Global assessment of functioning (GAF) ratings: Determinants and role as predictors of one-year treatment outcomes

Abstract

Objective: To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994). Method: We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one‐year symptom and psychosocial functioning outcomes. Results: Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one‐year psychological, social, and occupational functioning outcomes. Conclusions: These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning. © 2000 John Wiley & Sons, Inc. J Clin Psychol 56: 449–461, 2000.

Comparison of Self-report and Clinician-rated Measures of Psychiatric Symptoms and Functioning in Predicting 1-year Hospital Readmission

“…To date, findings as to the usefulness of clinician ratings in predicting psychiatric outcome have been mixed. Our results are consistent with those who have found little association between clinical ratings and rehospitalization (Moos et al, 2000;Parker et al, 2002), employment (Moos, Nichol, & Moos, 2002), and bed days (Parker et al, 2002). However, some studies have reported an association between clinical judgment and hospitalization (Hendryx et al, 2003;Monnelly, 1997;Vetter & Koller, 1996;Walker et al, 1996), service costs (Ruggeri, Biggeri, Rucci, & Tansella, 1998), and employment (Vetter & Koller, 1996).…”

“…At hospital admission, when the clinician may be unfamiliar with the patient and the patient is in acute distress, the clinician may not be able to assess accurately the full extent of his or her social and occupational functioning. Previous research suggests GAF scores at hospital admission are minimally related to indicators of social and occupational functioning (Moos et al, 2000;Parker et al, 2002). Level of social and occupational functioning prior to hospital admission is, however, related to readmission (Oiesvold et al, 2000;Russo et al, 1997b).…”

“…Number of days hospitalized, employment status, number of sick or bed days, and residential stability are other frequently used outcome measures. While the ability of both self-reported and clinicianrated measures of symptoms and/or functioning to predict outcomes other than rehospitalization have been evaluated (Hendryx et al, 2003;Moos et al, 2000;Vetter & Koller, 1996), to our knowledge none have explicitly compared the ratings by clinician and the patients themselves in relation to these measures. The relationship between self and clinician rating and other outcomes may be different from what we have presented here.…”

“…The ability of clinician-rated global measures to predict hospital readmission has been examined in a number of studies. Global ratings recorded during hospitalization predicted rehospitalization in some (Hendryx et al, 2003;Monnelly, 1997;Vetter & Koller, 1996;Walker, Minor-Schork, Bloch, & Esinhart, 1996), while in others no relationship was observed (Moos, McCoy, & Moos, 2000;Parker, O'Donnell, HadziPavlovic, & Proberts, 2002). Several studies have examined the ability of self-report symptom ratings, self-report measures of function, and self-report composite measures to predict hospital readmission, with mixed results (Eisen & Culhane, 1999;Parker et al, 2002).…”

Dysregulated Eating and Distress: Examining the Specific Role of Negative Urgency in a Clinical Sample

“…The GAF is based on clinician report, and ranges from 0 (very low functioning across domains) to 100 (superior functioning in a wide range of activities), with higher scores indicative of better functioning. The GAF has been shown to be a reliable correlate of psychiatric symptoms, clinical diagnoses, and various other clinical outcomes (Friis et al 1993;Moos et al 2000). Additionally, the GAF has displayed reliability and concurrent validity in the current study's setting (Reardon et al 2002).…”