Spanish normative data of the Strengths and Difficulties Questionnaire in a community-based sample of adolescents

Mentalizing in adolescence: Psychometric properties of the reflective functioning questionnaire (RFQ) and links with mental health, psychological well-being, and suicidal behaviours

BACKGROUND

Reflective functioning [RF], or mentalizing, refers to the ability to understand others and the self in terms of internal mental states. RF is thought to play a key role in the development of mental health problems, and to attenuate risk and morbidity associated to psychopathology. The main goal of this study was to validate the Reflective Functioning Questionnaire (RFQ) into Spanish in a community-derived sample of adolescents. In addition, the association between RFQ scores and suicidal behaviour, mental health strengths and difficulties, and personal well-being was analyzed.

METHOD

A total of 1588 students (M = 16.13 years, SD = 1.36; 46.5 % boys), participated in the study. Several measuring instruments of mental health, subjective well-being, and suicidal behaviours were administrated.

RESULTS

Results revealed that a model with 7 items, excluding item 4 and consistent with RFQ uncertainty scoring, had adequate goodness-of-fit indices. Partial measurement invariance of the RFQ-7 scores across gender was supported. The total score displayed a McDonald's Omega coefficient of 0.98 for the RFQ-7. The RFQ-7 was negatively correlated with psychological well-being and positively associated with suicidal behaviours, and emotional and behavioural problems.

CONCLUSIONS

The RFQ is a brief, easy, and reliable tool for assessing reflective functioning difficulties in adolescents from the general population.

Validation of the Multidimensional Scale of Perceived Social Support (MSPSS) in a Representative Sample of Adolescents: Links with Well-being, Mental Health, and Suicidal Behavior

Objective: Social support is understood as a protective factor for mental health and emotional well-being, especially at school. The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used tools worldwide to assess this construct. The main purpose of the present study was to validate the scores of the MSPSS in a large sample of non-clinical adolescents. Method: The sample consisted of 2,235 compulsory secondary education students in Spain (M age = 14.49, SD age = 1.76, age range 12-18 years, 52% female) obtained by stratified random sampling. Results: The model, consisting of three interrelated factors, showed the most adequate goodness-of-fit indices. The results support the measurement invariance of the MSPSS across sex, age, and sexual orientation. McDonald's omega reliability indices between .862-.934 were obtained. MSPSS scores were significantly and negatively associated with emotional and behavioral problems, depression, and suicidal behavior, and positively associated with life satisfaction. Conclusions: The MSPSS is a reliable instrument to assess social support through self-report in school settings. In this regard, assessing social support using this tool is particularly useful in programs promoting well-being or preventing mental health disorders.

Effects of Empathy and Regulatory Emotional Self-Efficacy on Difficulties and Strengths in Juvenile Offenders

This study examines the impact of empathy and emotional self-efficacy on the behavioral difficulties and strengths of young offenders deprived of liberty in Colombia. A total of 220 youths (M = 17.61 years, SD = 1.163) residing in specialized care centers participated. The Strengths and Difficulties Questionnaire (SDQ), the Interpersonal Reactivity Index (IRI), and the Regulatory Emotional Self-Efficacy Scale (RESE) were used. The findings indicate that regulatory emotional self-efficacy is negatively associated with behavioral difficulties and positively linked to prosocial behavior. Moreover, empathy exhibits distinct effects depending on its dimension, with perspective-taking and personal distress playing a significant role in emotional regulation. Mediation models suggest that emotional self-efficacy modulates the relationship between empathy and prosocial behavior. These results highlight the importance of interventions to enhance emotional self-efficacy and affective regulation to foster juvenile resocialization.

Schizotypal Traits, Psychopathology, and Reflective Functioning Impairments During Adolescence: A Bayesian Network Approach

BACKGROUND

New theoretical and measurement models related to Bayesian networks can usefully be implemented to enrich our understanding of psychosis risk. The present study aims to explore, using a directed acyclic graph (DAG), the putative causal relationship within schizotypal facets, as well as between schizotypal dimensions, psychopathology, and reflective functioning (RF) impairments, in a representative sample of non-clinical adolescents.

