Guidelines for rating Global Assessment of Functioning (GAF).
BACKGROUND
Global Assessment of Functioning (GAF) is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines.


METHODS
A thorough literature search was conducted.


RESULTS
Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1) general points about guidelines for rating GAF; (2) introduction to guidelines, with ground rules; (3) starting scoring at the top, middle or bottom level of the scale; (4) scoring for different time periods and of different values (highest, lowest or average); (5) the finer grading of the scale; (6) different guidelines for different conditions; and (7) different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding.


CONCLUSIONS
Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and empirical studies, and international expert panels would be valuable, as well as production of a manual with more information about scoring. Computerised assessment may well be the future.
Department of Research, Vestfold Mental Health Care Trust, Tönsberg, Norway. monrad.aas@piv.no
I H Monrad
IH
Aas
Compr Psychiatry. 2001 Sep-Oct;42(5):403-9
11559867
J Nurs Scholarsh. 2003;35(2):177-82
12854300
J Child Psychol Psychiatry. 1995 Jul;36(5):787-92
7559845
J Clin Psychol. 1995 Mar;51(2):153-7
7797637
Community Ment Health J. 1997 Feb;33(1):35-41
9061261
Hosp Community Psychiatry. 1990 Apr;41(4):416-9
2332226
BMC Psychiatry. 2008 Jul 25;8:64
18657263
Psychiatr Serv. 2005 Apr;56(4):444-51
15812095
Arch Gen Psychiatry. 1976 Jun;33(6):766-71
938196
Br J Clin Psychol. 2002 Nov;41(Pt 4):417-22
12437796
Ann Gen Psychiatry. 2010 May 07;9:20
20459646
Psychiatr Serv. 1996 Aug;47(8):864-6
8837160
Psychol Bull. 1966 Sep;66(3):178-200
5954895
J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
9881538
Am J Public Health. 1998 Mar;88(3):475-7
9518988
Am J Psychiatry. 1970 Aug;127(2):242-4
5473153
Acta Psychiatr Scand. 2007 Apr;115(4):326-30
17355524
Health Technol Assess. 2003;7(1):1-76
12583822
Eur Child Adolesc Psychiatry. 2004 Oct;13(5):273-86
15490275
CMAJ. 1987 May 1;136(9):927-8
3567808
Health Technol Assess. 2001;5(31):1-256
11809125
Am J Psychiatry. 2000 Nov;157(11):1858-63
11058486
Am Psychol. 2001 Feb;56(2):128-65
11279806
Acta Psychiatr Scand. 1996 Feb;93(2):125-8
8686482
Arch Gen Psychiatry. 1994 Mar;51(3):225-45
8122959
Psychol Rep. 2002 Dec;91(3 Pt 1):999-1006
12530758
Am Psychol. 2002 Dec;57(12):1041-7
12613156
Am J Psychiatry. 1979 Jun;136(6):818-20
443468
Community Ment Health J. 1990 Aug;26(4):335-44
2208964
Arch Gen Psychiatry. 1992 Aug;49(8):630-6
1637253
Psychiatr Serv. 2002 Mar;53(3):340-2
11875231
Psychol Bull. 2000 Nov;126(6):946-63
11107884
J Korean Med Sci. 2009 May;24 Suppl 2:S338-42
19503692
J Clin Psychol. 2000 Apr;56(4):449-61
10775040
Psychiatr Serv. 2005 Apr;56(4):439-43
15812094
Soc Psychiatry Psychiatr Epidemiol. 2007 Apr;42(4):322-7
17334898
Am J Psychiatry. 1995 Sep;152(9):1386-8
7653701
Br J Psychiatry. 1995 May;166(5):654-9
7620753
Eff Clin Pract. 2001 Jul-Aug;4(4):157-62
11525102
Am J Psychiatry. 1992 Sep;149(9):1148-56
1386964
Int J Soc Psychiatry. 2002 Mar;48(1):11-9
12008903
Psychiatr Serv. 2005 Apr;56(4):434-8
15812093
Br J Psychiatry. 2005 Feb;186:146-52
15684239
Psychiatr Serv. 2007 Apr;58(4):529-35
17412856
Compr Psychiatry. 2007 Jan-Feb;48(1):88-94
17145287
Psychiatr Serv. 2005 Apr;56(4):420-6
15812091
BMC Psychiatry. 2008 Jan 25;8:7
18221511
Psychiatr Serv. 2003 Jul;54(7):1028-30
12851442
BMJ. 1994 Sep 10;309(6955):648-51
8086990
Psychosomatics. 1995 May-Jun;36(3):267-75
7638314