The detection of psychiatric illness by questionnaire in Jamaica

ABSTRACT

The minor psychiatric disorders are common. It has often been claimed that a considerable proportion of patients attending general practitioners, health clinics and hospital clinics suffer from neurotic illness. Paradoxically, psychiatrists see a highly selected sample of psychiatric patients, in which more serious disorders are over-represented. In the past, psychiatric rating schedules and inventories have been designed primarily for use in this selected group of patients. The introduction of a diagnostic self-rating schedule, designed specifically for the detection of minor psychiatric disorders among patients attending general practice (or other "non-psychiatric") clinics, is therefore an innovation of considerable importance. Goldberg has recently described a General Health Questionnaire (GHQ) and demonstrated its reliability and validity in the detection of minor psychiatric disorders among patients in London (U.K.) and Philadelphia (U.S.A.). I have attemped to establish the reliability and validity of the G.H.Q. (shortened version) for use in Jamaica. The G.H.Q. has been administered to (1) 100 consecutive adult clinic attenders at the Lawrence Tavern Rural Health Clinic. (2) 30 patients attending the psychiatric clinic at U.H.W.I. for treatment of neurotic illness. (3) 30 "normal" controls i.e. rlatives of patients attending non-psychiatric clinics at U.H.W.I. who (a) regarded themselves as psychiatrically well; (b) had no past history of treatment for psychiatric disorders; and (c) showed no obvious behavioural disorder on recruitment. In addition a one-in-four sub-sample of the Lawrence Tavern patients had a standardised psychiatric interview. The results indicate that the shortened version of the G.H.Q. is both reliable and valid for use in Jamaica. It showed high degrees of specificity (81 percent) and sensitivity (89 percent) subject to a minor recalibration (treshold score to be increased from 3/4 to 4/5). It can be recommended for further use in Jamaica and may well be usefull in other English-speaking Caribbean countries. The results also indicate that 20-25 percent of adults attending the Lawrence Tavern Clinic have psychiatric illness (AU)