Reliability, validity and dimensionality of the 12-Item General Health Questionnaire among South African healthcare workers

Abstract

Healthcare workers (HCWs) were among the high-risk groups for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and suffer a high burden of challenges with mental health including depression, anxiety, traumatic stress, avoidance and burnout. The 12-Item General Health Questionnaire (GHQ-12) has shown the best fit in both a one-factor structure and a multidimensional structure for the screening of common mental disorders and psychiatric well-being. The aim was to test for reliability and validity and ascertain the factor structure of the GHQ-12 in a South African HCW population. Data were collected from 832 public hospital and clinic staff during the coronavirus disease 2019 (COVID-19) pandemic in Gauteng, South Africa. The factor structure of the GHQ-12 in this professional population was examined by exploratory factor analysis (EFA) to identify factors, confirmatory factor analysis (CFA) for construct validity and structural equation modelling (SEM) to establish model fit. The GHQ-12 median score was higher (n = 25) in women than in men (n = 24), p = 0.044. The assumptions for inferential statistics were tested: the determinant for the correlation matrix was 0.034, Bartlett’s test of sphericity was p < 0.001, Chi-square 2262.171 and the Kaiser-Meyer-Olkin (KMO) of sampling adequacy was 0.877. The four factors identified were labelled as social dysfunction (37.8%), anxiety depression (35.4%), capable (24.9%) and self-efficacy (22.7%). The sample had a Cronbach’s alpha and McDonald’s Omega coefficient of 0.85.

Contribution: The study highlighted the gaps in the use of GHQ-12. The findings affirm the validity and reliability of the GHQ-12 in this group of professionals and the multidimensional structure for screening for psychological distress.