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A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using Relative Operating Characteristic (ROC) analysis

Published online by Cambridge University Press:  09 July 2009

Jair De Jesus Mari*
Affiliation:
General Practice Research Unit, Institute of Psychiatry, London
Paul Williams
Affiliation:
General Practice Research Unit, Institute of Psychiatry, London
*
1Address for correspondence: Dr J. J. Mari, General Practice Research Unit, Istitute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.

Synopsis

The General Health Questionnaire (GHQ-12) (Goldberg, 1972) and the Self Report Questionnaire (SRQ-20) (Harding et al. 1980) were simultaneously validated against the criterion of the Clinical Interview Schedule (CIS) (Goldberg et al. 1970) in three primary care clinics in the city of Sao Paulo, Brazil. A comparison between the two screening instruments was carried out. The product-moment correlation between the two sets of scores was +0·72, and the validation coefficients for the GHQ-12 and the SRQ-20 were respectively: sensitivity 85% and 83%; specificity 79% and 80%; overall misclassification rate 18% and 19%.

The two screening instruments were further compared by the application of Relative Operating Characteristic (ROC) analysis and, again, were found to be very similar in performance. The area under the ROC curve was 0·87 for the GHQ and 0·90 for the SRQ-20 (Z = 0·92, NS). Both psychiatric screening instruments were therefore found to be acceptably valid when assessed against the CIS in three primary care settings in Brazil.

The application of ROC analysis to studies of this kind was feasible and straightforward. It was found to be superior to the conventional method of presentation of validity data. It is recommended that the application of ROC analysis to psychiatric screening studies be further utilized and explored.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1985

