Top

Child and Adolescent Psychiatry and Mental Health

Published in:

Open Access 01-12-2020 | Research article

Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants

Authors: Li Liu, Shuang Li, Wen Pan, Lijuan Wang, Yang Zheng, Xiaoxia An, Yan Zhou, Yanxia Li, Jun Na, Rui Zhang, Huijuan Mu, Wen Dong, Yuan Gao, Wei Sun, Guowei Pan, Lingjun Yan

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2020

Abstract

Background

To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren.

Methods

Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11–17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as ‘abnormal’. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants.

Results

The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems.

Conclusions

The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.

Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378(9801):1515–25. https://doi.org/10.1016/S0140-6736(11)60827-1.CrossRefPubMed

Kato N, Yanagawa T, Fujiwara T, Morawska A. Prevalence of Children's Mental Health problems and the effectiveness of population-level family interventions. J Epidemiol. 2015;25(8):507–16.CrossRefPubMed

Bricker D, Davis MS, Squires J. Mental health screening in young children. Infants Young Child. 2004;17:129–44.CrossRef

Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public health challenge. Lancet. 2007;369:1302–13.CrossRefPubMed

Parks RJ, Kalberg RJ, Carter EW. Systematic screening at the middle school level: score reliability and validity of the student risk screening scale. J Emot Behav Disord. 2007;15:209–22.CrossRef

Canino G, Alegría M. Psychiatric diagnosis-is it universal or relative to culture? J Child Psychol Psyc. 2008;49:237–50.CrossRef

Levitt JM, Saka N, Romanelli LH, Hoagwood K. Early identification of mental health problems in schools: the status of instrumentation. J School Psychol. 2007;45:163–91.CrossRef

Stone LL, Otten R, Engels RCME, Vermulst AA, Janssens JMAM. Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4- to 12-year-olds: a review. Clin Child Fam Psychol Rev. 2010;13(3):254–74.CrossRefPubMedPubMedCentral

Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull. 1987;101:213–32.CrossRefPubMed

10.

Goodman R, Ford T, Simmons H, Gatward R, Meltzer H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Brit J Psychiat. 2000;177:534–9.CrossRefPubMed

11.

Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adoles Psy. 2000;9:129–34.CrossRef

12.

De Los RA, Kazdin AE. Measuring informant discrepancies in clinical child research. Psychol Assess. 2004;16:330–4.CrossRef

13.

De Los RA, Kazdin AE. Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol Bull. 2005;131:483–509.CrossRef

14.

Verhulst FC, Dekker MC, Van der Ende J. Parent, teacher and self-reports as predictors of signs of disturbance in adolescents: whose information carries the most weight? Acta Psychiat Scand. 1997;96:75–81.CrossRefPubMed

15.

Achenbach TM. Advancing assessment of children and adolescents: commentary on evidence-based assessment of child and adolescent disorders. J Clin Child Adolesc Psychol. 2005;34(3):541–7.CrossRefPubMed

16.

Mash EJ, Hunsley J. Evidence-based assessment of child and adolescent disorders: issues and challenges. J Clin Child Adolesc. 2005;34(3):362–79.CrossRef

17.

Ravens-Sieberer U, Wille N, Erhart M, Bettge S, Wittchen HU, Rothenberger A, et al. Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. Eur Child Adoles Psy. 2008;17(Suppl 1):22–33. https://doi.org/10.1007/s00787-008-1003-2.P.CrossRef

18.

Rapee RM, Bogels SM, Van der Sluis CM, Michelle GC, Ollendick T. Annual research review: conceptualizing functional impairment in children and adolescents. J Child Psychol Psyc. 2012;53(5):454–68. https://doi.org/10.1111/j.1469-7610.2011.02479.x.CrossRef

19.

Dang HM, Weiss B, Trung LT. Functional impairment and mental health functioning among Vietnamese children. Soc Psych Psych Epid. 2016;51(1):39–47. https://doi.org/10.1007/s00127-015-1114-2.CrossRef

20.

Goodman R. The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psyc. 1999;40(5):791–9.CrossRef

21.

Stringaris A, Goodman R. The value of measuring impact alongside symptoms in children and adolescents: a longitudinal assessment in a community sample. J Abnorm Child Psychol. 2013;41(7):1109–20.CrossRefPubMedPubMedCentral

22.

Wang JN, Liu L, Wang L. Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: a cross-sectional survey. Child Care Health Dev. 2014;40(3):319–26. https://doi.org/10.1111/cch.12101.CrossRefPubMed

23.

Sun L, Guo X, Zhang J, Liu HH, Xu SJ, Xu YY, et al. Gender specific associations between early puberty and behavioral and emotional characteristics in children. Zhonghua Liu Xing Bing Xue Za Zhi. 2016;37(1):35–9. https://doi.org/10.3760/cma.j.issn.0254-6450.2016.01.007.CrossRefPubMed

24.

