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

Journal: BMC psychiatry

Volume: 22

Issue: 1

Year of Publication: 2022

Affiliated Institutions:  Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, W. th St. th Floor, New York, NY, , USA. kll@cumc.columbia.edu. Department of Mental Health, Ministry of Health, Maputo, Mozambique. Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

Abstract summary 

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.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.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.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.

Authors & Co-authors:  Lovero Kathryn L KL Adam Salma Ebrahim SE Bila Carolina Ezequias CE Canda Elda D ED Fernandes Maria Eduarda ME Rodrigues Teresa I Baltazar TIB Sander Mariel C Tai MCT Mellins Claude A CA Duarte Cristiane S CS Dos Santos Palmira Fortunato PF Wainberg Milton L ML

Study Outcome 

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Statistics
Citations :  Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet. 2011;377(9783):2093–2102. doi: 10.1016/S0140-6736(11)60512-6.
Authors :  11
Identifiers
Doi : 549
SSN : 1471-244X
Study Population
Female
Mesh Terms
Adolescent
Other Terms
ADHD;Anxiety;Depression;Disruptive behavior disorders;GAD;LMIC;PHQ;Psychometrics;SDQ;Youth
Study Design
Study Approach
Country of Study
Mozambique
Publication Country
England