Beyond the global assessment of functioning: learning from Virginia Apgar.
BACKGROUND
The Global Assessment of Functioning (GAF) scale is widely used in psychiatry, yet it has certain drawbacks.


OBJECTIVE
The authors seek to generate further discussion and research around developing an improved successor to the GAF.


METHODS
The authors used the Apgar scale as a template for constructing a possible successor to the GAF. Consulting with 16 colleagues, they selected 5 domains that were felt to be central to functioning in psychiatric patients. Psychiatrists in diverse clinical settings then completed both a GAF and a Psychiatric Apgar scale on 40 patients.


RESULTS
The two scales were found to agree significantly. Use of the Psychiatric Apgar, however, provides clearer guidance about assessing functioning.


CONCLUSIONS
The GAF was a brilliant addition to psychiatric practice. As we develop the next Diagnostic and Statistical Manual, it is pertinent to ask whether the GAF approach could be optimized even further by applying the lessons of Virginia Apgar.
correspondence and M.D., Dept. of Psychiatry, Univ. of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0804, USA. jdimsdale@ucsd.edu
Joel E
JE
Dimsdale
Dilip V
DV
Jeste
Thomas L
TL
Patterson
D001034:Apgar Score; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D001523:Mental Disorders / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D015203:Reproducibility of Results