Factorial structure of the Chinese version of the 12-item General Health Questionnaire in adolescents

Aims. To evaluate the underlying factor structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents and find out which factor model proposed by previous empirical research is the best-fit model. Background. The 12-item General Health Questionnaire has been extensively used with adolescents in the West. Yet, it has not been used with adolescents in a Hong Kong Chinese context. Design. A cross-sectional study was employed. Method. Chinese students between the ages of 12-19 from four secondary schools were invited to participate in the study using the multiple-stage stratified random sampling method during the period from December 2007-February, 2008. The total sample size included in the final analysed was 1883. Results. The General Health Questionnaire-12 was found to be internally consistent. The results of exploratory factor analysis showed that there are two factors underlying the General Health Questionnaire-12. Of nine factor models were tested by means of confirmatory factor analysis, only three factor model: the eight-item two-factor model, 12-item three-factor model and 10-item two-factor model, demonstrated good model fit across all model fit indices. Conclusion. This study addressed a gap in the literature by evaluating the factorial structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents. The findings revealed that the eight-item two-factor model is the best-fit model. Relevance to clinical practice. The adolescent mental health problem is alarming and aggravating and warrants special attention. It is essential for community nurses to differentiate psychological distress in adolescents and to identify those adolescents who are at a higher risk of suffering from mental health problems. The availability of a valid and reliable instrument that measures adolescents' psychological distress is crucial before any nursing interventions to promote their mental health can be appropriately planned, implemented and evaluated.