Prevalence of psychosocial distress in school going adolescents in rural Pakistan: findings from a cross-sectional epidemiological survey
Prevalence of psychosocial distress in school going adolescents in rural Pakistan: findings from a cross-sectional epidemiological survey
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DOI：
10.1192/bjo.2021.196
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发表时间：
2021-06-18
期刊：
影响因子：
5.4
通讯作者：
Minhas FA
中科院分区：
文献类型：
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作者：
Hamdani SU;Huma ZE;Javed H;Warraitch A;Rahman A;Nizami AT;Minhas FA
建议对青少年进行早期干预，以防止长期精神病发病。然而，在没有儿童和青少年心理健康服务的低收入和中等收入国家，早期识别有心理健康问题风险的青少年仍然是一项挑战。儿科症状检查表（PSC）在一些高收入国家的预防性儿童保健服务中使用，以早期识别需要心理健康服务的儿童和青少年。本研究的目的是评估的信度和效度的自我评价，乌尔都语版本的PSC，以确定在巴基斯坦农村拉瓦尔平迪的公立学校学习的青少年在风险。我们对巴基斯坦拉瓦尔平迪Kallar Syedan分区41所公立学校的所有13-15岁青少年进行了横断面流行病学调查。一个改编的乌尔都语版本的自我报告PSC被用来评估青少年的心理困扰的外化，内化和注意力问题。优势和困难问卷（SDQ）被用作金标准测量。青少年版的PSC和SDQ由训练有素的研究团队在课堂环境中进行。数据收集自2019年4月至5月期间的5856名青少年（应答率97%）。参与者的平均年龄为14.37岁（±1.06）; 51%的参与者为女性。乌尔都语版PSC的内部一致性信度良好（Cronbach α 0.85）。以PSC ≥28分为标准分界点，青少年心理社会困扰的患病率为25.5%（男生27.4%，女生23.6%）。以SDQ总难度评分≥16分为标准，ROC曲线下面积为0.85（95%CI 0.82-0.88），诊断PSC的敏感性为57.64%，特异性为89.10%。如果PSC的敏感性和特异性在PSC ≥ 24的临界值处优化为76%，则青少年心理社会困扰的患病率将增加到41%。在我们的研究中，巴基斯坦拉瓦尔平迪农村公立学校四分之一的青少年被确定为社会情感发展不良的风险。乌尔都语版的PSC是一个可靠和有效的工具，以确定在巴基斯坦农村公立学校需要心理社会干预的青少年。虽然标准的截止分数产生更好的特异性，PSC与相对较低的截止分数可以用来筛选工具，以确定在巴基斯坦农村公立学校的风险青少年。
Early interventions are recommended in adolescents to prevent long-term psychiatric morbidity. However, in Low and Middle Income Countries (LMICs), where there are no child and adolescent mental health services, early identification of adolescents at-risk of mental health problems remains a challenge. Pediatric Symptoms Checklist (PSC) is used in preventive child healthcare services in a number of high income countries for early identification of children and adolescents in need of mental health services. The aim of this study was to assess the reliability and validity of self-rated, Urdu version of PSC to identify at-risk adolescents studying in the public schools of rural Rawalpindi in Pakistan. We did a cross-sectional epidemiological survey with all adolescents aged 13–15 years, studying in 41 public schools of Kallar Syedan sub-district in Rawalpindi, Pakistan. An adapted Urdu version of self-reported PSC was used to assess the psychosocial distress in adolescents in-terms of externalizing, internalizing and attention problems. Strengths and Difficulties Questionnaire (SDQ) was used as a gold standard measure. Youth version of PSC and SDQ were administered in classroom settings by trained research teams. The data were collected from 5856 adolescents (response rate 97%) between April-May, 2019. The mean age of the participants was 14.37 years (±1.06); 51% participants were female. The internal consistency reliability of Urdu version of PSC was good (Cronbach alpha 0.85). At the standard cut-off score of PSC ≥28, the prevalence rate of psychosocial distress in adolescents was 25.5% (27.4% in boys & 23.6% in girls). Using the SDQ total difficulties score ≥16 as a standard criterion; the area under the ROC curve was 0.85 (95% CI 0.82–0.88), with a sensitivity of 57.64% and specificity of 89.10% of PSC. If the sensitivity and specificity of PSC is optimized to 76% at the cut-off score of PSC ≥ 24, the prevalence rates of psychosocial distress in adolescents is increased to 41%. In our study, 1 in 4 adolescents in public schools of rural Rawalpindi in Pakistan have been identified at-risk of poor socio-emotional development. Urdu version of PSC is a reliable and valid tool to identify adolescents in need of psychosocial interventions in public schools of rural Pakistan. While the standard cut-off score yields a better specificity; PSC with relatively lower cutoff score can be used a screening tool to identify at-risk adolescents in public schools of rural Pakistan.