• Self-report questionnaire
  • Used for the detection of psychiatric distress related to general medical illness. Respondents indicate if their current “state” differs from his or her usual state – thereby assessing change in characteristics and not lifelong personality characteristics.
  • Designed to assess 4 aspects of distress:
    1.  Depression
    2. Anxiety
    3. Social impairment
    4. Hypochondriasis

Clinical Considerations

  • The GHQ-28’s subscales represent dimensions of symptomatology and not distinct diagnoses.
  • As the scales are not independent of each other, the total score has better utility to indicate general psychological disorder than the individual scores do to screen for specific psychological disorders.
  • Only one study has assessed the construct validity of the GHQ-28 among SCI populations.
  • The GHQ-28 is appropriate for individuals who are at least 11 years of age.

ICF Domain

Body Function ▶ Mental Functions


  • Self-administered questionnaire
  • Patients base their responses on their health state over the past two weeks.
  • Administration time is usually approximately 5 minutes.

Number of Items





  • Calculation of total score
  • Different scoring methods of scoring are possible, which will affect the total score. The traditional scoring method provided assigns a score of 0 for responses 1 and 2 (“not at all” and “no more than usual”) and a score of 1 for responses 3 and 4 (“rather more than usual” and “much more than usual”). Another scoring method in use assigns a score of 0 for response 1 and a score of 1 for response 2-4 for the 18 negative items, and a score of 0 for responses 1 and 2, a score of 1 for responses 3 and 4 for the 7 positive items.


Translated into 38 languages

Training Required



Currently unavailable.

# of studies reporting psychometric properties: 1


MCID: not established
SEM: not established
MDC: not established

  • Total score range from 0 to 28.
  • Higher scores indicate a greater probability of a psychiatric distress.
  • Total scores that exceed 4 out of 28 suggest probable distress.
  • Cut-points and normative data have not been established for the SCI population.


No values have been reported for the reliability of the GHQ-28 for the SCI population.


  • Correlation of the GHQ-28 is High with the Clinical Interview Scale (r = 0.83).
  • With the 0011 scoring scheme, optimum discrimination occurred near GHQ 3/4, giving a specificity of 0.82 and a sensitivity of 0.81.

(Griffiths et al. 1993)


No values have been reported for the responsiveness of the GHQ-28 for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the GHQ-28 for the SCI population.


Dr. Janice Eng, Christie Chan

Date Last Updated

1 February 2013

Chung MC, Preveza E, Papandreou K, Prevezas N. Spinal cord injury, posttraumatic stress, and locus of control among the elderly: a comparison with young and middle-aged patients. Psychiatry 2006; 69: 69-80.

Griffiths TC, Myers DH, Talbot AW. A study of the validity of the scaled version of the General Health Questionnaire in paralysed spinally injured out-patients. Psychol Med 1993; 23: 497–504.

Goldberg DP, Hillier VF. A Scaled Version of the General Health Questionnaire. Psychol Med 1979; 9: 139-145.

Lykouras L, Adrachta D, Kalfakis N, Oulis P, Voulgari A, Christodoulou GN, Papageorgiou C, Stefanis C. GHQ-28 as an aid to detect mental disorders in neurological inpatients. Acta Psychiatr Scand, 1996; 93(3): 212-216.

Rush JA, First MB, Blacker D. Handbook of Psychiatric Measures. American Psychiatric Pub. 2008.