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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 8/2012

Open Access 01-08-2012 | Original Paper

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

Authors: Anna Goodman, Einar Heiervang, Bacy Fleitlich-Bilyk, Abdulla Alyahri, Vikram Patel, Mohammad S. I. Mullick, Helena Slobodskaya, Darci Neves dos Santos, Robert Goodman

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 8/2012

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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.
Appendix
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Literature
1.
Rose G, Day S (1990) The population mean predicts the number of deviant individuals. BMJ 301(6759):1031–1034PubMedCrossRef
2.
Veerman JL et al (2009) Population prevalence of depression and mean Beck Depression Inventory score. Br J Psychiatry 195(6):516–519PubMedCrossRef
3.
Goodman A, Goodman R (2011) Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. J Child Psychiatry Psychol 52(1):100–108CrossRef
4.
Heiervang E, Goodman A, Goodman R (2008) The Nordic advantage in child mental health: separating health differences from reporting style in a cross-cultural comparison of psychopathology. J Child Psychol Psychiatry 49(6):678–685PubMedCrossRef
5.
Breslau N (1987) Inquiring about the bizarre: false positives in Diagnostic Interview Schedule for Children (DISC) ascertainment of obsessions, compulsions, and psychotic symptoms. J Am Acad Child Adolesc Psychiatry 26(5):639–644PubMedCrossRef
6.
Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586PubMedCrossRef
7.
8.
Achenbach TM et al (1990) Epidemiological comparisons of Puerto-Rican and United-States Mainland children–parent, teacher, and self-reports. J Am Acad Child Adolesc Psychiatry 29(1):84–93PubMedCrossRef
9.
Weine AM, Phillips JS, Achenbach TM (1995) Behavioral and emotional-problems among Chinese and American children–parent and teacher reports for ages 6 to 13. J Abnorm Child Psychol 23(5):619–639PubMedCrossRef
10.
Crijnen AAM, Achenbach TM, Verhulst FC (1999) Problems reported by parents of children in multiple cultures: The Child Behavior Checklist Syndrome Constructs. Am J Psychiatry 156(4):569–574PubMed
11.
Becker A et al (2006) Psychopathological screening of children with ADHD: Strengths and Difficulties Questionnaire in a pan-European study. Eur Child Adolesc Psychiatry 15:56–62CrossRef
12.
Obel C et al (2004) The Strengths and Difficulties Questionnaire in the Nordic countries. Eur Child Adolesc Psychiatry 13(Suppl 2):II32–II39PubMed
13.
Luk S (1996) Cross cultural/ethnical aspects, in hyperactivity disorders of childhood. In: Sandberg S (ed). Cambridge University Press, Cambridge
14.
Mann EM et al (1992) Cross-cultural differences in rating hyperactive-disruptive behaviors in children. Am J Psychiatry 149(11):1539–1542PubMed
15.
Meltzer H et al (2000) Mental health of children and adolescents in Great Britain. The Stationery Office, London
16.
Green H et al (2005) Mental health of children and young people in Great Britain, 2004. Palgrave MacMillan, Basingstoke
17.
Heiervang E et al (2007) Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry 46(4):438–447PubMedCrossRef
18.
Fleitlich-Bilyk B, Goodman R (2004) Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry 43(6):727–734PubMedCrossRef
19.
Goodman R et al (2005) The Ilha de Mare study: a survey of child mental health problems in a predominantly African-Brazilian rural community. Soc Psychiatry Psychiatr Epidemiol 40(1):11–17PubMedCrossRef
20.
Alyahri A, Goodman R (2008) The prevalence of DSM-IV psychiatric disorders among 7–10 year old Yemeni schoolchildren. Soc Psychiatry Psychiatr Epidemiol 43(3):224–230PubMedCrossRef
21.
Pillai A et al (2008) Non-traditional lifestyles and the prevalence of mental disorders in young adolescents in a community in India. Br J Psychiatry 192:45–51PubMedCrossRef
22.
Mullick MS, Goodman R (2005) The prevalence of psychiatric disorders among 5–10 year olds in rural, urban and slum areas in Bangladesh: an exploratory study. Soc Psychiatry Psychiatr Epidemiol 40(8):663–671PubMedCrossRef
