Validity of the general health questionnaire and its subscales in patients receiving chemotherapy for early breast cancer

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Abstract

The performance of the General Health Questionnaire as a case detector was assessed in 75 patients receiving chemotherapy for early breast cancer. The questionnaire and its subscales were found to be valid when compared with observer ratings. The misclassification rate of the 60-item version of the questionnaire was lowest when the standard threshold score for clinical morbidity was doubled to 24. It was lowest for the 28-item version when the threshold score was doubled to 10. Suggested threshold scores for clinical morbidity for the subscales are: anxiety and insomnia subscale 6/7; severe depression subscale 2/3; somatic symptoms subscale 6/7; and social dysfunction subscale 7/8. However, lower thresholds would be appropriate if the questionnaire were used as screening instrument prior to interview by a trained observer.

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    Pugliese et al.24 proposed a HADS cut-off score of 8 for depression and 10 for anxiety but do not provide sensitivity and specificity scores at these levels. The 28-item GHQ-28 was reported by Hughson et al.23 and demonstrated excellent sensitivity and specificity scores for identifying what the authors characterize as psychosocial morbidity. The validation data were derived from a sample of 75 breast cancer patients on chemotherapy.

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