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

• Published in: Clinical epidemiology 2016-01, Vol.8, p.323-332
• Main Authors: Köhler, Ole, Horsdal, Henriette Thisted, Baandrup, Lone, Mors, Ole, Gasse, Christiane
• Format: Article
• Language: English
• Subjects: Clinical medicine; Clinical outcomes; Clinical trials; early phase treatment; Education; Epidemiology; Gender differences; Global assessment of functioning (GAF); Hospitalization; incident schizophrenia; Medical prognosis; Mental disorders; Mental health; Original Research; Outpatient care facilities; Patients; Psychiatry; Public health; Quality; Schizophrenia; Studies; Validity
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S109036

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.