Lucy Ashfaque

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Covers ashtanga, Anusara, Bikram, hatha, hot yoga, Iyengar, restorative and vinyasa yoga. How can you tell the difference between Anusara and Ashtanga?

CHAPTER 66: GENERAL HEALTH QUESTIONNAIRE (GHQ-12)

Description

The General Health Questionnaire (GHQ-12) by Goldberg (1976) is a self-administered questionnaire designed to detect persons that are symptomatic or at risk of developing the common, non-psychotic mental health problems associated with depression, anxiety, somatic symptoms, and social dysfunction (Jackson, 2007). Designed for the general population, available versions include the 60-, 30-, 28-, and the 12-item (GHQ-12) versions. The GHQ-12 was introduced in 1988 and is now considered one of the most extensively used outcome measures across a number of health professions (del Pilar Sánchez-López & Dresch, 2008). The GHQ-12 covers several domains associated with a person’s psychological well-being and is worded in such a way as to comprise six positive and six negative items concerning the past few weeks of a person’s life and includes such items as “Have you recently felt capable of making decisions about things?” while, negative items include “Have you recently felt constantly under strain?” (Hu, Stewart-Brown, Twigg, & Weich, 2007). Positively worded items have responses of “better than usual,” “same as usual,” “less than usual,” and “much less than usual,” while responses to negatively worded items are “not at all,” “no more than usual,” “rather more than usual,” and “much more than usual.” Scoring is along a 4-point ordinal scale (0 to 3) with higher scores suggestive of more distress. The GHQ-12 can be completed in less than 10 minutes.

Psychometrics

A study of 897 men and 911 women (59% ≥ 50 years old) determined that Cronbach’s alpha coefficients (estimates of reliability) were 0.83 for men and 0.85 for women (Doi & Minowa, 2003). Whereas Kihc et al. (1997) determined that the internal consistency of the GHQ-12 was α = 0.76, which compared to results of the GHQ-30 at 0.92 in their study of a stratified sample of 400 cases (15 to 65 years old). Although the GHQ-12 is often regarded as measuring only a single dimension of psychological health, a confirmatory factory analysis using a cohort of 9000 (mean age: 41 years; n = 2077 ≥ 56 years of age), suggested that 2 factors best described as symptoms of mental disorder (encompassing negative affect, anxiety, and impaired mental functioning) and positive mental health (covering positive mental functioning and positive affect) (Hu et al., 2007). A similar study by Gao et al. (2004) that compared six factor models relative to the measure, found that the one proposed by Graetz (1991) to be the best fit, as strong correlations between the 3 factors of anxiety and depression (4 items), social dysfunction (6 items), and loss of confidence (2 items) were found (range = 0.83-0.90), suggesting that even if there were 3 different factors, it would be difficult to differentiate them. Examples of other factor models compared in the study were general dysphoria, social, and the cope, stress, and depress model. A study comparing the level of agreement between the GHQ-12 and the Geriatric Depression Scale (GDS-30) using 1172 subjects (≥ 60 years old) found median scores to be 2.7 for the GHQ-12 and 11.7 for the GDS-30 with the prevalence of depressive symptoms based on the GHQ-12 at 40% and 33% using cutoff points of 2/3 and 3/4, whereas 50% and 38% were classified as depressed at cutoff points of 10/11 and 13/14 according to the GDS-30 (Costa, Barreto, Uchoa, & Lima-Costa, 2003). Agreement between the scales ranged from 0.50 to 0.60 with depressive symptoms significantly higher for woman and those individuals ≥ 75 years of age (Costa et al., 2003). A study by del Pilar Sánchez-López and Dresch (2008) of 1001 subjects (50% between 45 and 65 years old) generally concurred with those findings where they too established statistically significant differences between women and men’s scores at 7.34 and 9.30, respectively. The study by Hu et al. (2007) discussed previously, however, found that positive mental health was most strongly associated with younger age, being in work, being single, not having any financial strain, and having no or few physical health problems.

