title: Reimagining the General Health Questionnaire as a measure of emotional wellbeing: a study of postpartum women in Malta.
abstract: BACKGROUND
  Postpartum health has been subject to a focus on psychological morbidity, despite positive associations between postpartum recovery and maternal emotional wellbeing. There are currently many validated tools to measure wellbeing and related concepts, including non-psychiatric morbidity. The General Health Questionnaire, 12 items (GHQ-12) is one such instrument, widely used and validated in several languages. Its use in postpartum settings has been documented with disagreement about the instrument's utility in this population, particularly in relation to scoring method and threshold. The GHQ-12 has never been translated into Maltese. This study explored the psychometric properties of the GHQ-12 in a Maltese postpartum population to consider if the use of a different scoring method (visual analogue scale) in the GHQ-12 can determine postpartum wellbeing.
  
  
  METHODS
  One hundred and twenty-four postpartum women recruited from one hospital in Malta completed the translated and adapted GHQ-12 as a wellbeing measure (GHQ-12(WB)) at four postpartum time points. The psychometric properties of the GHQ-12(WB) were explored using confirmatory factor analysis, discriminant and divergent validity and reliability analysis.
  
  
  RESULTS
  The GHQ-12(WB) demonstrated good divergent and known-groups validity and internal consistency. No models offered a good fit to the data. The overall consistent best-fit to the data was an eight item, two factor model (GHQ-8). Model fit improved across all models in terms of CFI at 13 weeks.
  
  
  CONCLUSIONS
  Findings generally support the reliability and validity of the Maltese version of the GHQ-12(WB). Model fit changes over time reflect the dynamic nature of postpartum recovery. Further evaluation of the GHQ-8(WB) is recommended.
authors.affiliation: Faculty of Health Sciences, University of Malta, Malta.
authors.forename: M C
authors.initials: MC
authors.lastname: Spiteri
authors.forename: J
authors.initials: J
authors.lastname: Jomeen
authors.forename: C R
authors.initials: CR
authors.lastname: Martin
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006801:Humans; D007802:Language; D008319:Malta; D008403:Mass Screening / Q000379:methods; D049590:Postpartum Period; D011594:Psychometrics / Q000295:instrumentation* / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: GHQ-12; General Health; Postpartum; Psychometric; Wellbeing