The severity of illness in psychiatry is rated using the Global Assessment of Functioning (GAF) scale. The GAF scale is often used in both research settings and in the clinic. The scale ranges from 1 to 100 and is subdivided into ten 10-point intervals, each with verbal rating instructions called anchor points and examples. GAF is an instrument that needs improvement. Studying clinicians' experiences with this rating system may be important for developing improvements. The aim of this study was to collect information from clinicians about their experiences with the GAF instrument, and to collect their ideas on how the GAF scale can be improved, particularly in the area of verbal instructions (i.e., anchor points and examples). Qualitative interviews were performed with 25 clinicians. Through this interview process, several weaknesses of the GAF scale were revealed. We found that clinicians have unique experiences that can be important for the development of a better GAF scale. Rating with the GAF scale also requires sufficient collection of patient information.
This study investigated the reliability of the Global Assessment of Functioning Scale (GAF) when used by psychiatric staff from acute psychiatric wards. A special focus was attributed to factors predicting the reliability of the GAF.101 raters from six acute psychiatric wards assessed six GAF-vignettes. Intraclasscorrelation (ICC) with a model of absolute agreement was used as the overall reliability measure.An overall ICC of 0.79 was obtained. There were no significant differences found between the different occupational groups or psychiatric wards according to reliability. None of the predictive factors in the regression model yielded a significant contribution to reliability.The present study supports prior results of a reliability coefficient to be found mainly in the good to excellent range. There is supporting evidence that GAF ratings performed by trained psychiatric ward staff comprise a satisfactory reliability. The present study adds to prior research showing no consistent results between studies according to reliability factors. Further studies focusing on factors related to reliability are needed.
There is a growing demand for evaluating the process and outcome of mental health care. Most healthcare providers routinely collect and register data related to the process of treatment, and it is important to acquire more knowledge about how to make use of these databases. The aim of this study was to investigate the outcome of psychiatric inpatient care in relation to different clinical factors, using the Global Assessment of Functioning Scale (GAF) as a measure of outcome. Another objective was to explore the ability of routinely collected and registered data to provide valuable information about patients and their care. The studied psychiatric inpatient sample consisted of 816 care episodes with GAF ratings made both at admission and at discharge for 648 patients. Variables used in the study included GAF score at admission and at discharge, age, gender, diagnosis, length of stay and ward affiliation. The overall mean GAF change was 20.74, and the overall effect size Cohen's d 1.67, which corresponds to a large effect. The mean GAF change for women was 21.6, with an effect size of 1.80, and for men 19.4 with an effect size of 1.52. The effect size spectra including all groups of diagnoses ranged from 1.03 (substance-related disorders) to 2.33 (other mood disorders). Length of stay and ward affiliation also showed significant results concerning GAF change. Some limitations in this study could depend on the absence of randomization procedures and a control group. Another limitation concerns the insufficient control of the inpatient care interventions performed. The results support the capacity of the GAF to function as a measure of outcome in relation to different clinical factors, such as length of stay and diagnosis. Support was also found for the importance and usefulness of routinely collected and registered data.
Abstract. A small number of studies have investigated predictive factors in relation to the Global Assessment of Functioning (GAF) scale. This study aimed to explore the influence of clinical and socio-demographic factors in a psychiatric inpatient setting in relation to treatment outcome measured by the GAF. The studied psychiatric inpatient sample consisted of 816 episodes of care, with GAF ratings made at both admission and discharge. Multiple linear regressions were performed to analyze what variables predicted GAF scores at admission and at discharge. Significant predictors of GAF scores at admission were age, schizophrenia, other psychotic disorders, and no registered diagnosis. GAF scores at admission, patients’ diagnoses, and ward affiliation were able to significantly predict GAF at discharge. Specialized wards did not necessarily deliver the best treatment results in spite of their diagnostic specialization. This study provides support to the construct validity of the GAF when used as a measure of outcome.
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