© 2005 Cambridge University Press
Ethno-psychometric evaluation of the General
Health Questionnaire in rural China
DOMINIC T. S. LEE1,2*, WINNIE C. M. YI P 3, YENFONG CHEN4, QINGYUE MENG5
AND ARTHUR KLEINMAN1,6
Department of Social Medicine, Harvard Medical School, Boston, MA, USA; 2 Department of Psychiatry,
The Chinese University of Hong Kong, Shatin, Hong Kong; 3 Department of Population and International
Health, Harvard School of Public Health, Boston, MA, USA; 4 Hui Long Guan Hospital, Beijing, China;
5 Centre for Health Management and Policy, Shandong University, Shandong, China; 6 Department of
Anthropology, Harvard University, Cambridge, MA, USA
ABSTRACT
Background. Most mental health research tools are developed in Western, urban contexts. Few
studies have evaluated the applicability of these research tools in rural populations of non-Western
countries. We examined the cultural acceptance and psychometric performance of the 12-item
General Health Questionnaire (GHQ) in China’s rural villages.
Method. Ethnographic investigations were conducted to assess the cultural applicability of
self-report rating scales among villagers. This was followed by a survey of 1401 rural residents,
randomly selected from 48 villages of Shandong province using stratified multistage cluster sampling.
The respondents were administered the GHQ and the Composite International Diagnostic
Interview (CIDI).
Results. The GHQ, when administered by trained interviewers, was culturally acceptable to rural
residents. The scale had good psychometric properties in the study population. The area under
the curve was 0.86. At a cut-off of 1/2, the sensitivity and specificity were 80.6% and 79.3%
respectively.
Conclusions. The ethno-psychometric evaluation showed that the GHQ was both culturally valid
and psychometrically sound in the Chinese rural context.
Address for correspondence: Dr Dominic T. S. Lee,
Department of Psychiatry, The Chinese University of Hong Kong,
Shatin, NT, Hong Kong SAR, China.
(Email: dominiclee@cuhk.edu.hk)
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