Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia

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Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia. / Köhler-Forsberg, Ole; Horsdal, Henriette Thisted; Baandrup, Lone; Mors, Ole; Gasse, Christiane.

In: Clinical epidemiology, Vol. 8, 2016, p. 323—332.

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@article{99d879a966e747d5979c9b474fe99c52,
title = "Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia",
abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.",
keywords = "Journal Article",
author = "Ole K{\"o}hler-Forsberg and Horsdal, {Henriette Thisted} and Lone Baandrup and Ole Mors and Christiane Gasse",
year = "2016",
doi = "10.2147/CLEP.S109036",
language = "English",
volume = "8",
pages = "323—332",
journal = "Clinical Epidemiology",
issn = "1179-1349",
publisher = "Dove Medical Press Ltd.(Dovepress)",

}

RIS

TY - JOUR

T1 - Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia

AU - Köhler-Forsberg, Ole

AU - Horsdal, Henriette Thisted

AU - Baandrup, Lone

AU - Mors, Ole

AU - Gasse, Christiane

PY - 2016

Y1 - 2016

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

KW - Journal Article

U2 - 10.2147/CLEP.S109036

DO - 10.2147/CLEP.S109036

M3 - Journal article

C2 - 27660490

VL - 8

SP - 323—332

JO - Clinical Epidemiology

JF - Clinical Epidemiology

SN - 1179-1349

ER -