Abstract
BackgroundIn 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.
Highlights
In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery
In low-resource countries, the provision of mental health care is hampered by the lack of qualified personnel and limited access to health services [4] combined with stigma and poor awareness of psychological difficulties in young children [5, 6]
Building on the methods used for the cross-cultural validation of a screening tool designed for children aged three to six years [22, 23], we aimed to develop and to cross-culturally validate a screening tool for psychological difficulties among children aged six to 36 months
Summary
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. The largest proportion of this burden is located in low-resource countries, where up to half of the population is younger than 15 years [1]. In these countries, childhood psychological difficulties often remain undetected and untreated [2], limiting children’s full developmental potential and increasing the risk of later mental health difficulties [1]. Building on the methods used for the cross-cultural validation of a screening tool designed for children aged three to six years [22, 23], we aimed to develop and to cross-culturally validate a screening tool for psychological difficulties among children aged six to 36 months
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