Huang Y, Yan Q, Li Y, Liu J, Yao H, Yan Y. Strengths and Difficulties Questionnaire in 737 primary and middle school students aged 6–17 in Changsha. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012;37(8):860–4. https://doi.org/10.3969/j.issn.1672-7347.2012.08.018.CrossRefPubMed

25.

Hu XM, Luan XY, Rou ZWG, Gai GQ. Investigations of psychological status in middle school students in Shihezi city. Lin Chuang Shen Xin Za Zhi. 2015;21(5):101–4. https://doi.org/10.3969/j.issn.1672-187X.2015.05.034-0101-04.CrossRef

26.

Chen Q, Ding K, Lu HC, Shi BB, Zhang WW. A cross-sectional study on psychological and behavioral problems of primary and secondary school students. Zheiiang Prev Med. 2013;25(10):30–3. https://d.wanfangdata.com.cn/periodical/zjyfyx201310007(in Chinese).

27.

Wang XJ, Chen ZM. Investigation of 155 children aged 10–15 using SDQ parent version. Xian Dai Shi Yong Yi Xue. 2006;18(9):662–5. https://d.wanfangdata.com.cn/periodical/nbyx200609031(in Chinese).

28.

Gao X, Liang J, Wang SF, Zai Y, Lu YB, Shi WH, et al. Analysis on pupils’ current mental health situation and their guardians’ attitude in eight provinces in China. Zhong Hua Ji Bing Kong Zhi Za Zhi. 2013;17(7):592–5. https://d.wanfangdata.com.cn/periodical/jbkzzz201307013(in Chinese).

29.

WANG JN, Chang Y, Fu JL, Wang L. Relationship between mental health and personality characteristics among junior and senior school students in Shenyang. Zhong Guo Gong Gong Wei Sheng. 2010;26(11):1424–5. https://d.wanfangdata.com.cn/periodical/zgggws201011041(in Chinese).

30.

Lu AJ, Wang YQ, Wang YF, Zhao ZM. Investigation about emotional and behavioral problems in students aged 7 to 16 years old in Songjiang Shanghai. Jing Shen Yi Xue Za Zhi. 2015;28(2):99–101. doi: https://doi.org/10.1007/BF00165590. https://d.wanfangdata.com.cn/periodical/sdjsyx201502009(in Chinese).

31.

Yin L, Huang Y, Li Y, Shitu MJ, Xiang Y, Luo Y, et al. Epidemiological investigation on emotion difficulties among elementary and middle school students in Chengdu. 2012;12(3):238–40. https://doi.org/10.3969/j.issn.1009-6574.2012.03.007.CrossRef

32.

Xiaoli Y, Chao J, Wen P, Wenming X, Fang L, Ning L, et al. Prevalence of psychiatric disorders among children and adolescents in northeast China. PLoS ONE. 2014;9(10):e111223. https://doi.org/10.1371/journal.pone.0111223.CrossRefPubMedPubMedCentral

33.

Du Y, Kou J, Coghill D. The validity, reliability and normative scores of the parent, teacher and self report versions of the Strengths and Difficulties Questionnaire in China. Child Adol Psych Men. 2008;2(1):8. https://doi.org/10.1186/1753-2000-2-8.CrossRef

34.

SDQ: Information for researchers and professionals about the Strengths & Difficulties Questionnaires 2008. https://www.sdqinfo.com. Accessed 04 Feb 2020.

35.

Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psyc. 1997;38:581–6.CrossRef

36.

Nguyen N, Whittlesey S, Scimeca K, Digiacomo D, Bui B, et al. Parent-child agreement in prepubertal depression: findings with a modified assessment method. J Am Acad Child Psy. 1994;33:1275–83.CrossRef

37.

Piacentini JC, Cohen P, Cohen J. Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones? J Abnorm Child Psychol. 1992;20:51–63.CrossRefPubMed

38.

Kuhn C, Aebi M, Jakobsen H, Banaschewski T, Poustka L, Grimmer Y, et al. Effective mental health screening in adolescents: should we collect data from youth, parents or both? Child Psychiat Hum D. 2017;48:385–92.CrossRef

Title: Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants
Authors: Li Liu
Shuang Li
Wen Pan
Lijuan Wang
Yang Zheng
Xiaoxia An
Yan Zhou
Yanxia Li
Jun Na
Rui Zhang
Huijuan Mu
Wen Dong
Yuan Gao
Wei Sun
Guowei Pan
Lingjun Yan
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: Child and Adolescent Psychiatry and Mental Health / Issue 1/2020
Electronic ISSN: 1753-2000
DOI: https://doi.org/10.1186/s13034-020-00346-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Video gaming addiction and its association with memory, attention and learning skills in Lebanese children

Integrating clinical and research training in child psychiatry: fifteen-year outcomes of a federally supported program

Serial measurement of mood via text messaging in young people

Psychosocial distress among in-school adolescents in Mozambique: a cross-sectional study using the Global School-Based Health Survey data

Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction

Depression and suicidality among adolescents living with human immunodeficiency virus in Lagos, Nigeria