Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work

The aim of this study was to investigate the validity of the Global Assessment of Functioning (GAF) when routinely used in clinical work by focusing on the relations between the GAF, other axes in the DSM system, and some demographic variables conceptually derived on theoretical and clinical grounds.

A clinical database containing data for 5,538 patients assessed by 181 raters as a part of routine practice in psychiatric outpatient settings in Sweden was used. A hierarchical linear regression model and a variance component model were used to analyze the data. Regression models were also used to determine how the relation between the GAF and axis I depends on the selection of diagnostic groups in the sample.

Seventeen percent of the systematic variance in GAF scores was explained by diagnostic differences as defined on DSM-IV axis I, and 5.1 percent was explained by psychosocial and environmental problems as measured on DSM-IV axis IV. Unexpectedly, the site of the investigation explained another 3.6 percent of the variance.

The GAF can be used as a comprehensive measure of global mental health in routine clinical work for assessment and for outcome management.