STUDY DESIGN

A sample of 1476 adolescents from the general population participated in a cross-sectional survey. The Oviedo Schizotypy Assessment Questionnaire-Revised, the Strengths and Difficulties Questionnaire, and the Reflective Functioning Questionnaire (RFQ) were used.

STUDY RESULTS

Schizotypal traits were positively associated with psychopathology and hypomentalizing. Putative causal relationships are presented between Reality distortion, Social disorganization, and Anhedonia. In addition, estimated DAG suggests that schizotypal dimensions influence psychopathology and RF impairments.

CONCLUSIONS

The findings suggest different pathways connecting schizotypal traits, mental health problems, and RF impairments during adolescence. The use of probabilistic DAG may allow us to make more robust conclusions about the direction of causation and to unravel potentially complex causal chains in the study of psychosis risk.

Impact of Mental Health Literacy on Improving Quality of Life Among Adolescents in Barcelona

Background/Objectives: We aim to assess the effect of the Espaijove.net mental health literacy program on adolescents' quality of life (QOL). Additionally, we aim to describe their QOL and mental well-being. Methods: A multicenter, randomized, controlled trial was conducted, with pre- and post-intervention assessments and 6- and 12-month follow-ups. A total of 1032 students aged 13-14 from 18 schools in Barcelona participated in one of the three following mental health literacy (MHL) programs or were placed in a control group (CG): (1) a 1 h awareness session (G1h); (2) a 6 h MHL program (G6h); (3) a 7 h MHL program with stigma reduction (G7h). Measures: (1) Mental well-being: Strengths and Difficulties Questionnaire (SDQ); (2) QOL: EuroQol 5D-5L with its two parts: the EuroQol 5D-5L Index (0-1) and EuroQol 5D-5L visual analog scale (EQ-VAS) (0-100). Analyses were conducted on an intention-to-treat basis, using data imputation methods for missing data. Intervention effects were assessed using multilevel models. Results: Baseline EQ-VAS and EQ-5D-5L index scores were 77.84 (CI = 76.77-78.91) and 0.91 (CI = 0.90-0.92), respectively. Boys reported higher QOL and SDQ scores (p < 0.001), whereas participants of foreign nationality showed lower scores in QOL (EQ-VAS; p = 0.039) and mental well-being (p < 0.001). Post-intervention, all groups (intervention and control), except G6h, showed QOL improvements. However, in the 6-month follow-up, the CG outperformed the other groups. At 12 months, G7h achieved the highest EQ-VAS scores compared to the other groups. Conclusions: MHL-based interventions improved short-term QOL but failed to sustain these improvements over time. Groups with lower QOL and SDQ scores included girls and adolescents of foreign nationality.

Social-Emotional Functioning of Children With Different Hearing Status and Diverse Cultural Background

PURPOSE

The study investigated the social-emotional functioning of children with typical hearing and deaf and hard of hearing (D/HH) children from diverse cultural backgrounds in Israel through parental reports.

METHOD

A total of 242 parents from both Arabic and Jewish communities participated: 130 were parents of D/HH children and 112 were parents of children with typical hearing. The Strengths and Difficulties Questionnaire and a background questionnaire were used.

RESULTS

Results revealed increased total difficulties, emotional symptoms, and peer problems as reported by parents of D/HH children. Jewish parents of D/HH children reported greater total difficulties, conduct problems, and peer problems than Arab parents. Significant gender differences were found, with parents of boys reporting higher levels of hyperactivity/inattention and lower prosocial behavior. Among D/HH children, Arab parents reported higher peer problems among hearing aid users compared to cochlear implant users, whereas Jewish parents reported the opposite trend.

CONCLUSION

These findings highlight the significant social-emotional challenges faced by D/HH children, particularly in peer interactions, and underscore the need for tailored interventions that consider cultural differences.

Network Structure of Transdiagnostic Dimensions of Emotional Disorders in Adolescents With Subthreshold Anxiety and Depression: Links With Psychopathology and Socio-Emotional Adjustment

BACKGROUND

The transdiagnostic and network model approaches to psychopathology have emerged as an alternative to taxonomic systems. The main goal was to examine the network structure of the transdiagnostic dimensions of emotional disorders in adolescents with subclinical emotional symptoms. In addition, cross-sectional network analyses were conducted to investigate the relationships between transdiagnostic dimensions, psychopathology, and socio-emotional adjustment.