Advantages

There is a significant amount of research in support of the GHQ-12 as well as its other versions for use in clinical practice and it is arguably a gold standard measure of the symptoms of psychological distress in the general population. Several alternative scoring methodologies have also been proposed expanding its usefulness, and since its introduction in 1976, the GHQ has been translated into 38 different languages, highlighting its relevance as a cross-cultural assessment (Jackson, 2007). Finally, in certain populations the 28-item version may be considered as it is a more multidimensional outcome measure comprising 4 distinct subscales (somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression) of 7 items each (Gao et al., 2004).

Disadvantages

Some have argued that aspects of the negative and positive wording used by the measure has a latent effect on answer selection and thus on scoring. Also, the GHQ-12 is designed to only give a general indication of psychological distress and should not be considered a replacement for more thorough and accepted psychological assessments.

Administration

The GHQ-12 measure has standardized instructions as well as scoring interpretations for the clinician to follow and is administered as a self-report in which the subject is asked to consider 12 questions and how they relate to his or her personal life over the past few weeks. Total scores range from 0 to 36 with a score of 11 or 12 considered typical, scores > 15 suggesting evidence of distress, and scores > 20 are considered severe problems with psychological distress.

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Properties in New York City can range from hundreds of thousands of dollars up to hundreds of millions of dollars. But the biggest deals in the city are typically only handled by the biggest and best real estate companies. After all, the people who can afford these mega-deals will only deal with the top realtors from the city’s top firms. But which brokerages are the highest-rated and best known in New York? Let’s find out!

The best real estate company in NYC is Compass as it boasts cutting-edge technology and world-class agents. A relative newcomer to the brokerage game, Compass was founded in 2012 by Robert Reffkin and Ori Allon. Armed with a vision to transform real estate by using technology, Compass has expanded aggressively, quickly becoming the most successful real estate brokerage firm in NYC. If you're looking for the best when it comes to technology, Compass is leading the pack.

In less than 10 years Compass has managed to change the real estate game completely, introducing innovative new marketing tools, and bringing on some of the best talent around. Many of the top realtors from some of NYC's other great firms have jumped ship to Compass due to their incredible technology and Reffkin's visionary leadership.

Corcoran is one of the top real estate firms in New York and is well known for having experienced agents and its emphasis on luxury properties. Anyone who’s ever watched the wildly popular television show on NBC known as Shark Tank has heard of the founder of The Corcoran Group — Barbara Corcoran. As the introduction to the TV show puts it, “Barbara Corcoran went from working as a waitress in Manhattan to building the city’s pre-eminent real estate empire.”

Although that may seem a bit dramatized for TV, it’s actually a pretty accurate description of what Barbara Corcoran started. In 1973, Corcoran took out a $1,000 loan to start her real estate company in a small office in Manhattan. Less than four decades later, she sold her company to National Realty Trust (NRT) for a whopping $66 million. While she no longer runs things at Corcoran, the company remains one of the largest and most successful brokerage firms in NYC.

Today, the Corcoran Group operates under the parent organization of Realogy Holdings Corporation (also the parent company of NRT). The group is not only one of the premier real estate firms in NYC — boasting record-breaking sales, including units that went for over $100 million — but they also operate in The Hamptons as well as South Florida.

Another one of the best real estate companies in New York is Douglas Elliman. Elliman is one of the oldest companies on our list, with a long heritage of being amongst the best brokers in New York. Starting as a basement store way back in 1911 in Manhattan, the company changed hands three times throughout its history before being sold to Montauk Battery Realty in 2003, which is still the parent company to this day.

Douglas Elliman is one of the premier real estate companies in NYC, long competing with The Corcoran Group for most sales volume in the city. To put in perspective how big it is in NYC, Douglas Elliman has 22 offices in NYC, 26 offices on Long Island, and 6 additional offices in Westchester and Connecticut. They are currently a dominant force to be reckoned with in the NYC real estate market, but that’s not the only place they operate.

