Abstract
Purpose
The general health questionnaire-12 (GHQ-12) is a self-report instrument for measuring psychological morbidity. Previous work has suggested several multidimensional models for this instrument, although it has recently been proposed that these may be an artefact resulting from a response bias to negatively phrased items. The aim here was to explore the dimensionality of the GHQ-12.
Methods
Cluster analysis, exploratory factor analysis and confirmatory factor analysis were applied to waves of data from the English longitudinal study of ageing (ELSA Waves 1 and 3), in order to evaluate fit and factorial invariance over time of the GHQ-12.
Results
Two categories of respondents were identified: high and low scorers. Item variances were higher across all items for high scorers and higher for negatively phrased items (for both high and low scorers). The unidimensional model accounting for variance observed with negative phrasing (Hankins in Clin Pract Epidemiol Ment Health 4:10, 2008) was identified as having the best model fit across the two time points.
Conclusions
Item phrasing, item variance and levels of respondents’ distress affect the factor structure observed for the GHQ-12 and may perhaps explain why different factor structures of the instrument have been found in different populations.
Similar content being viewed by others
Abbreviations
- GHQ-12:
-
General health questionnaire-12
- ELSA:
-
English longitudinal study of ageing
- BIC:
-
Bayesian information criterion
- EFA:
-
Exploratory factor analysis
- PCA:
-
Principal components analysis
- CFA:
-
Confirmatory factor analysis
- RMSEA:
-
Root-mean-square error of approximation
- ECVI:
-
Expected cross-validation index
- ANOVA:
-
Analysis of variance
- ANCOVA:
-
Analysis of covariance
References
Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145.
Werneke, U., Goldberg, D. P., Yalcin, I., & Üstün, B. T. (2000). The stability of the factor structure of the General Health Questionnaire. Psychological Medicine, 30, 823–829.
Politi, P. L., Piccinelli, M., & Wilkinson, G. (1994). Reliability, validity & factor structure of the 12-item General Health Questionnaire among young males in Italy. Acta Psychiatrica Scandinavica, 90, 432–437.
Kiliç, C., Rezaki, M., Rezaki, B., Kaplan, I., & Özgen, G. (1997). General Health Questionnaire (GHQ12 & GHQ28): psychometric properties and factor structure of the scales in a Turkish primary care sample. Social Psychiatry and Psychiatric Epidemiology, 32, 327–331.
Schmitz, N., Kruse, J., & Tress, W. (1999). Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample. Acta Psychiatrica Scandinavica, 100, 462–468.
Martin, A. J. (1999). Assessing the multidimensionality of the 12-item General Health Questionnaire. Psychological Reports, 84, 927–935.
Picardi, A., Abeni, D., & Pasquini, P. (2001). Assessing psychological distress in patients with skin diseases: reliability, validity and factor structure of the GHQ-12. European Academy of Dermatology and Venereology, 15, 410–417.
Campbell, A., Walker, J., & Farrell, G. (2003). Confirmatory factor analysis of the GHQ12: Can I see that again? Australian and New Zealand Journal of Psychiatry, 37, 475–483.
Worsely, A., & Gribbin, C. C. (1977). A factor analytic study of the twelve-item General Health Questionnaire. Australian and New Zealand Journal of Psychiatry, 11, 269–272.
Graetz, B. (1991). Multidimensional properties of the 12-item General Health Questionnaire. Social Psychiatry and Psychiatric Epidemiology, 26, 132–138.
Cheung, Y. B. (2002). A confirmatory factor analysis of the 12-item General Health Questionnaire among older people. International Journal of Geriatric Psychiatry, 17, 739–744.
Gao, F., Luo, N., Thumboo, J., Fones, C., Li, S. C., & Cheung, Y. B. (2004). Does the 12-item General Health Questionnaire contain multiple factors and do we need them? Health and Quality of Life Outcomes, 2, 63.
Shevlin, M., & Adamson, G. (2005). Alternative factor models and factorial invariance of the GHQ-12: A large sample analysis using confirmatory factor analysis. Psychological Assessment, 17, 231–236.
Mäkikangas, A., Feldt, T., Kinnunen, U., Tolvanen, A., Kinnunen, M. L., & Pulkkinen, L. (2006). The factor structure and factorial invariance of the 12-item General Health Questionnaire (GHQ-12) across time: Evidence from two community-based samples. Psychological Assessment, 18, 444–451.
Penninkilampi-Kerola, V., Miettunen, J., & Ebeling, H. (2006). A comparative assessment of the factor structures and psychometric properties of the GHQ-12 and the GHQ-20 based on data from a Finnish population-based sample. Scandanavian Journal of Psychology, 47, 431–440.
Andrich, D., & van Schoubroeck, L. (1989). The General Health Questionnaire: A psychometric analysis using latent trait theory. Psychological Medicine, 19, 469–485.
Kalliath, T. J., O’Driscoll, M. P., & Brough, P. (2004). A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health, 20, 11–20.
Smith, A. B., Fallowfield, L. J., Stark, D. P., Velikova, G., & Jenkins, V. (2010). A Rasch and confirmatory factor analysis of the General Health Questionnaire (GHQ)-12. Health and Quality of Life Outcomes, 8, 45.
Hankins, M. (2008). The factor structure of the twelve item General Health Questionnaire (GHQ-12): The result of negative phrasing? Clinical Practice & Epidemiology in Mental Health, 4, 10.
Ye, S. (2009). Factor structure of the General Health Questionnaire (GHQ-12): The role of wording effects. Personality and Individual Differences, 46, 197–201.
Clark, S. A. (1992). Mental illness among new residents to residential care. International Journal of Geriatric Psychiatry, 7, 59–64.
Harrison, R., Savla, N., & Kafetz, K. (1990). Dementia, depression and physical disability in a London borough: A survey of elderly people in and out of residential care and implications for future developments. Age and Ageing, 19, 97–103.
Marmot, M., Banks, J., Blundell, R., Lessof, C., & Nazroo, J. (2003). Health, wealth and lifestyles of the older population in England: The 2002 English Longitudinal Study of Ageing. London: The Institute for Fiscal Studies.
Goldberg, D., & Williams, P. (1988). A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson.
Campbell, A., & Knowles, S. (2007). A confirmatory factor analysis of the GHQ12 using a large Australian sample. European Journal of Psychological Assessment, 23, 2–8.
Bentler, P. M. (1990). Comparative fit indices in structural models. Psychological Bulletin, 107, 238–246.
Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.
Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioural Research, 25, 173–180.
Jöreskog, K., & Sörbom, D. (1981). LISREL V: Analysis of linear structural relationships by the method of maximum likelihood. Chicago: National Educational Resources.
Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., & Mackintosh, B. (2011). Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 258–264.
Macleod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15–20.
Gilbody, S., House, A., & Sheldon, T. (2001). Routinely administered questionnaires for depression and anxiety: Systematic review. British Medical Journal, 332, 406–409.
Harwood, R. H., Prince, M. J., Mann, A. H., & Ebrahim, S. (1998). The prevalence of diagnoses, impairments, disabilities and handicaps in a population of elderly people living in a defined geographical area: The Gospel Oak project. Age and Ageing, 27, 707–714.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Smith, A.B., Oluboyede, Y., West, R. et al. The factor structure of the GHQ-12: the interaction between item phrasing, variance and levels of distress. Qual Life Res 22, 145–152 (2013). https://doi.org/10.1007/s11136-012-0133-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-012-0133-7