General Health Questionnaire-12 reliability, factor structur...

The GHQ-12 is used to measure the psychological distress and the SUBI, which is another instrument measuring mental health, is used to check the external ... Jan-Mar2018-Volume60-Issue1 Previous Article Next Article ArticleasEPUB ExportAllImagestoPowerPointFile AddtoMyFavorites Colleague'sE-mailisInvalid YourName: Colleague'sEmail: Separatemultiplee-mailswitha(;). Message: Thoughtyoumightappreciatethisitem(s)IsawinIndianJournalofPsychiatry. Yourmessagehasbeensuccessfullysenttoyourcolleague. Someerrorhasoccurredwhileprocessingyourrequest.Pleasetryaftersometime. EndNoteProciteReferenceManager Savemyselection ORIGINALARTICLEQin,Min;Vlachantoni,Athina;Evandrou,Maria;Falkingham,Jane AuthorInformation CentreforResearchonAgeingandESRCCentreforPopulationChange,UniversityofSouthampton,Southampton,UK Addressforcorrespondence:Dr.MinQin,CentreforResearchonAgeingandESRCCentreforPopulationChange,UniversityofSouthampton,Southampton,SO171BJ,UK.E-mail:[email protected] IndianJournalofPsychiatry: Jan–Mar2018-Volume60-Issue1-p56-59 doi:10.4103/psychiatry.IndianJPsychiatry_112_17 Open Metrics Abstract Aims:  Thepurposeofthisstudyistoanalyzetheinternalconsistency,factorstructure,andexternalvalidityofthe12-itemGeneralHealthQuestionnaire(GHQ-12)amongolderadultsinIndia. SettingsandDesign:  ThisstudyanalyzesdatacollectedaspartoftheUNFPA“BuildingKnowledgeBaseonAgeinginIndia(BKPAI)”project.TheBKPAISurveywasconductedin2011insevenmajordemographicallyadvancedstatesofIndia–HimachalPradesh,Punjab,WestBengal,Odisha,Maharashtra,Kerala,andTamilNadu. MaterialsandMethods:  Acommunity-basedrepresentativesampleof9692respondentsaged60andabovefromsevenIndianstateswasemployed.TheGHQ-12questionnairewasadministered. StatisticalAnalysis:  TheCronbach'salphawascalculatedtoanalyzeinternalconsistency.FactoranalysiswasappliedtoexplorethefactorstructureofGHQ-12,andthencorrelationcoefficientswerecalculatedtoexaminetheexternalvalidityofthemeasurement. Results:  TheCronbach'salphaoftheGHQ-12is0.9.Factoranalysisrevealstwosignificantcomponentswhichaccountedfor59%ofthevariance.ThecorrelationbetweentheoverallscoreofGHQ-12andthesubjectivewell-beinginventory(SUBI)is0.58. Conclusions:  TheGHQ-12showsadequatereliabilityamongtheolderpopulationinIndia. INTRODUCTION ScreeningPsychologicalDistressHelpsEarlyDetectionforPeopleatRiskofMentalIllness.theGeneralHealthQuestionnaire(Ghq)CreatedbyGoldbergin1972IsaToolWhichHasBeenWidelyUsedtoAssessSuchDistress.[1]theGhq-12Comprises12QuestionsRegardingtheGeneralLevelofHappiness,theExperienceofDepressiveandAnxietySymptoms,PerceivedStress,andSleepDisturbanceoverthePrevious4Weeks.EachItemHasa4-PointResponseScale.[2] Inmoststudies,theGHQ-12hasbeenusedasaunidimensionalmeasure.SomefactoranalysisstudiesfoundthatGHQ-12measuresthreedomainsincludingsocialdysfunction,anxiety,andlossofconfidence.[345]However,otherstudieshaveidentifiedonlytwofactors–depressionandsocialdysfunction[67]–andafurtherstudyarguedthatseparatedomainsdonotcontributetoidentifyingvulnerablepopulationgroupsorthefactorsassociatedwithdistress.