Screening for psychological difficulties in young children in crisis: complementary cross-cultural validation (original) (raw)
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BMC Pediatrics
Background: In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6-36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months. Methods: A primary validation of the PSYCa 6-36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6-36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6-36 and external validity was assessed by comparing the results of the PSYCa 6-36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant. Results: The PSYCa 6-36 showed satisfactory psychometric properties (Cronbach's alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia. Conclusions: The PSYCa 6-36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children's psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6-36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties.
BMC Psychiatry, 2012
The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3-6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed. Methods: This study was conducted in Maradi, Niger. The scale was translated into Hausa, using corroboration of independent translations. A cross-cultural validation was implemented using quantitative and qualitative methods. A random sample of 580 mothers or caregivers of children 3 to 6 years old were included. The tool was psychometrically examined and diagnostic properties were assessed comparing the PSYCa 3-6 against a clinical interview as the gold standard. Results: The PSYCa 3-6 Hausa version demonstrated good concurrent validity, as scores correlated with the gold standard and the Clinical Global Impression Severity Scale (CGI-S) [rho = 0.41, p-value = 0.00]. A reduction procedure was used to reduce the scale from 40 to 22 items. The test-retest reliability of the PSYCa 3-6 was found to be high (ICC 0.81, CI95% [0.68; 0.89]). In our sample, although not the purpose of this study, approximately 54 of 580 children required subsequent follow-up with a psychologist.
Journal of Child Psychology and Psychiatry, 2009
Background: Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low-and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief, multi-informant and multi-indicator Child Psychosocial Distress Screener (CPDS). Methods: The CPDS data of total samples in targeted catchment areas of a psychosocial care program in four conflict-affected countries (Burundi n = 4193; Sri Lanka n = 2573; Indonesia n = 1624; Sudan n = 1629) were studied to examine the cross-cultural construct validity of the CPDS across settings. First, confirmatory factor analyses were done to determine the likelihood of pre-determined theory-based factor structures in each country sample. Second, multi-sample confirmatory factor analyses were done within each country sample to test measurement equivalence of the factor structure as a measure of construct validity. Results: A 3-factor structure reflecting the theoretical premises of the instrument (e.g., child distress, child resilience and contextual factors) was found in the samples from Burundi, Sri Lanka and Indonesia, albeit with context specific deviations. The robustness of the 3-factor structure as an indicator of construct validity was confirmed within these three samples by means of multi-sample confirmatory factor-analyses. A 3-factor structure was not found in the Sudan sample. Conclusions: This study demonstrates the comparability of the assessment by the CPDS of the construct 'non-specific psychosocial distress' across three out of four countries. Robustness of the factor structure of the CPDS within different samples refers to the construct validity of the instrument. However, owing to context-specific deviations of inter-item relationships, the CPDS scores cannot be compared cross-culturally, a finding that confirms the need for attention to contextual factors when screening for non-specific psychosocial distress.
he article presents a research for the indicative evaluation of psychological distur- bance amongst young children following the 2010 earthquake in Haiti. We used a new psychological evaluation questionnaire for young children, the PSYCa 3–6. It is a hetero-evaluation tool and is completed on site by the interviewer. The questionnaire was conducted in Port-au-Prince. The average age of the 166 children taking part in the study was 58 months. Psychological disturbance score appears to be high amongst our child population in Port-au-Prince. This corroborates other research into the psycho- logical condition of natural disaster victims. A higher score of psychological distur- bance was observed amongst boys and in the youngest group of children. This first application of the PSYCa 3–6, in a natural disaster area, highlights its capacity to identify children in great difficulties, the acceptability of the questionnaire and its appropriateness for use in humanitarian crisis areas. Keywords: children; psychological disturbances; evaluation; Haiti; earthquake
Exposure to conflict and natural disasters poses significant risks to the mental health and psychosocial wellbeing of affected populations. Children and adolescents are particularly vulnerable given that humanitarian emergencies often disrupt the very social institutions, community resources, economic livelihoods, and infrastructural supports that children depend on for normal growth and development. Although children can be remarkably resilient and adaptive to change in their environments, such disruption of the social fabric commonly warrants the mobilization of interventions addressing mental health and psychosocial support to further facilitate recovery and growth (Loughrey & Eyber, 2003; Boothby, Wessells & Strang, 2006; Hunter, 2012).
