Claude A Mellins1, Qi Xu2, Danielle F Nestadt1, Justin Knox3, Shuaib Kauchali4, Stephen Arpadi3,5, Jane Kvalsvig4, Patrick E Shrout2, Leslie L Davidson3,5. 1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute & Columbia University, New York, NY. 2. Department of Psychology, New York University, New York, NY. 3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. 4. Department of Paediatrics and Child Health, Maternal and Child Health Unit, University of KwaZulu-Natal, Durban, South Africa. 5. Department of Pediatrics, College of Physicians and Surgeons, Columbia University of Medical Center, New York, NY.
Abstract
BACKGROUND: Little is known about the prevalence of child mental health (MH) problems in sub-Saharan Africa, where poverty, HIV, and family disruption increase risk. One barrier is the lack of MH assessment tools lay staff can validly and reliably administer in settings with few MH professionals. METHODS: In a South African (SA) peri-urban cohort, we examined psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a widely used measure of child emotional and behavioral functioning. Data come from a large population-based study (N=1581) of children 4-6 years old. Lay fieldworkers administered the SDQ in isiZulu to caregivers at baseline and two years later. Exploratory factor analysisexamined whether the established SDQ five-factor structure and Total Difficulties score would be replicated. The psychometric model was tailored for ordinal items, and target factor rotation was used. RESULTS: Total Difficulties, Emotional symptoms and Prosocial behavior factors were supported, with partial support for Conduct problems. Peer relationships and Hyperactivity/inattentive subscale items loaded poorly. Subscale Cronbach's alphas ranged from 0.29 (Peers) to 0.62 (Emotional). Internal consistency of Total Difficulties score was acceptable (0.74); 30% scored in the abnormal range on Total Difficulties, based on UK norms. CONCLUSIONS: SDQ scores in our sample suggest young children in SA are at high risk for MH problems. The SDQ, particularly the Total Difficulties score, may be a useful screening tool in SA. Yet, some subscales did not work in this language and context; if social skills and hyperactivity/inattention arebeing considered, modification or additional measures may be needed.
BACKGROUND: Little is known about the prevalence of child mental health (MH) problems in sub-Saharan Africa, where poverty, HIV, and family disruption increase risk. One barrier is the lack of MH assessment tools lay staff can validly and reliably administer in settings with few MH professionals. METHODS: In a South African (SA) peri-urban cohort, we examined psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a widely used measure of child emotional and behavioral functioning. Data come from a large population-based study (N=1581) of children 4-6 years old. Lay fieldworkers administered the SDQ in isiZulu to caregivers at baseline and two years later. Exploratory factor analysisexamined whether the established SDQ five-factor structure and Total Difficulties score would be replicated. The psychometric model was tailored for ordinal items, and target factor rotation was used. RESULTS: Total Difficulties, Emotional symptoms and Prosocial behavior factors were supported, with partial support for Conduct problems. Peer relationships and Hyperactivity/inattentive subscale items loaded poorly. Subscale Cronbach's alphas ranged from 0.29 (Peers) to 0.62 (Emotional). Internal consistency of Total Difficulties score was acceptable (0.74); 30% scored in the abnormal range on Total Difficulties, based on UK norms. CONCLUSIONS: SDQ scores in our sample suggest young children in SA are at high risk for MH problems. The SDQ, particularly the Total Difficulties score, may be a useful screening tool in SA. Yet, some subscales did not work in this language and context; if social skills and hyperactivity/inattention arebeing considered, modification or additional measures may be needed.
Entities:
Keywords:
South Africa; Strengths and Difficulties Questionnaire (SDQ); child mental health; psychometric; task shifting
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