Abstract
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
2002). Categorical data analysis. Probability and statistics. New York: Wiley-Interscience.
(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.
(1982). Unemployment and risk of minor psychiatric disorder in young people: Cross-sectional and longitudinal evidence. Psychological Medicine, 12, 789–798.
(1980). Factor analysis for categorical data. Journal of the Royal Statistical Society B, 42, 293–321.
(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.
(1991). Measuring health: A review of quality of life measurement scales. Buckingham: Open University Press.
(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.
(2007). Quality of life among older people with poor functioning. The influence of perceived control over life. Age and Ageing, 36, 310–315.
(2003). Confirmatory factor analysis of the GHQ-12: Can I see that again? Australian and New Zealand Journal of Psychiatry, 37, 475–483.
(2002). A confirmatory factor analysis of the 12-item General Health Questionnaire among older people. International Journal of Geriatric Psychiatry, 17, 739–744.
(1984). An introduction to latent variable models. London: Chapman & Hall Ltd.
(1999). Incidence of major depression in a very elderly population. International Journal of Geriatric Psychiatry, 14, 368–372.
(2004). Measurement invariance in the General Health Questionnaire-12 in young Australian adolescents. European Child and Adolescent Psychiatry, 13, 1–7.
(2002). Rates and predictors of mortality in an aging, rural, community-based cohort: The role of depression. Archives General Psychiatry, 59, 1046–1052.
(1972). The detection of psychiatric illness by questionnaire. Maudsley [Monograph No. 21]. Oxford, England: Oxford University Press.
(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.
(1998). Why GHQ threshold varies from one place to another. Psychological Medicine, 28, 915–921.
(1988). A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson.
(1999). Validation of the General Health Questionnaire-12 using a sample of employees from England’s health care services. Psychological Assessment, 11, 159–165.
(1998). Depression and depressive symptoms in old age. In , Clinical geropsychology (pp. 211–217). Washington, DC: APA.
(1978). Factor analysis: Statistical methods and practical issues (4th ed.). Beverly Hills: Sage.
(1968). Latent structure analysis. Boston: Houghton Mifflin Co.
(2001). Testing the number of components in a normal mixture. Biometrika, 88, 767–778.
(2002). Latent class models for clustering: A comparison with K-means. Canadian Journal of Marketing Research, 20, 37–44.
(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.
(1986). Misclassification by psychiatric screening questionnaires. Journal of Chronic Disease, 39, 371–378.
(2001). Disability associated with depressive symptoms in elderly primary care attenders. Archives of Gerontology and Geriatric, Suppl. 7, 261–266.
(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.
(2004). Mplus user’s guide: Statistical analysis with latent variables (version 3) [Computer software]. Los Angeles: Muthen & Muthen.
(2001). The incidence of first-onset depression in a population followed from the age of 70 to 85. Psychological Medicine, 31, 1159–1168.
(2006). Psychological distress, loneliness, and disability in old age. Psychology, Health, and Medicine, 11, 221–232.
(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.
(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.
(2005). Alternative factor models and factorial invariance of the GHQ-12: A large sample analysis using confirmatory factor analysis. Psychological Assessment, 17, 231–236.
(2004). Psychiatric epidemiology of old age: The H70 study – The NAPE lecture 2003. Acta Psychiatrica Scandinavica, 109, 4–18.
(2003). Latent class models for classification. Computational Statistics and Data Analysis, 41, 531–537.
(2000). The activity restriction model of depressed effect, antecedents, and consequences of restricted normal activities. In , Physical illness and depression in older adults. A handbook of theory, research and practice (pp. 173–200). New York: Kluwer /Plenum.
(