The General Health Questionnaire (GHQ-

(GHQ-12)
and the Subjective Vitality Scale (VS)
by Telepsychiatric services:
Milan Stojakovic 1,2

1 Department
p Of Psychiatry,
y y
School Of Medicine,
University Of Banjaluka, Banjaluka,
Bosnia Herzegovina; misos@blic.net

2 Clinic For Psychiatry,

Clinical Center, Banjaluka,

Bosnia Herzegovina;
 The General Health
Questionnaire (GHQ-
(GHQ-12)
and the Subjective Vitality
Scale (VS)
byy Telepsychiatric
p y services
 Milan Stojakovic 1,2
12

1 Department Of Psychiatry,
School Of Medicine
Medicine,
University Of Banjaluka, Banjaluka,
B
Bosnia
i H
Herzegovina;
i misos@blic.net
i @bli t

2 Clinic For Psychiatry,

Clinical Center,
Center Banjal
Banjaluka,
ka
Bosnia Herzegovina;
g ;
Abstract: BACKGROUND AND AIMS: The objectives of this study were to
test the General Health Questionnaire ((GHQ-12)) with 12-items and the
Subjective Vitality Scale (VS) by telepsychiatric services. METHODS: A
sample of 196 adults aged 2060 years then completed both
questionnaires. For statistical procesing we used programs and methods by
GraphPad INstat-3.05 and PASW-18. Internal consistency was assessed by
Cronbach's alpha coefficient (CAC). The factor structures of the two
instruments were extracted by confirmatory factor analysis (CFA) and
Comparisons by Bonferroni Multiple Comparisons Test. Finally, the
relationship between the two instruments was assessed by correlation
analysis.
l i RESULTS
RESULTS: Th The mean VS score was 2222.4
4 (SD
(SD=7.4)
7 4) andd itits iinternal
t l
consistency was found to be good (CAC=0.83). The mean GHQ-12 score
was 17.4 (SD=8.0), and analysis showed satisfactory internal consistency
(CAC=0.78). Bonferroni Multiple Comparisons Test between the GHQ-12
and the VS showed statistical significance (P<0.05) in Comparison for
anxiety and depression vs. loss of confidence, statistical significance
(P<0.01) for social dysfunction vs loss of confidence, all other item showed
hight statistical significance (P<0.001). CONCLUSIONS: The results showed
that the Serbian and Bosnian versions of the General Health Questionnaire
12-item (GHQ-12) and the Subjective Vitality Scale (VS) are reliable
measures of psychological distress and vitality by telepsychiatric services.
Introduction :
 The
e Ge
General
e a Health
ea t
Questionnaire ((GHQ)) was
developed in England as a
screening instrument to
id tif psychological
identify h l i l
distress in primary care
settings
It was originally designed as a 60-
60-
item instrument but several
shortened versions are currently
available including the GHQ
available, GHQ--30,
30 the
GHQ--28, the GHQ-
GHQ GHQ-20 and the GHQ-
GHQ-12.
The shortest version of the
questionnaire (GHQ-
(GHQ-12) has been
extensivelyy validated and used in
a number of countries and in
diff
differentt languages
l
Th Subjective
The S bj ti Vitality
Vit lit Scale
S l (VS)
is a seven
seven--item instrument that
was developed by Ryan and
Fredrick to measure vitality.