Development and validation of the child psychosocial distress screener in Burundi
American Journal of Orthopsychiatry, 2008
In non-Western countries, efficient and contextually valid methods of community screening are scarce. The present study describes the validation of a new, brief, 7-item multi-informant screener for conflictaffected children (Child Psychosocial Distress Screener; CPDS). To determine concurrent validity, the CPSD was administered to 65 children and their teachers. CPDS scores were compared with indication for psychosocial treatment based on an in-depth clinical assessment by a psychiatrist and psychologist. Construct validity was assessed by testing the measurement equivalence of the CPDS in a community sample (N ϭ 2,240) in Burundi. The CPDS identifies indication for treatment with an accurateness of .81(sensitivity of .84; specificity of .60). Test-retest reliability of the instrument is good (.83). A robust and invariant factor structure provides evidence for the construct validity of the CPSD. The CPDS appears to be a useful multidimensional tool that measures nonspecific child psychosocial distress, detecting children with an indication for treatment. Because of brevity and the ability to be administered by nonspecialists, the CPDS can be an appropriate instrument to screen large populations of conflictaffected children.
Psychological injury and law, 2014
Assessing mental health problems cross-culturally for children exposed to war and violence presents a number of unique challenges. One of the most important issues is the lack of validated symptom measures to assess these problems. The present study sought to evaluate the psychometric properties of two measures to assess mental health problems: the Achenbach Youth Self-Report and the Child Posttraumatic Stress Disorder Symptom Scale. We conducted a validity study in three refugee camps in Eastern Ethiopia in the outskirts of Jijiga, the capital of the Somali region. A total of 147 child and caregiver pairs were assessed, and scores obtained were submitted to rigorous psychometric evaluation. Excellent internal consistency reliability was obtained for symptom measures for children and their caregivers. Validation of study instruments based on local case definitions was obtained for the caregivers but not consistently for the children. Sensitivity and specificity of study measures wer...
Global mental health, 2024
Humanitarian emergencies pose a significant global health challenge for children and young people's mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low-and middleincome countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments. Impact statements Mental health and Humanitarian Emergencies are global issues, affecting over 200 million school-aged children and young people, placing them at risk of developing mental health conditions (Wait, 2022; UNICEF, 2023). Mental Health and Psychosocial Support (MHPSS) programmes, aiming to protect, promote, prevent and/or treat mental health conditions, are considered as a key priority by international actors in humanitarian emergencies. In recent years, there have been growing interests to explore the impact of MHPSS on children and young people. Contributing to this effort, we identified 43 randomised controlled trials evaluating different types and modalities of MHPSS on a wide range of outcomes. Overall, MHPSS programmes that explicitly link thoughts, emotions, feelings and behaviour, such as cognitive behavioural programmes, can potentially improve depression symptoms. Additionally, narrative exposure therapy may contribute to the reduction in feelings of guilt. Psychosocial programmes involving creative activities indicate potential unintended effects on depression. However, evidence regarding the impact of other MHPSS modalities remains inconclusive. The lack of clear and consistent findings across MHPSS modalities underscores the importance of gaining an understanding how implementation contexts and socio-cultural dimensions may, directly and indirectly, impact children and young people's mental health and well-being. This systematic review highlights the importance of tailoring MHPSS programmes to diverse needs in order to safely and effectively promote, prevent and treat mental health conditions in children and young people affected by humanitarian crises in low-and middle-income countries.
BMC Psychiatry, 2011
Background: The lack of culturally adapted and validated instruments for child mental health and psychosocial support in low and middle-income countries is a barrier to assessing prevalence of mental health problems, evaluating interventions, and determining program cost-effectiveness. Alternative procedures are needed to validate instruments in these settings. Methods: Six criteria are proposed to evaluate cross-cultural validity of child mental health instruments: (i) purpose of instrument, (ii) construct measured, (iii) contents of construct, (iv) local idioms employed, (v) structure of response sets, and (vi) comparison with other measurable phenomena. These criteria are applied to transcultural translation and alternative validation for the Depression Self-Rating Scale (DSRS) and Child PTSD Symptom Scale (CPSS) in Nepal, which recently suffered a decade of war including conscription of child soldiers and widespread displacement of youth. Transcultural translation was conducted with Nepali mental health professionals and six focus groups with children (n = 64) aged 11-15 years old. Because of the lack of child mental health professionals in Nepal, a psychosocial counselor performed an alternative validation procedure using psychosocial functioning as a criterion for intervention. The validation sample was 162 children (11-14 years old). The Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Global Assessment of Psychosocial Disability (GAPD) were used to derive indication for treatment as the external criterion.