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Screening for Mental Health Among Young South African Children: the Use of the Strengths and Difficulties Questionnaire (SDQ)

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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 2 years later. Exploratory factor analysis examined 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 are being considered, modification or additional measures may be needed.

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Acknowledgments

We would like to acknowledge the assistance of the four lay counselors Matilda Ngcoya, Cynthia Memela, Nozipho Sibiya, and Nothando Memela who administered the SDQ and the study participants who agreed to participate in additional focus group discussions in order to assist us with this study. We must also acknowledge the significant contribution of our collaborator and friend Meera Chhagan, whose life ended much too soon. This work could not have been done without her and we dedicate this article to her.

Funding

This work was supported by the National Institute of Drug Abuse at the National Institutes of Health (grant number 5 R01 DA023697) as part of the Fogarty Global Brain Disorders Program and by a center grant from the National Institute of Mental Health at the National Institutes of Health (grant number P30-MH43520; Principal Investigator: Robert Remien) to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. The opinions represented here are the sole responsibility of the authors and do not necessarily represent the official view of the NIH.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA

    Claude Ann Mellins & Danielle F. Nestadt

  2. Department of Psychology, New York University, New York, NY, USA

    Qi Xu & Patrick E. Shrout

  3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Justin Knox, Stephen Arpadi & Leslie L. Davidson

  4. Department of Paediatrics and Child Health, Maternal and Child Health Unit, University of KwaZulu-Natal, Durban, South Africa

    Shuaib Kauchali & Jane Kvalsvig

  5. Department of Pediatrics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA

    Stephen Arpadi & Leslie L. Davidson

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  1. Claude Ann Mellins
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  2. Qi Xu
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  3. Danielle F. Nestadt
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Corresponding author

Correspondence to Claude Ann Mellins.

Ethics declarations

Ethical Considerations

Study procedures were approved by Institutional Review Boards in both SA and the USA. Informed consent was obtained from caregivers for their own and their child’s study participation. Separate consent was obtained for focus group discussions.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Mellins, C.A., Xu, Q., Nestadt, D.F. et al. Screening for Mental Health Among Young South African Children: the Use of the Strengths and Difficulties Questionnaire (SDQ). Glob Soc Welf 5, 29–38 (2018). https://doi.org/10.1007/s40609-018-0110-3

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  • DOI: https://doi.org/10.1007/s40609-018-0110-3

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