Abstract
Although mental health program development and service delivery have progressed in Malaysia since its independence in 1957, a shortage of mental health professionals remains a main barrier to mental health care (Haque, 2005). Stigma and cultural beliefs about mental illness may further impede psychological help-seeking. An easy-to-use mental health screener such as the 12-item General Health Questionnaire (GHQ-12) could be used to streamline mental health service delivery and to facilitate integration into primary health care settings. In this study, we conducted a Multigroup Confirmatory Factor Analysis (MGCFA) across English and Chinese language versions for the GHQ-12 to examine the fit of existing factor structures for the GHQ-12. Participants were Malaysian college students of diverse ethnicities attending 2 schools in Malaysia who completed English or Chinese versions of the GHQ-12 (English subsample, n = 151, Chinese subsample, n = 127). Results suggested that an eight-item version of Ye’s (2009) model provided the best fit for both language versions. However, some items on the Chinese version appear to underestimate general psychological distress compared with the English version, thus potentially limiting its utility. Possible reasons for differential item performance and implications of the study are discussed.
References
2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/principles.pdf
. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246. 10.1037/0033-2909.107.2.238
(2006). When does measurement invariance matter? Medical Care, 44, S176–S181. 10.1097/01.mlr.0000245143.08679.cc
(2006). Confirmatory factor analysis for applied research. New York, NY: Guilford Press.
(2013). The world factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/my.html
. (2004). Some recommendations to assess depression in Chinese people in Australasia. Australian and New Zealand Journal of Psychiatry, 38, 141–147. 10.1080/j.1440-1614.2004.01321.x
(2008). What happens if we compare chopsticks with forks? The impact of making inappropriate comparisons in cross-cultural research. Journal of Personality and Social Psychology, 95, 1005–1018. 10.1037/a0013193
(1986). The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychological Medicine, 16, 415–422. 10.1017/S0033291700009247
(1989). A review on the clinical applications of the Chinese MMPI. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 230–237. 10.1037/1040-3590.1.3.230
(1999). Testing factorial invariance across groups: A reconceptualization and proposed new method. Journal of Management, 25, 1–27. 10.1177/014920639902500101
(2003). Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population. Psychiatry and Clinical Neurosciences, 57, 379–383. 10.1046/j.1440-1819.2003.01135.x
(2012). The importance of modeling method effects: Resolving the (uni)dimensionality of the loneliness questionnaire. Journal of Personality Assessment, 94, 186–195. 10.1080/00223891.2011.627967
(2013). Factorial validity and invariance of the GHQ-12 among clinical and nonclinical samples. Assessment, 20, 219–229. 10.1177/1073191112465768
(2010). Cross-cultural adaptation of research instruments: Language, setting, time and statistical considerations. BMC Medical Research Methodology, 10,
(13 . 10.1186/1471-2288-10-131972). The detection of psychiatric illness by questionnaire, No. 21. London: New York, NY: Oxford University Press.
(1970). Psychiatric illness in general practice. A detailed study using a new method of case identification. British Medical Journal, 2, 439–443. 10.1136/bmj.2.5707.439
(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. 10.1017/S0033291796004242
(1988). A user’s guide to the general health questionnaire. London, England: GL Assessment Limited.
(2000). Cultural identity and illness: Fulani views. Culture, Medicine and Psychiatry, 24, 297–330. 10.1023/A:1005677825795
(1991). Multidimensional properties of the General Health Questionnaire. Social Psychiatry and Psychiatric Epidemiology, 26, 132–138. 10.1007/BF00782952
(1991). Reliability and the factor structure of the Yoruba version of the 12-item General Health Questionnaire. Acta Psychiatrica Scandinavica, 84, 125–129. 10.1111/j.1600-0447.1991.tb03115.x
(2001). Response bias and public and private self-consciousness in Chinese. Social Behavior and Personality, 29, 733–742. 10.2224/sbp.2001.29.8.733
(2008). The factor structure of the twelve item General Health Questionnaire (GHQ-12): The result of negative phrasing? Clinical Practice and Epidemiology in Mental Health, 4, 10. 10.1186/1745-0179-4-10
(2005). Mental health concepts and program development in Malaysia. Journal of Mental Health, 14, 183–195. 10.1080/09638230500059997
(1998). A model of equivalence in the cultural adaptation of HRQoL instruments: The universalist approach. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 7, 323–335. 10.1023/A:1008846618880
(2011). Negative binomial regression. New York, NY: Cambridge University Press. 10.1017/CBO9780511973420
(2014). Cross-language consistency of the Comprehensive Assessment of Psychopathic Personality (CAPP) model. Personality Disorders: Theory, Research, and Treatment, 5, 356–368. 10.1037/per0000069
(2009). Measurement invariance matters: A case made for the ORTOFIN. Journal of Economic Psychology, 30, 667–674. 10.1016/j.joep.2009.06.002
(1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6, 65–70.
(2007). Statistical methods for psychology (6th ed.). Belmont, CA: Thomson Wadsworth.
(2006). Factor structure of the Chinese version of the 12-item General Health Questionnaire (GHQ-12) in pregnancy. Journal of Reproductive and Infant Psychology, 24, 87–98. 10.1080/02646830600643882
(2005). Religious practice and psychological distress: The importance of gender, ethnicity and immigrant status. Transcultural Psychiatry, 42, 657–675. 10.1177/1363461505058921
(2004). A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health: Journal of the International Society for the Investigation of Stress, 20, 11–20. 10.1002/smi.993
(2012). Psychological well-being using the 12-item General Health Questionnaire (GHQ12) and age in Japanese working men. Journal of Psychiatric and Mental Health Nursing, 19, 758–760. 10.1111/j.1365-2850.2012.01936.x
(1997). General Health Questionnaire (GHQ12 & GHQ28): Psychometric properties and factor structure of the scales in a Turkish primary care sample. Social Psychiatry and Psychiatric Epidemiology, 32, 327–331. 10.1007/BF00805437
(1980). Patients and healers in the context of culture: An exploration of the borderland between Anthropology, Medicine, and Psychiatry. Berkeley, CA: University of California Press.
