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Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence

Abstract

Purpose  

To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence
of child mental health problems cross nationally.

Methods  

We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain,
India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five
studies. We used these SDQ data to calculate three different sorts of “caseness indicators” based on (1) SDQ symptoms, (2)
SDQ symptoms plus impact and (3) an overall respondent judgement of ‘definite’ or ‘severe’ difficulties. Respondents also
completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment,
DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA’s creator, working in conjunction with experienced
local professionals.

Results  

As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness
indicators (three indicators times three informants) explained 8–56% of the cross-national variation in disorder prevalence.
This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder
on the DAWBA showed large variations across the various SDQ caseness indicators.

Conclusions  

The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national
differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable
caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.

  • Content Type Journal Article
  • Category Original Paper
  • Pages 1-11
  • DOI 10.1007/s00127-011-0440-2
  • Authors
    • Anna Goodman, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
    • Einar Heiervang, Centre for Child and Adolescent Mental Health, Bergen, Norway
    • Bacy Fleitlich-Bilyk, University of São Paulo, São Paulo, Brazil
    • Abdulla Alyahri, Hadramaut University, Mukalla, Hadramaut, Yemen
    • Vikram Patel, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
    • Mohammad S. I. Mullick, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
    • Helena Slobodskaya, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk State University, Novosibirsk, Russia
    • Darci Neves dos Santos, Federal University of Bahia, Salvador, Brazil
    • Robert Goodman, King’s College London Institute of Psychiatry, London, UK
    • Journal Social Psychiatry and Psychiatric Epidemiology
    • Online ISSN 1433-9285
    • Print ISSN 0933-7954
Posted in: Journal Article Abstracts on 10/31/2011 | Link to this post on IFP |
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