[8] ThevalidatingstudyoftheGHQ-12againststandardizedpsychiatricinterviewsacross15countriesaroundtheworldshoweduniformlygoodresults.[2]InIndia,theGHQhasbeenvalidatedinKannada,[9]Hindi,[10]andTamil.[11]However,thesestudieswerebasedonasmallclinicsampleinonestate,withtheparticipantsbeingyoungadults,andthereremainsalackofstudiesacrossmultiplestatesandfocusingamongolderadults.Thepurposeofthisstudyistoanalyzetheinternalconsistency,factorstructure,andexternalvalidityofGHQ-12amongolderadultsinsevenstatesinIndiawithdifferentlanguagesandcultures. MATERIALSANDMETHODS Subjects ThisstudyanalyzesdatacollectedaspartoftheUNFPA“BuildingKnowledgeBaseonAgeinginIndia(BKPAI)”project.TheBKPAISurveywasconductedin2011insevenmajordemographicallyadvancedstatesofIndia:HimachalPradesh,Punjab,WestBengal,Odisha,Maharashtra,Kerala,andTamilNadu.ArepresentativesamplewasobtainedusingarandomsamplingmethodcoveringtheNorthern,Southern,Western,andEasternregions.Theprimarysamplingunitswerehouseholds.Allthoseaged60andaboveinthesampledhouseholdswereinterviewedfacetoface.Thecompletionrateforhouseholdswas94.7%and92.9%forelderlyrespondents.Thedetailedinformationaboutthesurveysamplingisdescribedinapreviousreport.[12]Thetotalsamplesizeinterviewedis9692.Ofthese,214areexcludedbecauseofmissingvalues(missingnessisnotmutuallyexclusive)ontheGHQ-12score(n=36)andsubjectivewell-beinginventory(SUBI)score(n=192).Nodemographic(ageandgender)differenceswereobservedbetweenexcludingandstudycases.Thefinalanalyticalsampleis9478adultsaged60andabove(4988womenand4490men),63.4%agedbetween60and69years,26.5%agedbetween70and79years,and10.1%aged80yearsandabove(meanage=68.0years,standarddeviation[SD]=7.2). Instruments TheGHQ-12isusedtomeasurethepsychologicaldistressandtheSUBI,whichisanotherinstrumentmeasuringmentalhealth,isusedtochecktheexternalvalidityofGHQ.TheGHQ-12includesthefollowing12questions:(1)Haveyourecentlybeenabletoconcentrateonwhateveryouaredoing?(2)Haveyourecentlylostmuchsleepduetosomeworry?(3)Haveyourecentlyfeltconstantlyunderstrain?(4)Haveyourecentlyfeltthatyoucouldnotovercomeyourdifficulties?(5)Haveyourecentlybeenfeelingunhappyanddepressed?(6)Haveyourecentlybeenlosingconfidenceinyourself?(7)Haveyourecentlybeenthinkingofyourselfasaworthlessperson?(8)Haveyourecentlyfeltthatyouareplayingausefulroleinlife?(9)Haveyourecentlyfeltcapableofmakingdecisionsaboutthings?(10)Haveyourecentlybeenabletoenjoyyournormalday-to-dayactivities?(11)Haveyourecentlybeenabletofaceuptoyourproblems?(12)Haveyourecentlybeenfeelingreasonablyhappy,allthingsconsidered? TheSUBIconsistsofthefollowingninequestionstomeasurefeelingsofwell-beingorill-beingexperiencedbyanindividualinvariouslifeconcerns:[13](1)Doyoufeelyourlifeisinteresting?(2)Comparedwiththepast,howdoyoufeelyourpresentlifeis?(3)Onthewhole,howhappyareyouwiththekindofthingsyouhavebeendoinginrecentyears?(4)Doyouthinkyouhaveachievedinyourlifethestandardoflivingandthesocialstatusthatyouhadexpected?(5)Howdoyoufeelabouttheextenttowhichyouhaveachievedsuccessandaregettingahead?(6)Doyounormallyaccomplishwhatyouwantedtoaccomplish?(7)Doyoufeelyoucanmanagesituationsevenwhentheydonotturnouttobeasexpected?