Davina French

Validity and Psychometric Properties of the General Health Questionnaire-12 in Young Australian Adolescents

Background: The General Health Questionnaire (GHQ) is a measure of current mental wellbeing that has been extensively validated with adults. The instrument has also been used with adolescents. Objective: (i) To assess the psychometric properties of the GHQ-12 among school students in grades 7–10; (ii) to validate it against other psychological tests; and (iii) to suggest a threshold score. Method: The survey was conducted in single sex and mixed schools from the state and private system in Perth, Western Australia. The survey contained the GHQ-12 and measures of anxiety, depression, self-esteem, stress, generalized self-efficacy, social desirability and negative affectivity. Results: There were 336 students (female 55%) with an age range of 11–15 years (median 13). The GHQ showed good internal consistency (alpha 0.88). Girls had higher mean GHQ-12 scores than boys (F (1,326) 15.0, p < 0.001) and scores for both genders increased with school grade (F (3,326) 4.2, p < 0.01). Multiple linear regression showed that depression, anxiety, self-esteem and stress were significant independent predictors of GHQ scores. The model accounted for 68% of the variance (adjusted R 2). Screening indices were calculated by comparison with a combined depression and/or anxiety category. Threshold scores of 13/14 for males and 18/19 for females appeared optimal. General Health Questionnaire scores were compared with two criterion groups: adolescents in hospital with alcohol or drug (AOD) related problems and those with problems not related to AOD use. Only the former group had significantly higher total scores. Conclusions: The GHQ-12 showed good structural characteristics and was appropriately correlated with other measures of related traits. Overall, the GHQ-12 appears to be a valid index of psychological wellbeing in this population and was considerably shorter than some of the other instruments.

Distinguishing cognitive and somatic dimensions of state and trait anxiety : development and validation of the state-trait inventory for cognitive and somatic anxiety (STICSA)

To date, little research has endeavoured to discriminate between cognitive and somatic dimensions of trait anxiety and, consequently, it remains uncertain whether these anxiety dimensions can be reliably distinguished at the trait level. The four studies presented here support the validity of the distinction between cognitive and somatic anxiety at both state and trait levels. The research involved the development and validation of a self-report questionnaire, the State-Trait Inventory for cognitive and somatic anxiety (STICSA). The nature of the anxiety dimensions assessed by this new measure was then investigated. The results indicate that the state scales of this new measure assess the degree of cognitive and somatic anxiety experienced at a particular point in time. The trait scales of the STICSA predict the situations in which different individuals will display elevations in cognitive and somatic state anxiety. Trait cognitive and somatic anxiety are indeed distinct constructs that can be reliably and validly assessed. Theoretical and applied implications of this finding are discussed.

Health-related quality of life of children and adolescents with chronic illness--a two year prospective study

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10–16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.

Measurement invariance in the General Health Questionnaire-12 in young Australian adolescents

Abstract.The General Health Questionnaire-12 [8] (GHQ-12) has been extensively validated with adults, but its validity with young adolescents is questionable. Further, the dimensionality of the survey remains in doubt. Confirmatory factor analysis was used to compare five competing models for the GHQ-12 using an adult sample (n = 235). The best model was then applied to a young adolescent dataset (n = 236, aged 11–15): all fit indices were “adequate” or “good” (i. e. Comparative Fit Index 0.97). Measurement invariance for the combined data was demonstrated for item loadings and factor covariance but not for error variance. These data provide support for the validity of the survey with young adolescents and suggest that adolescents interpret the GHQ-12 in a similar manner to adults.

The reproducibility of the Childhood Asthma Questionnaires: measures of quality of life for children with asthma aged 4–16 years

This paper reports the internal consistency and reproducibility of the Childhood Asthma Questionnaires, measures of quality of life and symptom distress in paediatric asthma. A total of 535 children aged 4–16 years completed age appropriate forms of the questionnaire, over 1-or 3-week intervals. Pearson correlation coefficients between 0.63 and 0.84 for subscales of the questionnaires indicated good test-retest reliability while intraclass correlation coefficients in a very similar range showed that scores also remained at the same level on the two occasions. Comparisons between children with asthma and healthy non-asthmatics indicate that these are likely to be true estimates of stability. Internal consistency varied widely but was higher for older children and longer subscales. Implications of the findings for the use of the questionnaires in the evaluation of new asthma treatments are discussed.

Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma

Aim:  To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children’s health‐related quality of life (HRQL); and (ii) disease severity.

A two-year prospective study of the health-related quality of life of children with chronic illness – the parents’ perspective

The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10–16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their children’s HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2years of the study. This improvement was less evident for children with CF.

Pilgrim's progress: The effect of Salmeterol in older children with chronic severe asthma

Twenty-four children aged 12-17 years entered a randomized, double-blind placebo-controlled study investigating the use of salmeterol in chronic severe asthma. In addition to their usual medication, the children were given either placebo or 100 micrograms salmeterol b.d. by dry powder inhalation. Treatment was continued throughout one term at a residential school for asthma. Symptom scores, peak expiratory flow rates, spirometry and quality-of-life scores were compared between the two treatment groups. One child withdrew during the run-in period. Twelve pupils received placebo and 11 pupils received salmeterol. There were consistent improvements in favour of salmeterol, reaching statistical significance for morning and evening peak flow rates and spirometry when measured on four occasions during the study period. There were no medication-related adverse events recorded and no pulse rate changes. Salmeterol (100 micrograms b.d.) is well tolerated and efficacious in older children with chronic severe asthma.

Health-related quality of life in Australian children with asthma: lessons for the cross-cultural use of quality of life instruments

The development of Australian forms of the Childhood Asthma Questionnaires (CAQs) is reported. Focus group methods and psychometric analyses were used to establish the conceptual, semantic and technical equivalence of these forms with the UK versions. Both versions also provide for data collection from non-asthmatic youngsters. The internal consistency was found to be acceptable (Cronbachs α 0.52–0.90) and the health-related quality of life (HRQoL) scores were found to vary with asthma severity (p<0.05). Comparison with the UK data revealed that the non-asthmatic scores were higher for Australian than British children (p<0.001) but that the scores for children with asthma did not differ between the two countries. It was only in the Australian sample that the group with asthma reported impaired HRQoL when compared to their healthy peers. These findings were interpreted in the context of cultural expectations of life quality and conclusions are presented regarding the importance of the gap between experience and expectations. The difficulties raised by the developmental and cultural issues inherent in paediatric HRQoL research were discussed.

Western Australian Primary School Teachers' Knowledge About Childhood Asthma and Its Management

A total of 164 primary school teachers from Perth, Western Australia anonymously completed a survey of their knowledge and attitudes about asthma. These teachers were active in assisting children with asthma management but most (91.5%) felt that they did not know enough about asthma. Attitudes toward children with asthma were positive; 97% agreed that such children should be encouraged to participate in sporting activities. Specific knowledge about asthma management and medications was, however, poor. This large sample of Western Australian teachers knew more than their European counterparts but asthma training is needed and should be targeted at improving knowledge of both regular and emergency treatments for asthma.