Assessing psychological distress in patients with skin diseases: reliability, validity and factor structure of the GHQ‐12

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Abstract
Objective: We studied reliability, validity and factor structure of the 12‐item General Health Questionnaire (GHQ‐12) in dermatological patients.Methods: Subjects attending a dermatological outpatient clinic were administered the GHQ‐12 and the Skindex‐29. A random subsample was mailed another copy of the questionnaires to be completed within 1 week.Results: A total of 2579 subjects completed the GHQ‐12. The internal consistency of the GHQ‐12 was high (Cronbach’s α = 0.88). Test–retest reliability on 137 subjects was also fairly satisfactory (intraclass correlation coefficient = 0.72), notwithstanding a re‐test artefact probably related to reassurance from the physician. Evidence of construct validity was provided by the pattern of correlation between scores on the GHQ‐12 and on the scales of Skindex‐29, which were as hypothesized. Also, GHQ‐12 scores of patients in different clinical groups varied as hypothesized, with patients affected by inflammatory skin diseases scoring significantly higher than patients with isolated skin lesions. We obtained both a two‐factor and a three‐factor solution: the latter seemed theoretically more appropriate, although the first may have practical advantages. A ‘social dysfunction’ factor emerged in both analyses, while the other items loaded on a ‘general dysphoria’ factor or on two separate factors interpreted as ‘anxiety’ and ‘loss of self‐esteem’.Conclusions: The GHQ‐12 is a reliable and valid instrument with a factor structure that is quite stable across different samples as well as across diverse cultures. Its brevity and easiness of completion make it a useful tool to assess psychological distress in dermatological patients.

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