(2009). Factorial structure of the Chinese version of the 12-item General Health Questionnaire in adolescents. Journal of Clinical Nursing, 18, 3253–3261. 10.1111/j.1365-2702.2009.02905.x
(1999). Mental health issues for Asian Americans. Psychiatric Services, 50, 774–780. 10.1176/ps.50.6.774
(1999). Assessing the multidimensionality of the 12-item General Health Questionnaire. Psychological Reports, 84, 927–935. 10.2466/pr0.1999.84.3.927
(2004). Factor structure of the Hospital Anxiety and Depression Scale in individuals with facial disfigurement. Psychology, Health and Medicine, 9, 327–336. 10.1080/13548500410001721891
(2012). The role of mindfulness and psychological flexibility in somatization, depression, anxiety, and general psychological distress in a nonclinical college sample. Journal of Evidence-Based Complementary and Alternative Medicine, 17, 66–71. 10.1177/2156587211423400
(1999). Test theory: A unified approach. Mahwah, NJ: Erlbaum.
(1978). Basic principles of ROC analysis. Seminars in Nuclear Medicine, 8, 283–298. 10.1016/S0001-2998(78)80014-2
(2004). Evaluating the impact of partial factorial invariance on selection in two populations. Psychological Methods, 9, 93–115. 10.1037/1082-989X.9.1.93
(2004). Health facts, 2004. Retrieved from www.infosihat.gov.my/fakta/file/HEALTHFACTS2004.pdf
. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén & Muthén.
(1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
(2004). Malaysia mental health country profile. International Review of Psychiatry, 16, 167–176. 10.1080/09540260310001635203
(1992). The multigroup ethnic identity measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156–176. 10.1177/074355489272003
(1994). Reliability, validity and factor structure of the 12-item General Health Questionnaire among young males in Italy. Acta Psychiatrica Scandinavica, 90, 432–437. 10.1111/j.1600-0447.1994.tb01620.x
(2001). Reliability and validity of the General Health Questionnaire (GHQ-12) among urological patients: A Malaysian study. Psychiatry and Clinical Neurosciences, 55, 509–513. 10.1046/j.1440-1819.2001.00897.x
(1995). Bayesian model selection in social research. Sociological Methodology, 25, 111–163. 10.2307/271063
(1998). Testing measurement models for factorial invariance: A systematic approach. Educational and Psychological Measurement, 58, 1017–1034. 10.1177/0013164498058006010
(2013). Identifying elders with neuropsychiatric problems in a clinical setting. Journal of Neurosciences in Rural Practice, 4, S24–S30. 10.4103/0976-3147.116438
(2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99, 323–338. 10.3200/JOER.99.6.323-338
(2013). Primary care, behavioral health, and public health: Partners in reducing mental health stigma. American Journal of Public Health, 103, 774–776. 10.2105/AJPH.2013.301214
(2013). The factor structure of the GHQ-12: The interaction between item phrasing, variance and levels of distress. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 22, 145–152. 10.1007/s11136-012-0133-7
(1998). Assessing measurement invariance in cross-national consumer research. Journal of Consumer Research, 25, 78–107. 10.1086/209528
(1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173–180. 10.1207/s15327906mbr2502_4
(2009). Increasing mental health awareness and appropriate service use in older Chinese Americans: A pilot intervention. Patient Education and Counseling, 76, 143–146. 10.1016/j.pec.2008.11.008
(2013). A measurement invariance examination of the Revised Child Anxiety and Depression Scale in a Southern sample: Differential item functioning between African American and Caucasian youth. Assessment, 20, 175–187. 10.1177/1073191112450907
(1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10. 10.1007/BF02291170
(2012). Model selection and psychological theory: A discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychological Methods, 17, 228–243. 10.1037/a0027127
(2000). The stability of the factor structure of the General Health Questionnaire. Psychological Medicine, 30, 823–829. 10.1017/S0033291799002287
(1997). Has psychological distress among UK South Asians been under-estimated? A comparison of three measures in the west of Scotland population. Ethnicity & Health, 2, 21–29. 10.1080/13557858.1997.9961812
(1989). The General Health Questionnaire: Reliability and validity for Australian youth. Australian and New Zealand Journal of Psychiatry, 23, 53–58. 10.3109/00048678909062592
(1977). A factor analytic study on the twelve item general health questionnaire. The Australian and New Zealand Journal of Psychiatry, 11, 269–272. 10.3109/00048677709159577
(2009). Factor structure of the General Health Questionnaire (GHQ-12): The role of wording effects. Personality and Individual Differences, 46, 197–201. 10.1016/j.paid.2008.09.027
(1990). Explanatory models of major depression and implications for help-seeking among immigrant Chinese-American women. Culture, Medicine and Psychiatry, 14, 393–408. 10.1007/BF00117563
(2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes (Unpublished doctoral dissertation). University of California, Los Angeles. Retrieved from http://www.statmodel.com/download/Yudissertation.pdf
(2006). Affirmative action: Malaysia. Retrieved from http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/4078.pdf
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