Moos R H, McCoy L, Moos B S
Center for Health Care Evaluation, Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
J Clin Psychol. 2000 Apr;56(4):449-61. doi: 10.1002/(sici)1097-4679(200004)56:4<449::aid-jclp1>3.0.co;2-8.
To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994).
We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one-year symptom and psychosocial functioning outcomes.
Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one-year psychological, social, and occupational functioning outcomes.
These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning.
评估对患者心理社会功能的整体评分是否充分，该评分是当前获取多维度精神科诊断系统的一个组成部分，并由《精神障碍诊断与统计手册》第四版（美国精神病学协会，1994年）轴V的功能大体评定量表（GAF）体现。
我们确定了1688名患有物质使用障碍的患者样本，其中许多人还患有精神障碍；检查了GAF评分的决定因素；并重点关注这些评分对患者一年症状和心理社会功能结果的预测能力。
患者的临床诊断和精神症状比其社会和职业功能更能预测GAF评分。此外，GAF评分与患者一年的心理、社会和职业功能结果仅有极小的关联。
这些发现对当前评估精神科和药物滥用患者整体功能的标准方法的概念和临床价值提出了严重质疑。
