Timothy J. Avery, B.S.1,5; Will Barone, M.A.2,5; Samuel H. Barkin, M.S.3,5; Graham Danzer, LCSW, M.R.A.S.4,5; David Sugarbaker, M.S., M.P.H.1,5; Joseph ...
A Comparison of Measures of Psychiatric Symptom Change: GAF and BPRS-‐E Timothy J. Avery, B.S.1,5; Will Barone, M.A.2,5; Samuel H. Barkin, M.S.3,5; Graham Danzer, LCSW, M.R.A.S.4,5; David Sugarbaker, M.S., M.P.H.1,5; Joseph Walker, M.D. 5; Doug Cort, Ph.D.5 1PGSP-‐Stanford Psy.D. ConsorEum at Palo Alto University; 2John F. Kennedy University; 3Columbia University’s Teachers College; 4California School of Professional Psychology; 5John George Psychiatric Pavilion BPRS-‐E Improvement vs. GAF Improvement
Abstract
Discussion
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ρ=-‐.226 p=.029
Grandiosity Improvement
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BPRS-‐E Improvement
We compared the Global Assessment of Functioning (GAF) with a standardized measure of psychiatric symptom severity, the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E). There was no overall correlation between changes in BPRS-E and GAF, although some item level correlations were significant and possibly clinically meaningful.
Grandiosity Item Improvement vs. GAF Improvement
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Suspiciousness Item Improvement vs. GAF Improvement Suspiciousness Improvement
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IntroducNon Measuring symptom change is an important part of evaluating psychiatric care. Two ways of measuring patient symptom change during inpatient psychiatric care entail pre and post hospitalization measures of the Global Assessment of Functioning (GAF) and the Brief Psychiatric Rating Scale Expanded Version (BRPS-E). The BPRS-E consists of 24 items that attempt to cover a wide range of psychiatric signs and symptoms. While the GAF is a fast and easy measure for psychiatrists and psychologists to evaluate the impact of symptoms on functioning before and after inpatient treatment, its utility in research suggests uneven and even low levels of reliability and validity. Although it is a potentially longer semi-structured interview, a more reliable evaluation of symptomatic change may come from administration of the BPRS-E at the same intervals. Aim: This study sought to compare measures of change gathered by psychiatrists’ use of pre and post hospitalization GAF scores with evaluations of BPRS-E symptomatic change for the same patients at the same intervals.
GAF Improvement
Methods and Materials Sample Characteristics • Acute Serious Mental Illness Inpatients • Diagnoses: Schizophrenia, Undifferentiated (n=29); Schizoaffective (n=29); Psychotic Disorder NOS (n=15); Bipolar I (n=21); Depressive Disorder NOS (n=4) • N= 98 • 59 Males, 39 Females • 19-67 years of age Methods • BPRS-E Administered within four days of entering the hospital unit, and within two days of discharge. • GAF determined upon admission and upon discharge. Statistical Analysis • Spearman’s rho was used to compare GAF change and BPRS-E change. GAF change scores were non-parametric.
ρ=-‐.205 p=.047
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Results Correlation analyses (Spearman’s rho) did not reveal significant correlation between changes in GAF scores from intake to discharge compared with changes for the same patients in BPRS-E total scores for the same interval. There were, however, negative correlations between GAF improvement and two BPRS item improvements: • Grandiosity (ρ = -.226, p = .029) • Suspiciousness (ρ = -.205, p = .047). Further, there was no significant correlation between changes for GAF and BPRS-E scores for any sub-sample of specific diagnoses.
Given the high level of reliability and validity of the BPRS-E, these results call into question the validity of GAF scores in evaluating change in this population. The BPRS-E may be of greater utility for understanding symptom changes given the psychometric properties and specific symptoms evaluated. Given that GAF scores have not been found to correlate with the more robust BPRS-E, clinicians may choose to discontinue use of the GAF for the more specific BPRS-E. This is congruent with the decision to no longer include the GAF in the DSM-5 diagnosis format. A possible explanation for the negative correlation between GAF improvement and improvement in BPRS-E grandiosity and suspiciousness, is that grandiosity and suspiciousness provide some coping mechanism that supports functioning for severely mentally ill patients, which may lead to a determined higher score in the GAF.
Conclusions Assessed GAF change does not correlate with overall symptom change as measured by the BPRS-E among acute serious mental illness patients. Further studies with a larger sample sizes would be needed to ascertain the validity and reliability of these findings.
Acknowledgments Guy C. Qvistgaard, M.S., M.F.T., Administrator, John George Psychiatric Hospital The treatment teams at John George Psychiatric Hospital
