Abstract
Objectives: To compare responsiveness, screening performances and internal consistency between version 20 and 12 of the General Health Questionnaire (GHQ), and concurrent validity of the GHQ-12 through agreement with The Hospital Anxiety and Depression Scale (HADS) in patients with Chronic Obstructive Pulmonary Disease (COPD) prior to and after pulmonary rehabilitation. Methods: Consecutive COPD patients with a mean age of 65, comprising 161 patients at baseline and 136 at 4-weeks follow-up. Responsiveness was analyzed through Paired Sample T-test, screening performances by Mc Nemar Test, internal consistency through Cronbach's alpha, and concurrent validity by The Bland-Altman technique. Results: The GHQ mean score was significantly reduced by the GHQ-20 and GHQ-12 after rehabilitation, with score differences of -4 and -3.9 using Likert format (p 0.9 for both versions. The concurrent validity of the GHQ-12 is considered low assessed through agreement with the HADS, with mean values of the difference of 4.1 at baseline (p<0.001) and 1.3 at follow-up (p=0.010). Conclusions: The two GHQ versions vary along with different scoring methods regarding responsiveness and screening performances. As for internal consistency, the observed differences were only marginal irrespective of scoring methods. Assessed through agreement with the HADS, the concurrent validity of the GHQ-12 is considered low.
Highlights
In addition to physical problems, chronic obstructive pulmonary disease (COPD) is a considerable source of psychological distress such as anxiety and depression [1]
The prevalence of psychological distress has been reported to be higher among COPD patients compared to age-matched control populations and patients suffering from other chronic diseases [2]
A comparison of characteristics between responders and nonresponders at baseline is presented in Table 2, showing significant higher mean age (68.1 vs. 65.0, p=0.015) and prevalence of severe COPD (43.4 vs. 25.5%, p=0.004) in non-responders
Summary
In addition to physical problems, chronic obstructive pulmonary disease (COPD) is a considerable source of psychological distress such as anxiety and depression [1]. An established and well documented non-pharmacologic treatment for COPD patients is pulmonary rehabilitation, which has proven to be an effective treatment that enhances exercise capacity and quality of life and reduce psychological distress [5]. An efficient way to detect pre- and post-rehabilitation levels of psychological distress in COPD patients is through patient reported outcomes, provided by reliable, valid, and standardized questionnaires. Disease-specific questionnaires may be better tailored and more valid for detection of psychological distress in COPD patients, additional use of a generic form, such as the GHQ, makes comparisons with the general population and other patients groups possible
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