Beyond the Global Assessment of Functioning: Learning From Virginia Apgar

BackgroundThe Global Assessment of Functioning (GAF) scale is widely used in psychiatry, yet it has certain drawbacks.ObjectiveThe authors seek to generate further discussion and research around developing an improved successor to the GAF.MethodThe authors used the Apgar scale as a template for constructing a possible successor to the GAF. Consulting with 16 colleagues, they selected 5 domains that were felt to be central to functioning in psychiatric patients. Psychiatrists in diverse clinical settings then completed both a GAF and a Psychiatric Apgar scale on 40 patients.ResultsThe two scales were found to agree significantly. Use of the Psychiatric Apgar, however, provides clearer guidance about assessing functioning.ConclusionThe GAF was a brilliant addition to psychiatric practice. As we develop the next Diagnostic and Statistical Manual, it is pertinent to ask whether the GAF approach could be optimized even further by applying the lessons of Virginia Apgar.