Global Assessment of Functioning ratings and the allocation and outcomes of mental health services.
OBJECTIVE
The Global Assessment of Functioning (GAF) is an integral part of the standard multiaxial psychiatric diagnostic system. The purpose of including the GAF in DSM-IV as a tool for axis V assessment is to enable clinicians to obtain information about global functioning to supplement existing data about symptoms and diagnoses and to help predict the allocation and outcomes of mental health treatment. The purpose of this study was to examine the value of the GAF as part of a systemwide program for monitoring the allocation and outcomes of mental health care services.


METHODS
Clinicians used the GAF to assess global functioning among 9,854 patients with psychiatric or substance use disorders, or both, who were already participating in an outcomes monitoring program of the Department of Veterans Affairs. A longitudinal prospective follow-up design was used.


RESULTS
Patients' clinical diagnoses and symptoms were stronger predictors of GAF ratings than was their social or occupational functioning. GAF-rated impairment was associated with the provision of inpatient or residential care and outpatient psychiatric care, but patients with greater levels of impairment did not receive more treatment. GAF ratings were only minimally associated with treatment outcomes. No robust associations were found between GAF ratings and outcomes as assessed by clinician interview or by patients' self-report at follow-up.


CONCLUSIONS
Including GAF ratings in a program for predicting the allocation and outcomes of mental health care is of questionable value. Research is needed to determine whether systematic training and ongoing validity checks would enhance the contribution of the GAF in monitoring service use and outcomes.
Moos
Rudolf H
RH
Center for Health Care Evaluation, Program Evaluation and Resource Center of the Veterans Affairs Health Care System, Stanford University, Palo Alto, California, USA. bmoos@stanford.edu
Nichol
Aran C
AC
Moos
Bernice S
BS
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology*; D000328:Adult; D003156:Community Mental Health Services; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000534:rehabilitation; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012050:Rehabilitation, Vocational; D012917:Social Adjustment; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis* / Q000534:rehabilitation; D014481:United States