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References

REFERENCES

Banks, M. H. (1983). Validation of the General Health Questionnaire in a young community sample. Psychological Medicine 13, 349353.CrossRefGoogle Scholar
Burvill, P. W. & Knuiman, H. W. (1983). Which version of the General Health Questionnaire should be used in community studies? Australian and New Zealand Journal of Psychiatry 17, 237242.CrossRefGoogle ScholarPubMed
Busnello, E. L., Lima, B. & Bertolote, J. M. (1983). Aspectos Interculturais de classificaçao e diagnostico. Jornal Brasileiro de Psiquiatria 32 (4), 207210.Google Scholar
Chan, D. W. & Chan, T. S. C. (1983). Reliability, validity and the structure of the General Health Questionnaire in a Chinese context. Psychological Medicine 13, 363371.CrossRefGoogle Scholar
Climent, C. E. & Plutchick, R. (1980). Confiabilidad, validez y sensibilidad de los items de una scala de auto reportage de sintomas de enfermedad mental. Revista Colombiana de Psiquiatria 8.Google Scholar
Dhadphale, R., Ellison, R. H. & Griffin, L. (1983). The frequency of psychiatric disorders among patients attending semi-urban and rural general out-patient clinics in Kenya. British Journal of Psychiatry 142, 379383.CrossRefGoogle ScholarPubMed
Diamond, E. L. & Lilienfeld, A. M. (1962). Effects of errors in classification and diagnosis in various types of epidemiological studies. American Journal of Public Health 52, 11371144.CrossRefGoogle ScholarPubMed
Diop, B., Collignon, R., Gueye, M. & Harding, T. W. (1980). Symptomatologie et diagnostic psychiatriques dans une region rurale du Senegal. Psychopathologie Africaine 1, 520.Google Scholar
Dorfman, D. D. & Alf, E. (1969). Maximum-likelihood estimation of parameters of signal-detection theory and determination of confidence intervals: rating-method data. Journal of Mathematical Psychology 6, 487496.CrossRefGoogle Scholar
Dunbar, G. C. & Lishman, W. A. (1984). Depression, recognition-memory and hedonic tone. A signal detection analysis. British Journal of Psychiatry 144, 376382.CrossRefGoogle Scholar
Egan, J. P. (1975). Signal Detection Theory and ROC Analysis. Academic Press: New York.Google Scholar
Erdreich, L. S. & Lee, E. T. (1981). Use of Relative Operating Characteristic analysis in epidemiology. American Journal of Epidemiology 114 (5), 649662.CrossRefGoogle ScholarPubMed
Fleiss, J. L. (1981). Statistical Methods for Rates and Proportions. John Wiley & Sons: New York.Google Scholar
Giglio, J. S. (1976). Bem-estar emocional em universitarios. Post Graduation Thesis: Faculdade de Ciencias Medicas da Universidade de Campinas.Google Scholar
Goldberg, D. P. (1972). The Detection of Psychiatric Illness by Questionnaire. Maudsley Monograph No. 21. Oxford University Press: London.Google Scholar
Goldberg, D. P. (1978). Manual of the General Health Questionnaire. NFER Publishing Company: Windsor.Google Scholar
Goldberg, D. P. & Blackwell, B. (1970). Psychiatric illness in general practice: a detailed study using new methods of identification. British Medical Journal ii, 439443.CrossRefGoogle Scholar
Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B. & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 1823.Google ScholarPubMed
Harding, T. W., Arango, M. V., Baltazar, J., Climent, C. E., Ibrahim, H. H. A., Ignacio, L. L., Murthy, R. S. & Wig, N. N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231241.CrossRefGoogle ScholarPubMed
Harding, T. W., Climent, C. E., Diop, M., Giel, R., Ibrahim, H. H. A., Murthy, R. S., Suleiman, M. A. & Wig, N. N. (1983). The WHO collaborative study on strategies for extending mental health care: II. The development of new research methods. American Journal of Psychiatry 140 (11), 14741480.Google Scholar
Mari, J. J. & Williams, P. (1983). Estudo preliminar da confiabilidade da Entrevista para Estudos Comunitarios (EEC) de Goldberg e outros (1970) no Brasil. Revista da Associaçao Brasileira de Psiquiatria 5 (18), 173176.Google Scholar
Mari, J. J. & Williams, P. (1984). Minor psychiatric disorder in primary care in Brazil: a pilot study. Psychological Medicine 14, 223227.CrossRefGoogle ScholarPubMed
Mari, J. J. & Williams, P. (1985). A validity study of a psychiatric screening questionnaire (SRQ-20) in the city of Sao Paulo. British Journal of Psychiatry (in the press).Google Scholar
Mari, J. J., Blay, S. L. & lacoponi, E. (1985). Um estudo de confiabilidade da versao brasileira da Clinical Interview Schedule. Bulletin of the Pan American Health Organization (in the press).Google Scholar
Metz, C. E. (1978). Basic principles of ROC analysis. Seminars in Nuclear Medicine 4, 283298.CrossRefGoogle Scholar
Metz, C. E., Wang, P.-L. & Kronman, H. B. (1984). ROCFIT. Department of Radiology and the Franklin McLean Memorial Research Institute: University of Chicago.Google Scholar
Skuse, D. & Williams, P. (1984). Screening for psychiatric disorder in general practice. Psychological Medicine 14, 365377.CrossRefGoogle ScholarPubMed
Swets, J. A. (1964). Signal Detection and Recognition by Human Observers. John Wiley and Sons: New York.Google Scholar
Swets, J. A. (1979). ROC analysis applied to the evaluation of medical imaging techniques. Investigative Radiology 14, 109121.CrossRefGoogle Scholar
Swets, J. A. & Pickett, R. M. (1982). Evaluation of Diagnostic Systems: Methods from Signal Detection Theory. Academic Press: New York.Google Scholar
Swets, J. A., Pickett, R. M., Whitehead, S. F., Getty, D. J., Schnur, J. A., Swets, J. B. & Freeman, B. A. (1979). Assessment of diagnostic technologies. Advanced measurement methods are illustrated in a study of computed tomography of the brain. Science 205, 753759.CrossRefGoogle Scholar
Tarnopolsky, A., Hand, D. J., McLean, E. K., Roberts, H. & Wiggins, R. D. (1979). Validity and uses of a screening questionnaire (GHQ) in the community. British Journal of Psychiatry 134, 508515.CrossRefGoogle ScholarPubMed
Tennant, C. (1977). The General Health Questionnaire: a valid index of psychological impairment in Australian populations. Medical Journal of Australia ii, 392394.CrossRefGoogle Scholar
Verma, S. K. & Wig, N. N. (1977). Standardization of a neuroticism questionnaire in Hindi. Indian Journal of Psychiatry 19, 6772.Google Scholar
Vieweg, B. W. & Hedlund, J. L. (1983). The General Health Questionnaire (GHQ): a comprehensive review. Journal of Operational Psychiatry 14 (2), 7481.Google Scholar
Weinstein, M. C. & Fineberg, H. V. (1980). Clinical Decision Analysis. W. B. Saunders: Philadelphia.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar