Global Assessment of Functioning (GAF): properties and frontier of current knowledge

ABSTRACT: BACKGROUND: Global Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF). METHODS: A thorough literature search was conducted. RESULTS: A number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales? CONCLUSIONS: In the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF

Work status, daily activities and quality of life among people with severe mental illness.

OBJECTIVE: Work is often a desired goal for people with mental illness, as expressed by both themselves and their relatives. This study investigated the importance of work status, everyday activities and objective life indices for subjective quality of life, with a special focus on quality of life domains. METHOD: The sample consisted of 103 individuals with severe mental illness in Sweden, a majority of whom had schizophrenia. Interview-based questionnaires were used to assess quality of life (MANSA) and activity factors (SDO, OVal-pd). RESULTS: Work status and activity in terms of actual doing were of some, but minor, importance to subjective quality of life domains, whereas satisfying and valuable activities were consistently associated with most quality of life domains. CONCLUSION: Although no causal relationship could be established, the findings indicate that open-market work might not be decisive for subjective quality of life, but that satisfying and meaningful everyday activities could contribute to a better life quality for those who have a severe and lasting mental illness