Global Assessment of Functioning (GAF) Ratings and the Allocation and Outcomes of Mental Health Services

Rudolf H. Moos, Ph.D., Aran C. Nichol, A.B. and Bernice S. Moos, B.S.

OBJECTIVE: The Global Assessment of Functioning (GAF) is an integral part of the standard multiaxial psychiatric diagnostic system. The purpose of including the GAF in DSM-IV as a tool for axis V assessment is to enable clinicians to obtain information about global functioning to supplement existing data about symptoms and diagnoses and to help predict the allocation and outcomes of mental health treatment. The purpose of this study was to examine the value of the GAF as part of a systemwide program for monitoring the allocation and outcomes of mental health care services. METHODS: Clinicians used the GAF to assess global functioning among 9,854 patients with psychiatric or substance use disorders, or both, who were already participating in an outcomes monitoring program of the Department of Veterans Affairs. A longitudinal prospective follow-up design was used. RESULTS: Patients’ clinical diagnoses and symptoms were stronger predictors of GAF ratings than was their social or occupational functioning. GAF-rated impairment was associated with the provision of inpatient or residential care and outpatient psychiatric care, but patients with greater levels of impairment did not receive more treatment. GAF ratings were only minimally associated with treatment outcomes. No robust associations were found between GAF ratings and outcomes as assessed by clinician interview or by patients’ self-report at follow-up. CONCLUSIONS: Including GAF ratings in a program for predicting the allocation and outcomes of mental health care is of questionable value. Research is needed to determine whether systematic training and ongoing validity checks would enhance the contribution of the GAF in monitoring service use and outcomes.

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