School-based screening for psychiatric disorders in Moroccan-Dutch youth.

Marcia Adriaanse,Lieke van Domburgh,Wim Veling,Theo Doreleijers,Barbara Zwirs

doi:10.1186/s13034-015-0045-8

Abstract

BackgroundWhile ethnic diversity is increasing in many Western countries, access to youth mental health care is generally lower among ethnic minority youth compared to majority youth. It is unlikely that this is explained by a lower prevalence of psychiatric disorders in minority children. Effective screening methods to detect psychiatric disorders in ethnic minority youth are important to offer timely interventions.MethodsSchool-based screening was carried out at primary and secondary schools in the Netherlands with the Strengths and Difficulties Questionnaire (SDQ) self report and teacher report. Additionally, internalizing and psychotic symptoms were assessed with the depressive, somatic and anxiety symptoms scales of the Social and Health Assessment (SAHA) and items derived from the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). Of 361 Moroccan-Dutch youths (ages 9 to 16 years) with complete screening data, 152 children were diagnostically assessed for psychiatric disorders using the K-SADS. The ability to screen for any psychiatric disorder, and specific externalizing or internalizing disorders was estimated for the SDQ, as well as for the SAHA and K-SADS scales.ResultsTwenty cases with a psychiatric disorder were identified (13.2 %), thirteen of which with externalizing (8.6 %) and seven with internalizing (4.6 %) diagnoses. The SDQ predicted psychiatric disorders in Moroccan-Dutch youth with a good degree of accuracy, especially when the self report and teacher report were combined (AUC = 0.86, 95 % CI = 0.77-0.94). The SAHA scales improved identification of internalizing disorders. Psychotic experiences significantly predicted psychiatric disorders, but did not have additional discriminatory power as compared to screening instruments measuring non-psychotic psychiatric symptoms.ConclusionsSchool-based screening for psychiatric disorders is effective in Moroccan-Dutch youth. We suggest routine screening with the SDQ self report and teacher report at schools, supplemented by the SAHA measuring internalizing symptoms, and offering accessible non-stigmatizing interventions at school to children scoring high on screening questionnaires. Further research should estimate (subgroup-specific) norms and optimal cut-offs points in larger groups for use in school-based screening methods.

Highlights

While ethnic diversity is increasing in many Western countries, access to youth mental health care is generally lower among ethnic minority youth compared to majority youth
If school-based screening for psychiatric disorders is effective among ethnic minority youth in Western societies, it might provide a pathway to care for Adriaanse et al Child and Adolescent Psychiatry and Mental Health (2015) 9:13 ethnic minority youth and an opportunity to bridge the treatment gap observed in this group
Cut-offs for high-risk and low-risk subgroup selection, were based on scores on ninescales measuring psychiatric problems: subscales emotional symptoms, conduct problems and hyperactivity of the Strengths and Difficulties Questionnaire (SDQ) self report, subscales conduct problems and hyperactivity of the SDQ teacher report [11], subscales of depressive, somatic and anxiety symptoms scales of the Social and Health Assessment (SAHA) [26] and eight items derived from the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) [27] assessing psychotic experiences

Summary

Introduction

While ethnic diversity is increasing in many Western countries, access to youth mental health care is generally lower among ethnic minority youth compared to majority youth. If school-based screening for psychiatric disorders is effective among ethnic minority youth in Western societies, it might provide a pathway to care for Adriaanse et al Child and Adolescent Psychiatry and Mental Health (2015) 9:13 ethnic minority youth and an opportunity to bridge the treatment gap observed in this group. Since most screening instruments have been developed for Western populations and cross-cultural biases are likely to influence psychometric properties [5], it is not known how these questionnaires can be used in ethnic minority youth. Subgroup-specific norms may be required [8] This applies to self-report questionnaires because minority children may interpret questions differently or have different thresholds for reporting psychiatric symptoms, due to language or cultural differences. As a result of potential cross-cultural biases in construct validity and norms, it is preferable to study the performance of screening instruments for each ethnic group separately

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