Abstract
ObjectivesThe general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14–17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them.MethodsWe conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards.ResultsThe search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3–31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3–20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%–27.4%) vs. 19.2% (95 CIs 17.1%–21.3%)).ConclusionsCounter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all “stress” surveys.
Highlights
The general health questionnaire (GHQ) is one of the most commonly used measures to assess symptoms of common mental disorder (CMD) in the UK [1]
It is generally believed that there are particular occupational groups who are exposed to a higher level of stress than other occupations, e.g. police officers and military personnel; there are few studies comparing rates of CMD across these occupations or to the general population
UK prevalence estimates for common mental disorder from population studies are in the range of 14–17% [3,4], with the prevalence of CMD in occupational studies, such as military personnel and London civil servants higher at 20% and 27% respectively [5,6]
Summary
The general health questionnaire (GHQ) is one of the most commonly used measures to assess symptoms of common mental disorder (CMD) in the UK [1]. UK prevalence estimates for common mental disorder from population studies are in the range of 14–17% [3,4], with the prevalence of CMD in occupational studies, such as military personnel and London civil servants higher at 20% and 27% respectively [5,6]. This difference is inconsistent with the ‘healthy worker effect’ and the assumption that healthier individuals are more likely to be selected into work, which is well established [7]. Occupational samples are less likely to include the disabled, those with long term physical or mental health disorders, and by definition exclude the unemployed which in itself is a strong risk factor for poor mental health [9]
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