Global assessment of functioning ratings and the allocation and outcomes of mental health services
Global assessment of functioning ratings and the allocation and outcomes of mental health services
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DOI：
10.1176/appi.ps.53.6.730
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发表时间：
2002-06-01
影响因子：
3.8
通讯作者：
Moos, BS
中科院分区：
文献类型：
--
作者：
Moos, RH;Nichol, AC;Moos, BS
目的：功能全面评估（GAF）是标准多轴精神病诊断系统的一个组成部分。在DSM-IV中纳入GAF作为V轴评估工具的目的是使临床医生能够获得有关全球功能的信息，以补充有关症状和诊断的现有数据，并帮助预测心理健康治疗的分配和结果。本研究的目的是检查GAF的价值，作为监测精神卫生保健服务的分配和结果的全系统计划的一部分。研究方法：临床医生使用GAF评估了9，854名患有精神病或物质使用障碍或两者兼而有之的患者的整体功能，这些患者已经参加了退伍军人事务部的结果监测计划。采用纵向前瞻性随访设计。结果：患者的临床诊断和症状比他们的社会或职业功能更能预测GAF评分。GAF评定的损伤与提供住院或住院护理和门诊精神病护理相关，但损伤程度更高的患者没有接受更多的治疗。GAF评级仅与治疗结局极轻微相关。通过临床医生访谈或患者随访时的自我报告评估，未发现GAF评分与结局之间存在强有力的相关性。结论：包括GAF评级在一个程序中预测分配和精神卫生保健的结果是值得怀疑的价值。需要进行研究，以确定系统的培训和持续的有效性检查是否会加强GAF在监测服务使用和结果方面的贡献。
Objective: The Global Assessment of Functioning (GAF) is an integral part of the standard multiaxial psychiatric diagnostic system. The purpose of including the GAF in DSM-IV as a tool for axis V assessment is to enable clinicians to obtain information about global functioning to supplement existing data about symptoms and diagnoses and to help predict the allocation and outcomes of mental health treatment. The purpose of this study was to examine the value of the GAF as part of a systemwide program for monitoring the allocation and outcomes of mental health care services. Methods: Clinicians used the GAF to assess global functioning among 9,854 patients with psychiatric or substance use disorders, or both, who were already participating in an outcomes monitoring program of the Department of Veterans Affairs. A longitudinal prospective follow-up design was used. Results: Patients' clinical diagnoses and symptoms were stronger predictors of GAF ratings than was their social or occupational functioning. GAF-rated impairment was associated,with the provision of inpatient or residential care and outpatient psychiatric care, but patients with greater levels of impairment did not receive more treatment. GAF ratings were only minimally, associated with treatment outcomes. No robust associations were found between GAF ratings and outcomes as assessed by clinician interview or by patients' self-report at follow-up. Conclusions: Including GAF ratings in a program for predicting the allocation and outcomes of mental health care is of questionable value. Research is needed to determine whether systematic training and ongoing validity, checks would enhance the contribution of the GAF in monitoring service use and outcomes.