(8)Doyoufeelconfidentthatincaseofacrisis(anythingthatsubstantiallyupsetsyoursituationinlife)youwillbeabletohandleitorfaceitboldly?(9)Thewaythingsaregoingnow,doyoufeelconfidentincopingwithyourfuture?Thequestionnairesforeachstatewerebilingual,withquestionsinboththeprimarylanguageofthestates(Hindi,Punjabi,BengaliandNepali,Odia,Marathi,Malayalam,andTamil)andEnglish. FortheGHQ,thescoringmethod(0-0-1-1)isusedtosumupthepointstoatotalscorerangingbetween0and12,withahigherscoreindicatingpoorermentalhealth.FortheSUBI,thethreeresponsesoneachitemarescored(1-2-3),withthepointssummedtoatotalscorerangingbetween9and27,withahigherscoreindicatingpoorerwell-being. Methods Cronbach'salphawascalculatedtoanalyzeinternalconsistency.Itrangesfrom0to1.00,withvaluescloseto1.00indicatinghighconsistency.Avalueof0.7–0.8isanacceptablevalue.Thenormalalphaisappropriatewhenitemsonascalearesummedtoproduceasinglescoreforthatscale. FactoranalysiswasappliedtoexplorefactorstructureofGHQ-12.TheadequacyofthecorrelationmatrixoftheGHQ-12itemwaschecked,anditwasobservedthattherewasastrongandstatisticallysignificantcorrelationbetweenthevariables(0.3–0.6).Theprinciplecomponentextractionmethodwasadoptedasitissuggestedinestablishingpreliminarysolutionsinexploratoryfactoranalysis.[14]Factorextractionwasbasedonastatisticalcriterionofeigenvalues>1.Theinitialun-rotatedsolutionsuggestedsomeitemsloadontomorethanonefactors.Toobtainamoreinterpretableandsimplifiedsolution,theorthogonalvarimaxrotationwaschosentotestanydiverseunderlyingstructuresinGHQ-12items.Thecutoffthresholdtodefinetheitemasrepresentingthefactorwaschosenwiththefactorloadingat>0.5.Then,thecorrelationcoefficientswerecalculatedtoexaminetheexternalvalidityoftheGHQ-12scoreasawholeandintermsoftheindividualfactors. RESULTS AmeanGHQ-12scoreof3.4(SD=3.7)wasobtainedinthesample,3.7(SD=3.8)forwomenand3.1(SD=3.6)formen.Thedifferencebetweenwomenandmenwasstatisticallysignificant(P<0.001).Themeanscorevariesacrossstates,withthelowestscore1.7(SD=2.8)inPunjabandthehighestscore4.7(SD=3.7)inOdisha.Theotherfivestatesscoreinbetween–HimachalPradesh2.3(SD=3.6),Kerala2.5(SD=3.2),Maharashtra3.6(SD=3.7),TamilNadu4.5(SD=4.4),andWestBengal4.7(SD=2.9).Thedifferencewasstatisticallysignificant(P<0.001).AtGHQ-12score≥4,3839(40.5%)ofelderlyrespondentsweredeemedtobepsychologicallydistressed. Internalconsistency Table1showstheresultsofthereliabilityanalysis.Thevaluesinthecolumnlabeled“Adjusteditem-scalecorrelation”arethecorrelationsbetweeneachitemandthetotalscorefromthequestionnaire.Inareliablescale,allitemsshouldcorrelatewiththetotal.Ifanyofthesevaluesis<0.3,itmeansthataparticularitemdoesnotcorrelateverywellwiththeoverallscale.Boththesampleandsubsampleshaveitem-totalcorrelationsabove0.5,whichisencouraging.Thevaluesinthecolumnlabeled“Cronbachalphaiftheitemiseliminated”arethevaluesoftheoverallalphaifthatitemwasnotincludedinthecalculation.Theoverallalphais0.9,andtherefore,allvaluesinthiscolumnshouldbearoundthatsamevalue.Theresultsshowthatnoneoftheitemswouldsubstantiallyaffectreliabilityiftheywereomitted,reflectingareasonabledegreeofreliability.Table1:Item-scaleanalysisoftheGeneralHealthQuestionnaire-12Analphavalueof0.90fortheentiresampleindicatesaverygoodreliability,withsatisfactoryinternalconsistencybeingthecaseforbothwomenandmen.Comparedwithotherstates,theWestBengalsubsamplehadthepoorerinternalconsistency,withanalphaof0.74.Therangeofitem-scalecorrelationsisbetween0.7and0.5,withitem3“feltconstantlyunderstrain”beingtheonewiththelowestcorrelationcoefficient. Factorstructure