Skip to main content
Original Article

Psychological Disorders in Old Age

Better Identification for Better Treatment

Published Online:https://doi.org/10.1027/1015-5759/a000006

Optimal cutoff points based on response to the General Health Questionnaire (GHQ) used to identify cases of psychological disorder have serious limitations. We used a latent class model (LCM) to improve case identification, on a national survey data of 999 individuals aged 65 + years, living in Britain. The method suggested three clusters of homogeneous response to GHQ-12, comprising 70% noncases, 24% possible, and 6%, probable cases. The three groups differ in characteristics including objective ones, such as health and subjective such as optimism. The solution seems sensible in recognizing a range of case severity, which will help in applying suitable interventions on mild and moderate cases that are common among older people and are likely to become more serious.

References

  • Agresti, A. (2002). Categorical data analysis. Probability and statistics. New York: Wiley-Interscience. First citation in articleCrossrefGoogle Scholar

  • Ayis, S. , Gooberman-Hill, R. , Ebrahim, S. (2003). Long-standing and limiting long-standing illness in older people: Associations with chronic diseases, psychosocial, and environmental factors. Age and Ageing, 32, 265–272. First citation in articleCrossrefGoogle Scholar

  • Banks, M.H. , Jackson, P.R. (1982). Unemployment and risk of minor psychiatric disorder in young people: Cross-sectional and longitudinal evidence. Psychological Medicine, 12, 789–798. First citation in articleCrossrefGoogle Scholar

  • Bartholomew, D.J. (1980). Factor analysis for categorical data. Journal of the Royal Statistical Society B, 42, 293–321. First citation in articleGoogle Scholar

  • Bisschop, M.I. , Kriegsman, D.M. , Deeg, D.J. , Beekman, A.T. , Willem van Tilburg, T.W. (2004). The longitudinal relation between chronic diseases and depression in older persons in the community: The Longitudinal Aging Study Amsterdam. Journal of Clinical Epidemiology, 57, 187–194. First citation in articleCrossrefGoogle Scholar

  • Bowling, A. (1991). Measuring health: A review of quality of life measurement scales. Buckingham: Open University Press. First citation in articleGoogle Scholar

  • Bowling, A. , Gabriel, Z. (2004). An integrational model of quality of life in older age. Results from the ESRC/MRC, HSRC, quality of life survey in Britain. Social Indicators Research, 69, 1–36. First citation in articleCrossrefGoogle Scholar

  • Bowling, A. , Seetai, S. , Morris, R. , Ebrahim, S. (2007). Quality of life among older people with poor functioning. The influence of perceived control over life. Age and Ageing, 36, 310–315. First citation in articleCrossrefGoogle Scholar

  • Campbell, A. , Walker, J. , Farrell, G. (2003). Confirmatory factor analysis of the GHQ-12: Can I see that again? Australian and New Zealand Journal of Psychiatry, 37, 475–483. First citation in articleCrossrefGoogle Scholar

  • Cheung, Y.B. (2002). A confirmatory factor analysis of the 12-item General Health Questionnaire among older people. International Journal of Geriatric Psychiatry, 17, 739–744. First citation in articleCrossrefGoogle Scholar

  • Everitt, B.S. (1984). An introduction to latent variable models. London: Chapman & Hall Ltd. First citation in articleCrossrefGoogle Scholar

  • Forsell, Y. , Winblad, B. (1999). Incidence of major depression in a very elderly population. International Journal of Geriatric Psychiatry, 14, 368–372. First citation in articleCrossrefGoogle Scholar

  • French, D.J. , Tait, R.J. (2004). Measurement invariance in the General Health Questionnaire-12 in young Australian adolescents. European Child and Adolescent Psychiatry, 13, 1–7. First citation in articleCrossrefGoogle Scholar

  • Ganguli, M. , Dodge, H.H. , Mulsant, B.H. (2002). Rates and predictors of mortality in an aging, rural, community-based cohort: The role of depression. Archives General Psychiatry, 59, 1046–1052. First citation in articleCrossrefGoogle Scholar

  • Goldberg, D.P. (1972). The detection of psychiatric illness by questionnaire. Maudsley [Monograph No. 21]. Oxford, England: Oxford University Press. First citation in articleGoogle Scholar

  • Goldberg, D.P. , Gater, R. , Sartorius, N. , Ustun, T.B. , Piccinelli, M. , Gureje, O. et al. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197. First citation in articleCrossrefGoogle Scholar

  • Goldberg, D.P. , Oldehinkel, T. , Ormel, J. (1998). Why GHQ threshold varies from one place to another. Psychological Medicine, 28, 915–921. First citation in articleCrossrefGoogle Scholar

  • Goldberg, D. , Williams, P. (1988). A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson. First citation in articleGoogle Scholar

