Background. Most mental health research tools are developed in Western, urban contexts. Few studies have evaluated the applicability of these research tools in rural populations of non-Western countries. We examined the cultural acceptance and psychometric performance of the 12-item General Health Questionnaire (GHQ) in China's rural villages.

Method. Ethnographic investigations were conducted to assess the cultural applicability of self-report rating scales among villagers. This was followed by a survey of 1401 rural residents, randomly selected from 48 villages of Shandong province using stratified multistage cluster sampling. The respondents were administered the GHQ and the Composite International Diagnostic Interview (CIDI).

Results. The GHQ, when administered by trained interviewers, was culturally acceptable to rural residents. The scale had good psychometric properties in the study population. The area under the curve was 0·86. At a cut-off of 1/2, the sensitivity and specificity were 80·6% and 79·3% respectively.

Conclusions. The ethno-psychometric evaluation showed that the GHQ was both culturally valid and psychometrically sound in the Chinese rural context.