Screening for Mental Health Among Young South African Children: the Use of the Strengths and Difficulties Questionnaire (SDQ)

Background: Little is known about the prevalence of child mental health (MH) problems in sub-Saharan Africa, where poverty, HIV, and family disruption increase risk. One barrier is the lack of MH assessment tools lay staff can validly and reliably administer in settings with few MH professionals. Methods: In a South African (SA) peri-urban cohort, we examined psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a widely used measure of child emotional and behavioral functioning. Data come from a large population-based study (N = 1581) of children 4–6 years old. Lay fieldworkers administered the SDQ in isiZulu to caregivers at baseline and 2 years later. Exploratory factor analysis examined whether the established SDQ five-factor structure and Total Difficulties score would be replicated. The psychometric model was tailored for ordinal items, and target factor rotation was used. Results: Total difficulties, emotional symptoms, and prosocial behavior factors were supported, with partial support for conduct problems. Peer relationships and hyperactivity/inattentive subscale items loaded poorly. Subscale Cronbach’s alphas ranged from 0.29 (Peers) to 0.62 (emotional). Internal consistency of total difficulties score was acceptable (0.74); 30% scored in the abnormal range on total difficulties, based on UK norms. Conclusions: SDQ scores in our sample suggest young children in SA are at high risk for MH problems. The SDQ, particularly the total difficulties score, may be a useful screening tool in SA. Yet, some subscales did not work in this language and context; if social skills and hyperactivity/inattention are being considered, modification or additional measures may be needed.