Overall functioning

Derived from the Health-Sickness Rating Scale(59) and incorporated into the DSM system as a separate axis (Axis V), the Global Assessment of Functioning scale (69 (GAF) is the most widely used measure of psychosocial impairment. Clinicians rate on a scale of 1 to 100 the current level of functioning, or if desired, the highest or lowest level of functioning within some designated time period. There are several limitations of this scale, which make it a less than optimal research tool. These include the confounding of symptom severity with functioning, the lack of quality psychometric data, and the unstandardized, imprecise, and often idiosyncratic way in which scores are assigned.

General well being and functioning are also assessed with scales that have been developed for the routine outcome assessment in clinical practice, rather than for efficacy trials. The Mental Health Index(61) is a self-report measure consisting of current life functioning, subjective well being, and current symptom scales that are combined into an overall index.

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