Douglas Elliman also has headquarters in Florida, California, and The Hamptons to truly take advantage of some of the biggest real estate markets in the country. With 19 Florida offices, a headquarters in Beverly Hills (combined with their acquisition of Teles Properties), and 9 additional offices in The Hamptons, Douglas Elliman is a true player in the industry and they’re here to stay.

The oldest real estate company on this list, and one of the oldest that you’ll find anywhere in New York City, Brown Harris Stevens was founded back in 1873 by Charles Stelle Brown. After going through a few name changes, the company has been known as Brown Harris Stevens since 1948, after the aforementioned founder and Duncan Harris and Francis Stevens.

Known throughout the city as one of the premier real estate companies, Brown Harris Stevens is known for brokering real estate deals among the wealthiest sellers and buyers in the city. And when you’re talking about NYC, that’s some serious wealth. Brown Harris Stevens does billions of dollars in sales every year, with over $4 billion being brokered in NYC in the year 2016 alone.

A much smaller company in size than most of the other options seen here, Brown Harris Stevens had just over 500 agents in 2017, but they were all based in NYC. This is what made the firm the city’s second-largest behind Douglas Elliman. As of 2020, Brown Harris Stevens joined forces with Terra Holdings, and the two companies combined to bring together over 2,500 agents and 55 offices across the area.

After the merger, the firm now operates in New York City, New Jersey, Connecticut, the Hamptons, Hudson Valley, Palm Beach, and Miami — some of the best markets in the country. In 2019, the two companies combined for over $9 billion in sales, so they should be a major player in the real estate industry moving forward, for years to come.

Keller Williams Realty, typically just referred to as Keller Williams, was founded in 1983 by Gary Keller and Joe Williams in Austin, Texas. Following the housing bubble of the 1980s, Keller Williams offered profit-sharing through franchising starting in the early 90s, and that’s when the company really started to grow, at a rate never seen before.

The company went from a single office with two employees in 1983, to 130 agents in the mid-1980s, to becoming the second-largest brokerage in the US in 2011. And ever since 2014, Keller Williams has been touted as the largest real estate company in the entire world in terms of the number of agents, with an estimated 190,000 working throughout over 980 offices around the world.

Needless to say, Keller Williams offers their services in NYC, as you would expect the world’s biggest real estate company to be a massive player in one of the toughest real estate markets in the world. These days, the company is expanding even further. Keller Williams formed the holding company KWx in 2020 to operate the realty portion as well as all the new operations as they branch out into the world of technology.

As the name suggests, Sotheby’s International Realty is not limited to just NYC or even the United States, but it is instead a worldwide purveyor of real estate. Founded in 1976 by the world-famous Sotheby’s Auction House, Sotheby’s International Realty focuses on brokering deals on luxury real estate properties across the globe. And as you can imagine, NYC has plenty of luxury real estate within the city limits.

Similar to a couple of other brokerages on this list, Sotheby’s International Realty entered into an agreement with the massive Realogy Holdings Corporation in 2004. This deal was made as a long-term strategic partnership that allows Realogy to use Sotheby’s International Realty name as well as entering the two into a full franchise system.

Using this franchising system, Realogy Holdings Corporation was able to open a Sotheby’s International Realty office on the east side of Manhattan to broker deals on luxury properties. This office is just one of many that use the Sotheby’s name, as they have nearly 1,000 offices in more than 72 countries all over the world.

The brokerage firm with the most sales volume in New York City is The Corcoran Group. In 2020 they closed over 2,520 transactions in NYC for a sales volume totaling a whopping $5.8 billion. Compass came in number two for volume but led the pack in terms of raw transaction volume with 2,805 sales totaling more than the $4 billion. The brokerage in the third spot for both sales volume and total transactions was Elliman with $3 billion in sales across 1,792 deals.

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