Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

Abstract

Background Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa. Methods We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12–19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents. Results Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test–retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test–retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden’s index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity. Conclusions Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.

A Chinese adaptation of the Patient Health Questionnaire for Adolescents (PHQ-A): factor structure and psychometric properties

“…The Spearman correlation coefficient of the scale was 0.70, which suggested good test–retest reliability for the scale, indicating the stability of the PHQ-A. These findings align with prior studies [ 27 – 29 ]. The satisfactory internal reliability and fair test-retest reliability of the PHQ-A confirmed its acceptable reliability among Chinese adolescents with MDD.…”

Validation of Generalized Anxiety Disorder 6 (GAD-6)—A Modified Structure of Screening for Anxiety in the Adolescent French Population

“…Moreover, although race is a factor influencing the level of stress and anxiety, no study has mentioned to our knowledge that this factor can impact the perception of the items or the scale structure. Additionally, after a review of the international literature aiming to assess the structural validity of GAD-7 in different populations, an absence of the racial factor in data collection is noticeable [ 13 , 15 , 18 , 19 , 20 , 21 , 22 ], affirming the argument that it would not have an impact on the perception of items or on the structure of the scale. However, this study demonstrates relevant information that needs to be carefully taken into consideration in future screening studies of the general population of French adolescents.…”

“…However, the measurement properties have not been demonstrated in the French youth population. Recent studies have shown increasing interest in validating GAD-7 and other self-assessment questionnaires in adolescent and pediatric populations [ 13 , 15 , 18 , 19 , 20 , 21 , 22 ] in different languages, as concern grows for the mental well-being of youngsters and as early detection is considered an important factor in the successful treatment of mental disorders. Adolescents could potentially have a different understanding of certain items when compared to their adult counterparts, either due to a less developed vocabulary or due to a different generational perception of certain terms.…”

“…Given the recent works on the GAD-7 among adolescents in different languages [ 13 , 15 , 18 , 19 , 20 , 21 , 22 ], the need for a brief and robust instrument to screen anxiety among French adolescents, as well as the importance of verifying the structure stability of GAD-7 during a particularly anxiety-inducing time, such as the COVID-19 pandemic, this study aimed to achieve the following: Examine the construct validity of the French version of the GAD-7 in a sample of French adolescents (11–18 years old) by combining the Classical Test Theory (CTT) and the Item Response Theory (IRT). Explore the invariance of items on the French version of the GAD-7 scale.…”

Mental health and psychological well-being of Kenyan adolescents from Nairobi and the Coast regions in the context of COVID-19

“…A score of 5–9, 10–14, 15–19, and 20–27 represents the cut-off points for mild, moderate, moderately severe, and severe depression, respectively. PHQ-9 has been used and validated for use in adolescents from Africa [ 2 , 20 , 43 ]. The tool has been validated in the Swahili language [ 24 ].…”