MARCO CONCEPTUAL

In this study the GHQ-28 was used in the context of Pakistani culture, amongst indigenous

Pakistanis and first generation British Pakistanis. Although very few studies using the GHQ

have been carried out in the Pakistani context, a lead can be taken from studies conducted in

India, given that these cultures share heritage and similar languages.

Previous research using the GHQ in India has found the GHQ to be a valid screening

instrument (Gautam et al., 1987; Bandyopadhyay et a l, 1988). In order to improve

validation indices, however, these researchers have recommended the use of higher cut-off

scores for identifying cases in this setting . In terms of the effects of language, Sriram et al. (1989), like Chan (1985), found discrepancies between the English and Hindi versions of the GHQ at the item level but not at the structural level. Sriram et al. (1989) concluded that

these discrepancies could be ascribed to semantic and technical problems in translating and

finding conceptual equivalents for phrases in the GHQ, such as ‘tasks’, ‘out of sorts’, and ‘strung up ’. In both the Hindi and Chinese studies, thus, although translation appeared to

exert an effect on the GHQ at the item level, these effects did not seem to have repercussions on validity levels^®.

The only known GHQ study in Pakistan was conducted by Mumford (1989). This study, however, was not concerned primarily with validity issues and did not use an Urdu version of the GHQ. Rather, it administered the English version o f the GHQ in

conjunction with the Bradford Somatic Inventory to second year Pakistani medical students to ascertain the relationship between somatic symptoms and psychological distress.

The GHQ has also been used in British Asian migrants (Cochrane et al., 1977; Currer, 1986;

Krause et al., 1990). Cochrane et al (1977) using a modified version of the GHQ on a British Asian sample concluded, on the basis of a criteria group method, that the GHQ and the

Langner-22 was a valid measure of psychological distress. Interestingly, they found no

significant difference in GHQ score between British and Asian respondents. Krause et al.

(1990), in a more recent study, compared the GHQ with a devised Punjabi Health

Questionnaire (PHQ) in Bedford. They also found little significant difference in British and

Punjabi responses. The authors of this study, however, did express some unease about

drawing definitive conclusions on Punjabis mental health on the basis of these results alone.

They stressed the need to relate the findings to wider Punjabi cultural themes and concepts.

To summarise, on the basis of these studies, the GHQ appears to be a potentially valid instrument for measuring mental distress in Pakistanis. Although the construct issue (that is,

w hether or not it can detect depression) and the effects of language and translation on the

GHQ, do not appear to be as clear cut.

Bearing in mind the previous research, the aim of this GHQ - 28 study was two fold^h

I. To investigate the effects of language and translation on the internal structure o f an Urdu version o f the GHQ. Enabling, thus, an establishment o f the degree of congruence between

both Urdu and English language versions and the construct they are measuring.

^^The 28 item version of the GHQ was chosen for this study due to its sub-scale structure. The GHQ-28, through the depression sub-scale, offered an opportunity to investigate whether 'depression' can be measured on the basis of this instrument. It also, through the somatic sub-scale, offered the opportunity to investigating the 'somatisation' notion in Asians (Katon et al. 1982 ; Bal 1987; Leff 1988; Goldberg & Bridges 1988; Mumford 1989).

IL To measure symptom levels and psychiatric morbidity in the three cultural samples, and to investigate demographic correlates of morbidity, with particular reference to sex and class

differences, in order to identify vulnerable groups

The GHQ-28 was translated into Urdu and back translated to ensure a valid conceptual

translation, before being administered to: an indigenous Pakistani (?) sample in Karachi, a sample of British Pakistani (BP) migrants in London and an indigenous British (B) control

sample (who, of course, were administered the original English version).

Hypotheses predicted that:

I. There would be more similarities at the structural level ie. in terms of response styles

between P and first generation BP samples than the B sample (as determined by reliability

statistics, item endorsement patterns and factor analysis), given the strong retention of culture

o f origin in BPs (Ballard, 1994). In the case of the British sample, the GHQ structure was predicted to be in line with Goldberg's predicated sub-scales.

Ila. There would be differential cultural endorsements and scores at the item and sub-scale level, due to translational and other socio-cultural factors. This is on the basis of Sriram (1989) and Chan's (1985) findings.

Ilb. P and BP samples would score higher on and endorse more somatic items than the B

sample, on the basis of somatisation findings of Kakar (1982); Rack (1982); Bavington and

Majid (1986); Bal (1987) and Leff (1989).

111. Indigenous Ps would score higher than BPs and B respondents, given the higher rates

found in indigenous Indian samples by Prema (1978) and Bandyopadhyay (1988). The

direction o f greater psychiatric morbidity in BPs and B respondents was left open given the existence of only a small number of inconclusive findings. Studies on mental hospital

admission rates (Cochrane, 1977; Cochrane & Bal, 1989) and community studies (Cochrane

& Stopes-R oe, 1977, 1981) have indicated markedly less affective disorders in Asian migrants; whereas anecdotal evidence and smaller studies have suggested that Asian migrants

suffer more distress than their British counterparts due to stressful life situations (Rack, 1982;

Mahmud, 1987) and low levels of diagnosis of disorders in Asians by health professionals

(Brewin, 1980; Shaikh, 1985; Bal, 1987) (refer to Chapter 3). Studies that have used the

GHQ in Asian samples have found no significant difference in Asian migrant and British

psychiatric morbidity rates (Cochrane & Stopes-Roe, 1977; Murray & Williams, 1986;

Krause, 1990).

IV. At the demographic level, women would score higher than men, and working class

respondents would score higher than middle class respondents given the evidence of previous

GHQ studies (Finlay-Jones & Burvill, 1977; D'Arcy, 1982; Cox et al., 1987).

4.2 METHOD