GHQ-28

To evaluate the effect of the psychosocial intervention on well-being, the GHQ-28 was
chosen as the primary outcome based on results from a comparable trial and because it was
evaluated as an appropriate tool to capture emotional stress. The GHQ-28 requests
participants to indicate how their health in general has been over the past few weeks, using
behavioural items with a 4-point scale indicating the following frequencies of experience:
“not at all”, “no more than usual”, “rather more than usual” and “much more than usual”. The
scoring system applied in this study was the same as the original scoring system, the Likert
scale 0, 1, 2, 3. The minimum score for the 28 version is 0, and the maximum is 84. Higher
GHQ-28 scores indicate higher levels of distress. Goldberg suggests that participants with
total scores of 23 or below should be classified as non-psychiatric, while participants with
scores > 24 may be classified as psychiatric, but this score is not an absolute cut-off. It is
recommended that each researcher derive a cut-off score based on the mean of their
respective sample.

Purpose of the measure

The General Health Questionnaire – 28 (GHQ-28) is self-report screening measure used to

detect possible psychological disorder. The GHQ-28 identifies two main concerns: (1) the
inability to carry out normal functions; and (2) the appearance of new and distressing
phenomena (Goldberg & Hillier, 1979).

Available versions

The GHQ-28 is derived from the original 60-item General Health Questionnaire. There is
also a 30-item version (GHQ-30) and a 12-item version (GHQ-12).

Features of the measure

Items:
The GHQ-28 consists of 28 questions designed to identify whether an individual’s current
mental state differs from his/her typical state. Questions include:

Have you recently been feeling perfectly well and in good health?
Have you recently lost much sleep over worry?
Have you recently been managing to keep yourself busy and occupied?
Have you recently felt constantly under strain?
Have you recently felt that life is entirely hopeless?

Factor analysis of the GHQ-28 identified four 7-item subscales:

Somatic symptoms (items 1-7)
Anxiety/insomnia (items 8-14)
Social dysfunction (items 15-21)
Severe depression (items 22-28).
 There is a high correlation between the anxiety subscale and the total score, showing that
anxiety is a common symptom of psychiatric disorders (Goldberg & Hillier, 1979).
Accordingly, subscales are not independent of each other and subscores should not be used to
indicate specific psychological diagnoses. Rather, the measure is used to identify the presence
of symptoms compared to what is normal for the individual (Salter et al., 2013).

Scoring:
The individual is asked to rate how he/she feels in relation to each question, according to the
following criteria:

 Better than usual

 Same as usual
 Worse than usual
 Much worse than usual

Different scoring methods have been reported. One scoring method adopts a Likert scale of 0
to 3, resulting in a total possible score range of 0 to 84. This Likert scoring system was used
with the original 60-item GHQ (Goldberg & Hillier, 1979).