Table2showsthefactorloadingsaftertheVarimaxrotation.Twofactorswereobtained.Basedontheitemsallocatedoneachfactor,FactorIImaybecalled“socialdysfunction”andFactorIImaybetermed“depression”accordingly.ThedatamettheKaiser–Meyer–Olkincriteriaforsamplingadequacyas0.93isgreaterthanthesuggestedminimumof0.6.TheBartlett'stestforsphericitywassignificant(χ2=50581,P<0.001).Overall,thetestssuggestthatthedatameettheminimumstandardsforfactoranalysis.Table2:Factorloadingsforthe12-itemGeneralHealthQuestionnaire(varimaxrotation)Table3showstheeigenvaluesandpercentageofexplainedvarianceassociatedwitheach.Bothfactorshaveeigenvaluesthatexceedtheunit,acriterionusedtoguidethenumberofmeaningfulfactors.Beforetherotation,FactorIisamajorfactorandaccountsfornearlyhalfofthevarianceoftheGHQ-12,whereasFactorIIisaminorfactor.Together,thetwofactorsaccountfor59%ofthevarianceoftheGHQ-12.Table3:EigenvaluesandpercentageofexplainedvariancefortheGeneralHealthQuestionnaire-12Externalvalidity ExternalvaliditywasanalyzedbycalculatingthecorrelationsbetweenthetotalscoreofGHQ-12anditstwofactors,andtheSUBI'stotalscore.Theresultsdisplayamodestpositivecorrelationof0.58withthetotalGHQ-12score,of0.5withFactorI,andof0.32withFactorII.Allthreecorrelationsarestatisticallysignificant[Table4].Table4:Pearson'scorrelationcoefficients(r)betweenGeneralHealthQuestionnaire-12andsubjectivewell-beinginventoryDISCUSSION ThereliabilityoftheGHQ-12intheolderIndianpopulationis0.90,withlittledifferencebetweenmenandwomen,andmorevariationamongstates,withWestBengalindicatingthelowestreliability,althoughthisvalueiswithintheacceptablerange.TheoverallreliabilityisslightlyhigherthaninpreviousresearchamongyoungeradultsinIndian.[1011] Withregardtothefactorstructure,twofactorsemergedintheolderIndianpopulation:“socialdysfunction”and“depression.”Thisfeatureisconsistentwithpreviousresearchinothercountries.[67] TheanalysisofexternalvalidityrevealsthattheGHQ-12hasapositiveassociationwiththeSUBI.ThecorrelationislowerwhenthefactorsareanalyzedindependentlythanthatwhentheoverallGHQ-12scoreisapplied.ThisfindingmightfavoraunidimensionalpropertyofGHQ-12.However,giventhedatalimitation(lackofdatathatcangeneratediagnoses,suchastheInternationalClassificationofDisease10thEditionsystem,[15]ortheCompositeInternationalDiagnosticInterview[assessment]),wecouldnotconductasensitivityandspecificitytest. CONCLUSION TheGhq-12ShowsAdequateReliabilityamongtheOlderPopulationinIndia. Financialsupportandsponsorship ThisresearchhasbeenfundedundertheNWO-ESRC-ICSSRAgeGlobeNetwork(Indian-Europeanresearchnetworking:agingandwell-beinginaglobalizingworld;grantnumberES/K005979/1). 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