Validation studies on a screening tool for mental disorder of children and youth in Canada and the implication for program evaluation
Date
2021
Authors
Jiang, Xuejing
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Abstract
Background: The early detection of mental disorders holds the best promise for population mental disorder prevention. However, child welfare resources are often limited to conduct in-depth mental assessments. Therefore, we studied the Strengths and Difficulties Questionnaire (SDQ) and its scoring metrics for quick and convenient mental screening in Canadian children.
Study purposes: The following research questions were addressed: How well do the SDQ scores diagnose mental disorders among children? Are the SDQ cut-offs proposed in other countries applicable to Canada? Does combining the SDQ scores and the SDQ impact supplement improve predictive values? Does it have different implications for the program evaluation when treating SDQ scores as continuous versus categorical variables?
Method: The study was conducted using PAX program data along with the longitudinal health, education and social services administrative data. PAX is a classroom-based early mental health prevention program. A full sample of 4,676 students was used for PAX program evaluation, and a subsample of 1,993 students was used in the SDQ validation study. We analyzed the association between SDQ scores and mental disorder, explored the screening properties of the SDQ using sensitivity, specificity, accuracy, and ROC, and achieved the best SDQ cut-off by assessing all possible combinations of the SDQ scores. Then, a series of linear mixed models were fitted to illustrate the program evaluations using SDQ scores or classification.
Conclusions: The SDQ scores significantly differ among those with mental disorders and those without. Our proposed cut-offs showed improved sensitivity. Including the additional SDQ impact scores had a better prediction for mental disorders than using the SDQ difficulty score alone. Using the SDQ scores as continuous and categorical variables can lead to different estimations of program effect size and identify different factors associated with mental wellness.
Impact and Significance: This study fills the knowledge gap of using SDQ for mental health screening. The recommendation on the use of SDQ will help to identify children who may need early intervention and additional supports. The evidence from this thesis helps to evaluate mental health prevention programs and understand what factors might facilitate the implementation of mental health programs in Canada.
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Keywords
Mental health, SDQ, Hierarchical model, Longitudinal analysis, Administrative data