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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    • "All participants were evaluated using the Global Assessment of Functioning scale (Jones et al., 1995) (GAF). Parental socioeconomic status (PSES) was assessed using the Hollingshead four-factor index (Hollingshead, 1975). "
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    ABSTRACT: The lateral and third ventricles, as well as the corpus callosum (CC), are known to be affected in schizophrenia. Here we investigate whether abnormalities in the lateral ventricles (LVs), third ventricle, and corpus callosum are related to one another in first episode schizophrenia (FESZ), and whether such abnormalities show progression over time. Nineteen FESZ and 19 age- and handedness-matched controls were included in the study. MR images were acquired on a 3-Tesla MRI at baseline and ~1.2 years later. FreeSurfer v.5.3 was employed for segmentation. Two-way or univariate ANCOVAs were used for statistical analysis, where the covariate was intracranial volume. Group and gender were included as between-subjects factors. Percent volume changes between baseline and follow-up were used to determine volume changes at follow-up. Bilateral LV and third ventricle volumes were significantly increased, while central CC volume was significantly decreased in patients compared to controls at baseline and at follow-up. In FESZ, the bilateral LV volume was also inversely correlated with volume of the central CC. This inverse correlation was not present in controls. In FESZ, an inverse correlation was found between percent volume increase from baseline to follow-up for bilateral LVs and lesser improvement in the Global Assessment of Functioning score. Significant correlations were observed for abnormalities of central CC, LVs and third ventricle volumes in FESZ, suggesting a common neurodevelopmental origin in schizophrenia. Enlargement of ventricles was associated with less improvement in global functioning over time.
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    • "General functioning. General functioning was assessed using the GAF (Jones et al., 1995) resulting in scores ranging from 0 to 100. "
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    ABSTRACT: During recent years, a decrease has been noted in the rate of transition of ultra-high risk (UHR) clients to a psychotic disorder. Although important to the concept of the at-risk mental state, the reasons for this decline remain largely unknown. We investigated the possibility of a 'dilution effect' in contributing to the decline, i.e. if later UHR cohorts present with less severe clinical intake characteristics than earlier cohorts.Firstly, clinical intake characteristics of a large UHR sample (n = 397) were compared across baseline year epochs (1995-2006). Characteristics showing significant differences were included in a Cox-regression to examine if they could explain the decline in transition rates. Secondly, because later cohorts show lower transition rates, 'more stringent' UHR-criteria were retrospectively applied to these cohorts (post-2000, n = 219), investigating if this resulted in a higher transition rate.Results indicated that earlier cohorts presented with (1) a larger array of attenuated psychotic symptoms, (2) higher ratings on conceptual disorganization (formal thought disorder) and (3) a higher proportion of individuals with trait risk factor (all P. <. .001). However, these factors could not fully account for the decline in transition rates. Applying more stringent UHR-criteria to the post-2000-subsample did not substantially change the rate of transition.Our study suggests that later UHR cohorts presented with different clinical intake characteristics than earlier cohorts. While this may have contributed to the observed decrease in transition rates to psychosis, it does not appear to fully account for this decline, suggesting other factors have also impacted on transition rates over time.
    Full-text · Article · Dec 2015 · Schizophrenia Research
    • "Participants' impulsivity was assessed using Barratt Impulsiveness Scale (BIS) version 11, a 30-item self-report measure designed to assess the personality trait of impulsivity composed of three subscales: attentional (intolerance of complexity), motor (impetuous action), and nonplanning (lack of future orientation) impulsivity (Patton et al., 1995). Patient functioning was measured by Social Functioning Scale (SFS) (Birchwood et al., 1990) and Global Assessment of Functioning (GAF) (Jones et al., 1995). Patient symptomatology was quantified using Positive And Negative Syndrome Scale (PANSS) (Kay et al., 1987) and cognition was evaluated using Brief Assessment of Cognition in Schizophrenia (BACS) (Keefe, 2004). "
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    ABSTRACT: Patients with psychotic disorders appear to exhibit greater impulsivity-related behaviors relative to healthy controls. However, the neural underpinning of this impulsivity remains uncertain. Furthermore, it remains unclear how impulsivity might differ or be conserved between psychotic disorder diagnoses in mechanism and manifestation. In this study, self-reported impulsivity, measured by Barratt Impulsiveness Scale (BIS), was compared between 305 controls (HC), 139 patients with schizophrenia (SZ), 100 with schizoaffective disorder (SZA), and 125 with psychotic bipolar disorder (PBP). In each proband group, impulsivity was associated with regional cortical volumes (using FreeSurfer analysis of T1 MRI scans), suicide attempt history, Global Assessment of Functioning (GAF), and Social Functioning Scale (SFS). BIS scores were found to differ significantly between participant groups, with SZA and PBP exhibiting significantly higher impulsivity than SZ, which exhibited significantly higher impulsivity than HC. BIS scores were significantly related to suicide attempt history, and they were inversely associated with GAF, SFS, and bilateral orbitofrontal cortex (OFC) volume in both SZA and PBP, but not SZ. These findings indicate that psychotic disorders, particularly those with prominent affective symptoms, are characterized by elevated self-reported impulsivity measures. Impulsivity's correlations with suicide attempt history, GAF, and SFS suggest that impulsivity may be a mediator of clinical outcome. The observed impulsivity-OFC correlations corroborate the importance of OFC deficits in impulsivity. These correlations' presence in SZA and PBP but not in SZ suggests that impulsivity may have different underlying mechanisms in affective and non-affective psychotic disorders.
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