The conceptp of subjective

j vitality
y
refers to the state of feeling alive
and
d alert
l t to
t having
h i energy
available to the self.
 Vit lit is
Vitality i considered
id d an aspectt
of eudaimonic well well--being (Ryan &
Deci, 2001), as being vital and
energetic is part of what it means
to be fully functioning and
psychologically
p y g y well.
Ryan and Frederick (1997)
d
developed
l d a scale
l off subjective
bj ti
vitality that has two versions.
TELEPSYCHIATRIC
TELEPSYCHIATR
TELEPSYCHIATRIC
TELEPSYCHIATRIC SERVICES
SERVICES
 THE TERM
TELEPSYCHIATRY
TELEPSYCHIATRY REFERS
TO THE USE OF
TELECOMMUNICATION
TECHNOLOGIES WITH THE
AIM OF PROVIDING
PSYCHIATRIC SERVICES
FROM A DISTANCE.
DISTANCE
 Telepsychiatric services(TS)
and e-
e-mental health services
primarily involve
videoconferencing
id f i over hihigh
h
speed (broadband) networks to
enable natural interactions
between patients and providers.
METHODS:
 METHODS:
Extensive study included 220
subjects but a total of 196 adults
subjects,
participated
pa t c pated in tthe
e study
study.
Using a standard translation procedure
th English
the E li h llanguage versionsi off th
the ttwo
instruments ((i.e. the 12-
12-item General
Health Questionnaire and the Subjective
Vitality Scale) were translated into
Serbian.
INSTRUMENTS:
Measures. 1. The General Health Questionnaire
(GHQ--12). GHQ-
(GHQ GHQ-12 include information over the
last few weeks.
weeks.
Q
Questions: Have you recently:
1. been able to concentrate on what youre doing?
2. lost much sleep p over worry?
y
3. felt that you are playing a useful part in things?
4. felt capable of making decisions about things?
5 felt constantly under strain?
5.
6. felt you couldnt overcome your difficulties?
7. been able to enjoy your normal day to day activities?
8 been able to face up to your problems?
8.
9. been feeling unhappy or depressed?
10. been losing confidence in yourself?
11. been thinking of yourself as a worthless person?
12. been feeling reasonably happy, all things
considered?
id d?
 2 The Subjective Vitality Scale
2.
(VS). Questions of Vitality Scale:
1.I feel alive and vital.
2 I don't
2.I don t feel very energetic
energetic.
3.Sometimes I feel so alive I just want to
burst.
burst.
4.I have energy and spirit.
5.I look forward to each new day.
6 I nearly
6.I l always
l ffeell alert
l t and
d awake.
k
7.I feel
ee e energized.
e g ed
 Statistical and Data Analyses
Analyses.
For statistical procesing we used
programs and methods by
SPSS--10,
SPSS 10 GraphPad INstat
INstat--3.05
3 05
and PASW
PASW--18 statiscis for
Microsoft Windows.
I t
Internall consistency
i t was assessed d by
b
calculatingg Cronbach's coefficient.
Values of 0.70 or greater were
considered
id d satisfactory
ti f t
RESULTS
 Among 220 subjects a sample of
196 adults aged 20 2060 years then
completed both questionnaires
administered by services for
telepsychiatry.
The mean age of the respondents
was 35.1 (SD
(S = 6.9)) years,
education 10 10,772,9
2 9 years
years, married
((120)) 61,2%, male (165)
( ) 84,2%.
The mean VS score was 22 22.4
4 (SD = 7.4)
7 4)
and its internal consistency was found to
b good
be d
(Cronbach's
(Cronbach s alpha coefficient = 0.83).
Using
g the Likert scale,, the mean GHQ-
GHQ Q-
12(range from 0 to 36), score was 17.4
(SD = 8.0)
8 0) and 22
22.4
4 (SD = 77.4)
4) for the
VS ((range from 6 to 36)) and analysis
y
showed satisfactory internal consistency
(Cronbach's
(Cronbach s alpha coefficient = 0.78).
0 78)
 These findings indicate that at
least 50% of the respondents
reported
p less stress and showed
high vitality. As expected, there
was a strong and significant
i ifi
negative correlation between
the GHQ-
GHQ-12 and the VS
(r =-
=-0.71, P < 0.001).
Factor analysis and internal consistency.
1. The Subjective Vitality Scale (VS).
The internal consistency of the questionnaire
was measured using Cronbach's
Cronbach s alpha
coefficient and was found to be 0.83, well
above
b th
the th
threshold
h ld ffor a satisfactory
ti f t value.
l
2. The General Health Questionnaire
(GHQ--12). The internal consistency of the
(GHQ
questionnaire was measured using
Cronbach's alpha coefficient.
 This coefficient was found to be 0.78 for the
unidimensional model, while for the two-
two-factor
and three
three--factor models the alpha values
were found to be: Anxiety/depression, 0.84;
S i ld
Social dysfunction,
f ti 0
0.76;
76 anddL
Loss off
confidence, 0.81.
Also, we tested the three factors identified by
Graetz
G ae (("anxiety
a eya andd dep
depression",
ess o , "social
soc a
dysfunction" and "loss of confidence")
Analysis showed that the model was
highly consistent with our data
data.
 Correlation and Multiple Comparisons
between the GHQ
GHQ--12 and the VS.
The correlation between the GHQ-
GHQ-12
and the VS scores was investigated and
as expected a significant negative
correlation emerged (r=-
(r=-0.71, P< 0.01),
and Bonferroni Multiple Comparisons
Test indicating that those who were
more distressed
di t d showed
h d llower llevels
l off
subjective vitality.
DISCUSSION
 This ppaper
p reports
p data
from a validation study of
the 12-item GHQ in
Serbian and Bosnian
population by
telepsichiatric services.
 I general,
In l the
th findings
fi di showed
h d
satisfactory results and were
comparable with most research
findings throughout the world
Campbell A, Knowles S: A confirmatory factor analysis of the GHQ12 using a large Australian sample.
Eur J Psychol Assess 2007, 23:2-8.
Martin CR
CR, Ne
Newell
ell RJ
RJ: Is the 12
12-item
item General Health Q
Questionnaire
estionnaire (GHQ
(GHQ-12)
12) confo
confounded
nded by
b scoring
method in individuals with facial disfigurement. Psychology and Health 2005, 20:651-659.
Mkikangas A, Feldt T, Kinnunen U, Tolvanen A, Kinnunen ML, Pulkkinen L: The factor structure and
factorial invariance of the 12-Item General Health Questionnaire (GHQ-12) across time: evidence from
two community-based
community based samples.
samples Psychol Assess 2006,
2006 18:444-451.
18:444 451
Hankins M: The factor structure of the twelve-item General Health Questionnaire (GHQ-12): the result of

negative
g p
phrasing?
g Clin Pract Epid
p Mental Health 2008,, 4:1-10.
 Our results by
y Bonferroni
Multiple Comparisons Test
b
between the
h GHQ
GHQ-12 12 and
d the
h VS
showed that three factors could
be identified
(i.e. anxiety/depression, social
dysfunction and loss of confidence).
 The findings
f from
f the present
study showed that the Serbian
and Bosnian version of the GHQ- GHQ
12 is a valid measure of
psychological distress, but the
questionnaire
ti i h has a diff
differentt
factor structure from that in the
original
g language.
g g
Conclusion
 The findings
f suggest that the
Serbian and Bosnian version
of the GHQ-
GHQ-12 is a reliable and
valid instrument for measuring
minor psychological distress
i people
in l andd has
h a good d
factor structure
structure.
 In addition, the results show that it
has good psychometric properties in
terms of internal consistency and
factor structure. Finally, as expected,
the relationship between the two
instruments was significantly
negative, lending support to their
convergent validity.