICC<0,813). L'effetto della pa-tologia del paziente sui punteggi ottenuti alle diverse sotto-scale è stato confermato dai risultati del test non parametrico di Kruskal-Wallis per campioni indipendenti. Le scale dell'Asse K, a eccezione di quella dei Comportamenti violenti, discrimi-nano significativamente i profili di funzionamento di pazienti con diagnosi differenti. Conclusioni. I risultati di questo studio dimostrano che l'Asse K ha una buona riproducibilità tra osservatori, anche se applicato in contesti clinici differenti e da operatori con diverse qualifiche professionali; le scale permettono di descrivere un utile profilo funzionale del paziente in base alla sua diagnosi specifica. PAROLE CHIAVE: Asse V, DSM, Asse K, funzionamento globale, doppia-diagnosi. SUMMARY. Introduction. Kennedy Axis V or K Axis acts as an alternative tool to the DSM-IVTR Global Assessment of Functioning (GAF) Scale, that many researchers describe as a scale with poor inter-rater reliability and clinical utility. Unlike the GAF scale, K Axis provides a multidimensional and multiaxial approach to measure personal, social and interpersonal functioning in psychiatric outpatients and inpatients. In this study, we examined K Axis's inter-raters reliability by using it with an Italian clinical population. Methods. Clinicians used Kennedy Axis V to assess global functioning among 180 inpatients, in 9 psychiatric services in Lombardia and Piemonte. Patients were divided into 4 different diagnostic groups, according to the DSM-IV-TR criteria. Results. Intraclass correlations between two independent raters's scores reveal high level of inter-rater reliability for all K Axis scales (0,633<ICC<0,813). Highly significant results in the Kruskal-Wallis test demonstrate that the patient diagnosis influence all the scales scores. Significant differences in patients functioning profiles in all K Axis scales, apart from Violence one, were noted between different diagnosis groups. Conclusions. In this study high level of raters agreement was noted, even if K Axis scales were used in different mental health services from different clinicians. K Axis scales provide a useful profile of patient global functioning, in line with the specific pathology.
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