23.
Goodman R, Slobodskaya H, Knyazev G (2005) Russian child mental health–a cross-sectional study of prevalence and risk factors. Eur Child Adolesc Psychiatry 14(1):28–33PubMedCrossRef
24.
Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345PubMedCrossRef
25.
Goodman R, Scott S (1999) Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful? J Abnorm Child Psychol 27(1):17–24PubMedCrossRef
26.
Klasen H et al (2000) Comparing the German versions of the Strengths and Difficulties Questionnaire (SDQ-Deu) and the Child Behavior Checklist. Eur Child Adolesc Psychiatry 9(4):271–276PubMedCrossRef
27.
Achenbach TM et al (2008) Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications, and future directions. J Child Psychol Psychiatry 49(3):251–275PubMedCrossRef
28.
Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 9(2):129–134PubMedCrossRef
29.
Goodman R (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40(5):791–799PubMedCrossRef
30.
Mullick MS, Goodman R (2001) Questionnaire screening for mental health problems in Bangladeshi children: a preliminary study. Soc Psychiatry Psychiatr Epidemiol 36(2):94–99PubMedCrossRef
31.
Goodman A, Goodman R (2009) Strengths and difficulties questionnaire as a dimensional measure of child mental health. J Am Acad Child Adolesc Psychiatry 48(4):400–403PubMedCrossRef
32.
Goodman R, Ford T, Meltzer H (2002) Mental health problems of children in the community: 18 month follow up. BMJ 324(7352):1496–1497PubMedCrossRef
33.
Goodman R et al (2000) The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41(5):645–655PubMedCrossRef
34.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). American Psychiatric Association, Washington, DC
35.
Goodman R et al (1996) Rating child psychiatric caseness from detailed case histories. J Child Psychol Psychiatry 37(4):369–379PubMedCrossRef
36.
Alyahri A, Goodman R (2006) Validation of the Arabic Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment. East Mediterr Health J 12(Suppl 2):S138–S146PubMed
37.
Ford T, Goodman R, Meltzer H (2003) The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 42(10):1203–1211PubMedCrossRef
38.
Goodman A et al (2007) Child, family, school and community risk factors for poor mental health in Brazilian school children. J Am Acad Child Adolesc Psychiatry 46(4):448–456PubMedCrossRef
39.
Ford T et al (2008) Predictors of service use for mental health problems among British school children. Child Adolesc Mental Health 13(1):32–40CrossRef
40.
Goodman A, Patel V, Leon DA (2010) Why do British Indian children have an apparent mental health advantage? J Child Psychol Psychiatry 51(10):1171–1183PubMedCrossRef
41.
Alyahri A, Goodman R (2008) Harsh corporal punishment of Yemeni children: occurrence, type and associations. Child Abuse Negl 32(8):766–773PubMedCrossRef
42.
Rutter M, Tizard J, Whitmore K (1970) Education, health and behaviour. Longmans, London
43.
Achenbach TM (1991) Manual for the Teacher’s Report Form and 1991 profile. University of Vermont, Burlington
44.
Achenbach TM (1991) Manual for the Youth Self-Report and 1991 profile. University of Vermont, Burlington
45.
Achenbach TM (1991) Manual for the Child Behavior Checklist 4-18 and 1991 Profile. University of Vermont, Burlington
46.
Goodman R (1994) A modified version of the Rutter parent questionnaire including extra items on children’s strengths: a research note. J Child Psychol Psychiatry 35(8):1483–1494PubMedCrossRef
47.
Noble M et al (2004) Indices of deprivation. Report to the Office of the Deputy Prime Minister. Neighbourhood Renewal Unit, London
Metadata
Title
Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence
Authors
Anna Goodman
Einar Heiervang
Bacy Fleitlich-Bilyk
Abdulla Alyahri
Vikram Patel
Mohammad S. I. Mullick
Helena Slobodskaya
Darci Neves dos Santos
Robert Goodman
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 8/2012
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-011-0440-2

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