Abstract
BackgroundThe use of screening instruments can reduce waiting lists and increase treatment capacity. The aim of this study was to examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) with the original UK scoring algorithms, when used as a screening instrument to detect mental health disorders among patients in the Norwegian Child and Adolescent Mental Health Services (CAMHS) North Study.MethodsA total of 286 outpatients, aged 5 to 18 years, from the CAMHS North Study were assigned diagnoses based on a Development and Well-Being Assessment (DAWBA). The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: 'possible' and 'probable' levels. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (ORD) were calculated.ResultsSensitivity for the diagnostic categories included was 0.47-0.85 ('probable' dichotomisation level) and 0.81-1.00 ('possible' dichotomisation level). Specificity was 0.52-0.87 ('probable' level) and 0.24-0.58 ('possible' level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the 'possible' level.ConclusionsThe usefulness of the SDQ UK-based scoring algorithms in detecting mental health disorders among patients in the CAMHS North Study is only partly supported in the present study. They seem best suited to identify children and adolescents who do not require further psychiatric evaluation, although this as well is problematic from a clinical point of view.
Highlights
The use of screening instruments can reduce waiting lists and increase treatment capacity
The aim of this study was to examine whether the application of specific scoring algorithms for the Strengths and Difficulties Questionnaire (SDQ), as proposed by earlier findings from the UK [20], could be used for screening in order to detect mental health disorders among children and adolescents in the Child and Adolescent Mental Health Services (CAMHS) North Study by examining sensitivity, specificity, Positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LHR+), negative likelihood ratio (LHR-), and diagnostic odds ratio (ORD)
For all patients (N = 286) clinician-assigned diagnoses were recorded based on information collected from parents, teachers and/or self-report through the Development and Well-Being Assessment (DAWBA), including the SDQ [32]
Summary
The use of screening instruments can reduce waiting lists and increase treatment capacity. The aim of this study was to examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) with the original UK scoring algorithms, when used as a screening instrument to detect mental health disorders among patients in the Norwegian Child and Adolescent Mental Health Services (CAMHS) North Study. One large study showed a prevalence of 7% among children aged 8 to 10 years [2] It is even more common for children and adolescents to suffer psychosocial impairment due to mental health problems, with an estimated 15 to 20% of this age group being affected [1]. The gap between the prevalence/impairment estimates and CAMHS coverage highlights a very real capacity problem in the Norwegian mental health care system, which results in long waiting lists and added burdens for children and families who are in need of help. If less time is spent on the evaluation of healthy youngsters, and referrals to appropriate treatment programmes are more rapid, it could potentially increase treatment capacity, and decrease the long waiting lists in CAMHS
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