Division of Mental Health and Addiction, Oslo University Hospital, Ullevaal, PO Box 4956 Nydalen, 0424 Oslo, Norway.
Compr Psychiatry. 2012 Apr;53(3):292-8. doi: 10.1016/j.comppsych.2011.04.007. Epub 2011 May 31.
The objective was to investigate the validity and clinical impact of the symptom and function dimensions of the Global Assessment of Functioning (GAF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition. Is there any need for revision with respect to the DSM, Fifth Edition?
The sample comprised 2695 patients consecutively admitted to 14 different treatment units participating in the Norwegian Network of Personality-Focused Treatment Programs from 1998 to 2007.
Convergent and discriminant validity of the symptom and function dimensions of GAF was analyzed by their associations with demographic variables, diagnostic status, and other self-reported variables assessing symptom distress, interpersonal problems, work and social impairment, and quality of life.
The validity of the separate GAF dimensions was confirmed by discriminant and concurrent associations to other relevant clinical measures. However, the traditional GAF measure based on the lower score of either symptom or function level was found to serve well as a global indicator of symptom distress and social dysfunction. A substantial difference between the symptom and function score of GAF was found in about 10% of the cases; and when differences were found, functional impairment was most often more severe.
This study confirms the validity of the 2 GAF dimensions. However, substantial differences between these dimensions are rarely occurring. We therefore recommend that the GAF scale be prolonged in the DSM, Fifth Edition, roughly in the same shape as in the DSM, Fourth Edition.
本研究旨在探讨《精神障碍诊断与统计手册》（DSM）第四版中全球功能评估（GAF）的症状和功能维度的有效性及其对临床的影响。DSM-5 是否需要对此进行修订？
本研究样本包括了 2695 名患者，他们在 1998 年至 2007 年间连续入住了 14 个不同的治疗单位，这些治疗单位都参与了挪威以人格为中心的治疗方案网络。
通过与人口统计学变量、诊断状况以及其他自我报告的评估症状困扰、人际问题、工作和社会功能障碍以及生活质量的变量进行相关性分析，来检验 GAF 的症状和功能维度的聚合效度和区别效度。
GAF 各维度的有效性通过与其他相关临床指标的区别和同时关联得到了确认。然而，基于症状或功能水平较低的传统 GAF 测量值被发现是评估症状困扰和社会功能障碍的一个很好的整体指标。在大约 10%的病例中，GAF 的症状和功能评分存在显著差异；而且当差异存在时，功能障碍通常更为严重。
本研究证实了 GAF 的两个维度的有效性。然而，这些维度之间的显著差异很少发生。因此，我们建议在 DSM-5 中延长 GAF 量表，大致延续 DSM-4 中的形状。