  • Hardy, G.E. , Shapiro, D.A. , Haynes, C.E. , Rick, J.E. (1999). Validation of the General Health Questionnaire-12 using a sample of employees from England’s health care services. Psychological Assessment, 11, 159–165. First citation in articleCrossrefGoogle Scholar

  • Kasl-Godley, J. , Gatz, M. , Fiske, A. (1998). Depression and depressive symptoms in old age. In I. Nordhus, G. VandenBos, S. Berg, P. Fromholt, (Eds.), Clinical geropsychology (pp. 211–217). Washington, DC: APA. First citation in articleCrossrefGoogle Scholar

  • Kim, J.-O. , & Mueller, C.W. (1978). Factor analysis: Statistical methods and practical issues (4th ed.). Beverly Hills: Sage. First citation in articleCrossrefGoogle Scholar

  • Lazarfeld, P.F. (1968). Latent structure analysis. Boston: Houghton Mifflin Co. First citation in articleGoogle Scholar

  • Lo, Y.T. , Mendell, N.R. , Rubin, D.B. (2001). Testing the number of components in a normal mixture. Biometrika, 88, 767–778. First citation in articleCrossrefGoogle Scholar

  • Magidson, J. , Vermunt, J.K. (2002). Latent class models for clustering: A comparison with K-means. Canadian Journal of Marketing Research, 20, 37–44. First citation in articleGoogle Scholar

  • Mäkikangas, A. , Feldt, T. , Kinnunen, U. , Tolvanen, A. , Kinnunen, M.L. , Pulkkinen, L. (2006). The factor structure and factorial invariance of the 12-item General Health Questionnaire (GHQ-12) across time: Evidence from two community-based samples. Psychological Assessment, 18, 444–451. First citation in articleCrossrefGoogle Scholar

  • Mari, J.J. , & Williams, P. (1986). Misclassification by psychiatric screening questionnaires. Journal of Chronic Disease, 39, 371–378. First citation in articleCrossrefGoogle Scholar

  • Menchetti, M. , Fava, C. , Berardi, D. (2001). Disability associated with depressive symptoms in elderly primary care attenders. Archives of Gerontology and Geriatric, Suppl. 7, 261–266. First citation in articleCrossrefGoogle Scholar

  • Montazeri, A. , Harirchi, A.M. , Shariati, M. , Garmaroudi, G. , Ebadi, M. , Fateh, A. (2003). The 12-Item General Health Questionnaire (GHQ-12): Translation and validation study of the Iranian version. Health and Quality of Life Outcomes, 1(66), 1–4. First citation in articleGoogle Scholar

  • Muthen, L.K. , Muthen, B.O. (2004). Mplus user’s guide: Statistical analysis with latent variables (version 3) [Computer software]. Los Angeles: Muthen & Muthen. First citation in articleGoogle Scholar

  • Palsson, S.P. , Ostling, S. , Skoog, I. (2001). The incidence of first-onset depression in a population followed from the age of 70 to 85. Psychological Medicine, 31, 1159–1168. First citation in articleCrossrefGoogle Scholar

  • Paul, C. , Ayis, S. , & Ebrahim, S. (2006). Psychological distress, loneliness, and disability in old age. Psychology, Health, and Medicine, 11, 221–232. First citation in articleGoogle Scholar

  • Power, C. , Graham, H. , Due, P. , Hallqvist, J. , Joung, I. , Kuh, D. et al. (2005). The contribution of childhood and adult socioeconomic position to adult obesity and smoking behavior: An international comparison. International Journal of Epidemiology, 34, 335–344. First citation in articleCrossrefGoogle Scholar

  • Samuelsson, G. , Camish-Svensson, C. , Hagberg, B. , Sundstrom, G. , Dehlin, O. (2005). Incidence and risk factors for depression and anxiety disorders: Results from a 34-year longitudinal Swedish cohort study. Aging and Mental Health, 9, 571–575. First citation in articleCrossrefGoogle Scholar

  • Shevlin, M. , Adamson, G. (2005). Alternative factor models and factorial invariance of the GHQ-12: A large sample analysis using confirmatory factor analysis. Psychological Assessment, 17, 231–236. First citation in articleCrossrefGoogle Scholar

  • Skoog, I. (2004). Psychiatric epidemiology of old age: The H70 study – The NAPE lecture 2003. Acta Psychiatrica Scandinavica, 109, 4–18. First citation in articleCrossrefGoogle Scholar

  • Vermunt, J.K. , Magidson, J. (2003). Latent class models for classification. Computational Statistics and Data Analysis, 41, 531–537. First citation in articleCrossrefGoogle Scholar

  • Williamson, G. , Shaffer, D. (2000). The activity restriction model of depressed effect, antecedents, and consequences of restricted normal activities. In G. Williamson, D. Shaffer, P. Parmelee, (Eds.), Physical illness and depression in older adults. A handbook of theory, research and practice (pp. 173–200). New York: Kluwer /Plenum. First citation in articleCrossrefGoogle Scholar