Global Assessment of Functioning (GAF) ratings: Determinants and role as predictors of one-year treatment outcomes

Objective: To assess the adequacy of global ratings of patients' psychosoci al functioning, which are an integral part of the current system for obtain ing multidimensional psychiatric diagnoses and are embodied by the Global A ssessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statis tical Manual of Mental Disorders. Fourth Edition (American Psychiatric Asso ciation. 1994). Method: We identified a sample of 1,688 patients with subst ance use disorders, many of whom also had psychiatric disorders: examined t he determinants of GAF ratings: and focused on how well these ratings predi cted patients' one-year symptom and psychosocial functioning outcomes. Resu lts: Patients' clinical diagnoses and psychiatric symptoms were stronger pr edictors of GAF ratings than was their social and occupational functioning. Moreover. GAF ratings were only minimally associated with patients' one-ye ar psychological, social, and occupational functioning outcomes. Conclusion s: These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substanc e abuse patients' global functioning. (C) 2000 John Wiley & Sons. Inc.