Psychometric Evaluation of GHQ-12 as a Screening Tool for Psychological Impairment of Healthcare Workers Facing COVID-19 Pandemic

Abstract

Background:

The General Health Questionnaire (GHQ) is a widely used tool in clinical and research settings due to its brevity and easy administration. Researchers often adopt a dichotomous measurement method, considering a total score above or below a certain threshold, leading to an extreme simplification of the gathered data and, therefore, the loss of clinical details. In a multistep evaluation study aimed at assessing health care workers’ mental health during the COVID-19 pandemic, GHQ-12 proved to be the most effective tool to detect psychological distress compared to other scales. These results deepened the understanding of GHQ-12 properties through a statistical study focusing on items’ properties and characteristics.

Methods:

GHQ-12 responses were analyzed using Item Response Theory (IRT), a suitable method for scale assessment. Instead of considering the single overall score, in which each item accounts equally, it focuses on individual items’ characteristics. Moreover, IRT models were applied combined with the latent class (LC) analysis, aiming to determine subgroups of individuals according to their level of psychological distress.

Results:

GHQ-12 was administered to 990 healthcare workers, and responses were scored using the binary method (0-0-1-1). We applied the two-parameter logistic (2-PL) model, finding that the items showed different ways of responses and features. The latent class analysis classified subjects into three sub-groups according to their responses to GHQ-12 only: 47% of individuals with general well-being, 38% expressing signs of discomfort without severity, and 15% of subjects with a high level of impairment. This result almost reproduces the subjects’ classification obtained after administering the six questionnaires of the study protocol.

Conclusions:

Accurate statistical techniques and a deep understanding of the latent factors underlying the GHQ-12 resulted in more effective usage of such a psychometric questionnaire – i.e., a more refined gathering of data and significant time and resource efficiency. We underlined the need to maximize the extraction of data from questionnaires and the necessity of them being less lengthy and repetitive.