Background: A valid screening tool for behavioral and emotional problems in children and adolescents is needed to promote psychological wellbeing and to prevent mental disorders in China's children.
Aim: Assess the use of the Chinese version of the internationally recognized Strengths and Difficulties Questionnaire (SDQ) - which assesses emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviors - in a large sample of urban and rural children from different parts of China.
Methods: The Chinese version of the parent-reported SDQ was administered to legal guardians (primarily parents) of a stratified random sample of 22,108 primary school children 5 to 13 years of age from eight provinces in China. The association between SDQ scores and socio-demographic characteristics was assessed and the percentile cutoff scores for 'abnormal', 'borderline' and 'normal' results in China were compared with those for Japan and the United Kingdom.
Results: The internal consistency of the 4 of the 5 SDQ subscales were satisfactory but that for the 'peer relationships problems' subscale was quite poor (alpha=0.22). Guardians reported that boys were more likely than girls to have hyperactivity/inattention problems and that girls were more likely than boys to have problems with emotional symptoms. For both boys and girls hyperactivity/inattention problems decreased with age while peer relationship problems increased with age. Emotional symptoms, conduct problems and peer relationship problems were more common in children from rural areas and in children whose identified guardian was not a parent (i.e., a grandparent or other relative). The 90(th) percentile cutoff score for abnormal results was higher in Chinese children than the cutoff scores reported for children in Japan and the United Kingdom.
Conclusions: This study suggests that prevention programs for hyperactivity/inattention problems in boys need to start before the age of 10 and that training in methods of reducing the stress associated with peer relationships should start in early adolescence. Further work is needed to improve the cultural validity of the SDQ in China and to determine its sensitivity and specificity for identifying children who are in need of mental health services.
背景: 我国儿童心理问题不断增多，因此能够快速有效评估儿童的行为和情绪问题的筛查工具对于促进我国儿童身心健康和预防儿童精神疾病有重要的意义。
目的: 在来源于中国不同地区城市和农村的大样本儿童中对国际公认的长处和困难问卷（SDQ）中文版的使用进行评估，包括情绪症状、品行问题、多动/注意缺陷、同伴交往问题和亲社会行为。
方法: 采用分层随机抽样选取八省22,108名5~13岁小学生，请其的监护人（主要为父母）填写SDQ进行评估。本研究探讨了SDQ得分与其他社会人口学特征的关系，并将所得到的筛查界值与日本和英国相关研究的筛查界值进行了比较。
结果: 在中文版SDQ（父母版）的五个分量表中，四个分量表的内部一致性尚可，但是 “同伴关系” 分量表的内部一致性效度较差（α=0.22）。依据监护人的报告，男孩比女孩的多动/注意力缺陷问题更突出，而女孩比男孩的情绪问题更突出。对于5~13岁的男孩女孩，多动/注意力缺陷问题随着年龄增长而减少，同伴交往困难随着年龄增长而增多。农村地区和监护人不是父母（即祖父母或其他亲属）的孩子中，情绪症状、品行问题和同伴交往问题较为普遍。我国儿童的SDQ困难总分的划界异常值（90%百分位）为19~40，高于日本和英国的划界分。
结论: 此项研究提示，对男孩的多动/注意缺陷问题应在十岁之前开始预防，并且在青春期早期就要开始训练如何减轻与同伴交往带来的压力。进一步的研究需要注重于提高SDQ在中国文化背景下的信效度，并确定SDQ对达到临床诊断标准的精神疾病是否具有良好的筛查敏感性和特异性。