Köhler Ole, Horsdal Henriette Thisted, Baandrup Lone, Mors Ole, Gasse Christiane
Psychosis Research Unit, Aarhus University Hospital, Risskov.
National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus.
Clin Epidemiol. 2016 Sep 2;8:323-32. doi: 10.2147/CLEP.S109036. eCollection 2016.
Assessment of psychosocial functioning in people with schizophrenia is important. The Global Assessment of Functioning (GAF-F) scale represents a widely applied, easy, and quick tool, but its validity and reliability have been debated. The aim was to investigate whether GAF-F scores are associated with other indicators of functioning, severity, and hospitalization.
A Danish population-based cohort study of adults (≥18 years) with a recorded GAF-F score at first-time schizophrenia diagnosis during 2004-2011 was performed. The internal validity of GAF-F was evaluated by assessing its association with other baseline measures of functioning and illness severity. Risk of schizophrenia hospitalization within 2 years was evaluated using Cox regression stratified by sex and adjusted for age, year of diagnosis, and inpatient/outpatient status at diagnosis.
We identified 2,837 cases of schizophrenia with a GAF-F score at first-time diagnosis (73.0% inpatients; 62.6% males). GAF-F was associated with several baseline measures of functioning and illness severity, such as female sex, being in work, and a longer baseline hospitalization. Lower GAF-F scores were associated with higher hospitalization risk among males (reference GAF-F 61-100): GAF-F 51-60: hazard rate ratio (HRR) =1.24 (95% confidence interval [CI] =0.89-1.75); GAF-F 41-50: HRR =1.31 (95% CI =0.97-1.77); GAF-F 31-40: HRR =1.36 (95% CI =1.01-1.82); GAF-F 21-30: HRR =1.50 (95% CI =1.09-2.06); and GAF-F 1-20: HRR =2.30 (95% CI =1.36-3.90), fitting a dose-response relationship (P=0.031). This association was not found in females.
GAF-F at first-time schizophrenia diagnosis showed good internal validity against other measures of functionality in a Danish hospital setting. Severe impairment (as measured by the GAF-F score) at first-time schizophrenia diagnosis was associated with a higher risk of 2-year hospitalization among males, which may indicate sex differences in the course of disease and treatment response.
评估精神分裂症患者的心理社会功能很重要。全球功能评估（GAF-F）量表是一种广泛应用、简便快捷的工具，但其有效性和可靠性一直存在争议。目的是调查GAF-F评分是否与其他功能、严重程度及住院指标相关。
对2004年至2011年首次诊断为精神分裂症且有记录GAF-F评分的丹麦成年（≥18岁）人群进行队列研究。通过评估GAF-F与其他功能和疾病严重程度基线指标的关联来评价其内部效度。使用Cox回归按性别分层，并对年龄、诊断年份及诊断时的住院/门诊状态进行校正，评估2年内精神分裂症住院风险。
我们确定了2837例首次诊断时有GAF-F评分的精神分裂症病例（73.0%为住院患者；62.6%为男性）。GAF-F与多项功能和疾病严重程度基线指标相关，如女性、就业及较长的基线住院时间。男性中较低的GAF-F评分与较高的住院风险相关（参考GAF-F 61 - 100）：GAF-F 51 - 60：风险率比（HRR）=1.24（95%置信区间[CI]=0.89 - 1.75）；GAF-F 41 - 50：HRR =1.31（95% CI =0.97 - 1.77）；GAF-F 31 - 40：HRR =1.36（95% CI =1.01 - 1.82）；GAF-F 21 - 30：HRR =1.50（95% CI =1.09 - 2.06）；GAF-F 1 - 20：HRR =2.30（95% CI =1.36 - 3.90），呈现剂量反应关系（P =0.031）。女性中未发现这种关联。
在丹麦医院环境中，首次精神分裂症诊断时的GAF-F相对于其他功能指标显示出良好的内部效度。首次精神分裂症诊断时的严重损害（以GAF-F评分衡量）与男性2年住院风险较高相关，这可能表明疾病过程和治疗反应存在性别差异。
