I H Monrad Aas1. 1. Department of Research, Vestfold Mental Health Care Trust, Tönsberg, Norway. monrad.aas@piv.no
Abstract
BACKGROUND: Global Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF). METHODS: A thorough literature search was conducted. RESULTS: A number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales? CONCLUSIONS: In the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF.
BACKGROUND: Global Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF). METHODS: A thorough literature search was conducted. RESULTS: A number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales? CONCLUSIONS: In the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF.
Authors: E McColl; A Jacoby; L Thomas; J Soutter; C Bamford; N Steen; R Thomas; E Harvey; A Garratt; J Bond Journal: Health Technol Assess Date: 2001 Impact factor: 4.014
Authors: Bent Rosenbaum; Kristian Valbak; Susanne Harder; Per Knudsen; Anne Køster; Matilde Lajer; Anne Lindhardt; Gerda Winther; Lone Petersen; Per Jørgensen; Merete Nordentoft; Anne Helms Andreasen Journal: Br J Psychiatry Date: 2005-05 Impact factor: 9.319
Authors: Ángel Del Rey-Mejías; David Fraguas; Covadonga M Díaz-Caneja; Laura Pina-Camacho; Josefina Castro-Fornieles; Inmaculada Baeza; Ana Espliego; Jessica Merchán-Naranjo; Ana González-Pinto; Elena de la Serna; Beatriz Payá; Montserrat Graell; Celso Arango; Mara Parellada Journal: Eur Child Adolesc Psychiatry Date: 2015-03-01 Impact factor: 4.785
Authors: T H Zhang; H J Li; K A Woodberry; L H Xu; Y Y Tang; Q Guo; H R Cui; X H Liu; A Chow; C B Li; K D Jiang; Z P Xiao; L J Seidman; J J Wang Journal: Epidemiol Psychiatr Sci Date: 2016-04-08 Impact factor: 6.892
Authors: Matthias N Hartmann-Riemer; Steffen Aschenbrenner; Magdalena Bossert; Celina Westermann; Erich Seifritz; Philippe N Tobler; Matthias Weisbrod; Stefan Kaiser Journal: Sci Rep Date: 2017-01-10 Impact factor: 4.379
Authors: Heidemarie Lex; Yarden Ginsburg; Adam F Sitzmann; Clara Grayhack; Daniel F Maixner; Brian J Mickey Journal: J Affect Disord Date: 2018-09-19 Impact factor: 4.839
Authors: A G Nevarez-Flores; K Sanderson; M Breslin; V J Carr; V A Morgan; A L Neil Journal: Epidemiol Psychiatr Sci Date: 2018-10-01 Impact factor: 6.892
Authors: Ulrike Stentzel; Neeltje van den Berg; Kilson Moon; Lara N Schulze; Josephine Schulte; Jens M Langosch; Wolfgang Hoffmann; Hans J Grabe Journal: BMC Psychiatry Date: 2021-06-29 Impact factor: 3.630
Authors: Helen T Paradise; Dan R Berlowitz; Al Ozonoff; Donald R Miller; Elaine M Hylek; Arlene S Ash; Guneet K Jasuja; Shibei Zhao; Joel I Reisman; Adam J Rose Journal: J Gen Intern Med Date: 2014-02-19 Impact factor: 5.128