Inappropriate rating scale.

[email protected] Editor – We read with interest the study by Chan et al into the effect of needling HT7 on psychological stress in hospice staff. We agree that stress in hospice staff is an important problem and that a simple effective treatment would be useful. However, although Chan et al aimed to measure reductions in psychological stress, we feel that the outcome measure they chose was inappropriate. The Edinburgh Postnatal Depression Scale has not been validated as a measure of psychological stress in the general population and a fall to below 12 or 13 in their study population is meaningless as this threshold was determined in postpartum women. There have been numerous studies examining stress within hospice staff and the use of a previously used tool would have been more appropriate. The general health questionnaire (GHQ) is a widely used and acceptable method of establishing minor psychiatric illness in the general population and has also been validated for use in occupational settings. Chan et al do not comment on how they determined user friendliness. The 12 point GHQ takes on average less than 5 minutes to complete (the same time as the Edinburgh Postnatal Depression Scale) and is generally well received. We agree that a further, controlled study is now required but hope that a more appropriate outcome measure will be used.