Abstract
The Strengths and Difficulties Questionnaire (SDQ) has been used in many epidemiological studies to assess adolescent mental health problems, but cross-country comparisons of the self-report SDQ are scarce and so far failed to find a good-fitting, common, invariant measurement model across countries. The present study aims to evaluate and establish a version of the self-report SDQ that allows for a valid cross-country comparison of adolescent self-reported mental health problems. Using the Health Behaviour in School-aged Children study, the measurement model and measurement invariance of the 20 items of the self-report SDQ measuring adolescent mental health problems were evaluated. Nationally representative samples of 11-, 13- and 15-year old adolescents (n = 33 233) from seven countries of different regions in Europe (Bulgaria, Germany, Greece, the Netherlands, Poland, Romania, Slovenia) were used. In order to establish a good-fitting and common measurement model, the five reverse worded items of the self-report SDQ had to be removed. Using this revised version of the self-report SDQ, the SDQ-R, partial measurement invariance was established, indicating that latent factor means assessing conduct problems, emotional symptoms, peer relationships problems and hyperactivity-inattention problems could be validly compared across the countries in this study. Results showed that adolescents in Greece scored relatively low on almost all problem subscales, whereas adolescents in Poland scored relatively high on almost all problem subscales. Adolescents in the Netherlands reported the most divergent profile of mental health problems with the lowest levels of conduct problems, low levels of emotional symptoms and peer relationship problems, but the highest levels of hyperactivity-inattention problems. With six factor loadings being non-invariant, partial measurement invariance was established, indicating that the 15-item SDQ-R could be used in our cross-country comparison of adolescent mental health problems. To move the field of internationally comparative research on adolescent mental health forward, studies should test the applicability of the SDQ-R in other countries in- and outside Europe, continue to develop the SDQ-R as a cross-country invariant measure of adolescent mental health, and examine explanations for the found country differences in adolescent mental health problems.
Highlights
Worldwide, a significant percentage of adolescents experience mental health problems (Polanczyk et al, 2015)
The two largest modification indices (MI) suggested to correlate the residuals of the reverse worded items belonging to the same subscale
The Strengths and Difficulties Questionnaire (SDQ)-R was found to have a sufficient amount of invariant items, indicating that adolescent mental health problems could be validly compared across the seven countries in this study
Summary
A significant percentage of adolescents experience mental health problems (Polanczyk et al, 2015). As these problems are likely to continue into adulthood (Rutter et al, 2006), mental health promotion efforts in adolescence are a global public health priority (Patel et al, 2007). There is clear evidence of cross-country variation in adolescent subjective well-being (e.g., life satisfaction) in Europe (Bradshaw and Richardson, 2009; Klocke et al, 2014; Inchley et al, 2016), but global prevalence data on adolescent mental health problems are scarce (Erskine et al, 2017).
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