METHOD

The sample consisted of a total of 476 adolescents from 85 schools from different provinces in Spain with subthreshold anxiety and depression. The mean age was 13.77 years (SD = 1.43, range: 10-18 years), 73.9% were female. Several questionnaires assessing transdiagnostic dimensions of emotional disorders, mental health difficulties, self-esteem, perceived social support, sense of belonging at school, and prosocial behaviour were used.

RESULTS

A strong interrelation was found between the transdiagnostic variables, except with the positive temperament dimension. The dimensions with the greatest weight were those of traumatic re-experiencing, intrusive cognitions, avoidance, neuroticism, and depressed mood. Negative relationships were found between the transdiagnostic dimensions of emotional disorders and the protective factors included in the study. Stability analyses indicated that the networks were accurately estimated.

CONCLUSION

The present paper points to the value of conceptualising emotional disorders from a transdiagnostic and network model perspective. In addition, the work provides new insights into the nature of the relationships between transdiagnostic dimensions of emotional disorders, and the role played by risk and protective factors.

Mental health dynamics between mothers and siblings of children with disabilities

Introduction

When a child has a disability, their families face significant challenges that also impact parents' and siblings' mental health and adjustment. We examined the potential bidirectional relationships between parental mental health and sibling mental health and adjustment in families of children with a disability.

Methods

We utilized baseline and 12-month follow-up data from a randomized controlled trial of a brief intervention designed to enhance parent-sibling communication in families of children with a disability. The sample comprised 214 siblings aged 8-16 years and their parents (N = 203 mothers, N = 124 fathers). We estimated bivariate latent change score models to examine the longitudinal cross-domain associations between changes in parental mental health and changes in sibling mental health, and changes in parental mental health and sibling adjustment.

Results

The results showed that changes in maternal mental health and sibling adjustment over the 12-month period were correlated (r = 0.22). The cross-domain associations between changes in maternal mental health and sibling mental health and adjustment were not statistically significant in any of the two models. However, baseline sibling mental health had nearly doubled impact on changes in maternal mental health (Β = 0.232, p = 0.061) compared to maternal health's impact on sibling mental health (Β = -0.134, p = 0.289). Models with paternal mental health data unfortunately did not run due to low paternal response rate at 12-months.

Discussion

The findings suggest that whereas maternal mental health and sibling adjustment changes are correlated over time, the relationship between maternal and sibling measures does not necessarily operate bidirectionally. Future studies on family mental health dynamics should include data from fathers that may contribute to a broader understanding of these complex relationships.

Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples

Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.

The assessment of transdiagnostic dimensions of emotional disorders: Validation of the Multidimensional Emotional Disorders Inventory (MEDI) in adolescents with subthreshold anxiety and depression

BACKGROUND

The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression.

METHOD

The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used.

RESULTS

The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life.

LIMITATIONS

Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance.

CONCLUSION

The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels.

Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population

OBJECTIVES

Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores.

MATERIALS AND METHODS

This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents.

RESULTS

Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5-0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants.

CONCLUSIONS

This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

Identifying Adolescents at Risk for Emotional Disorders with Latent Profile Analysis: A Personalized, Transdiagnostic Preventive Intervention

It can be challenging to assign patients to the appropriate intervention programs, as risk and protective factors for developing emotional disorders are multiple and shared across disorders. This study aimed to provide a theoretical and empirical approach to identify and categorise adolescents into different levels of severity. The risk of developing emotional symptoms was assessed in 1425 Spanish adolescents (M = 14.34, SD = 1.76; 59.9% women). Latent Profile Analysis (LPA) was conducted to identify subgroups based on their emotional symptom severity, risk, and resilience factors. Results revealed four profiles: at low risk (emotionally healthy), moderate risk (for selective interventions), high risk (for indicated interventions), and severe risk (for clinical referral). Older age and especially female gender were predictors of higher risk clusters, and there were differences in the levels of psychopathology and health-related quality of life across clusters. Identification of at-risk adolescents for emotional disorders by means of LPA may contribute to designing personalised and tailored prevention programs that match adolescents' specific needs.

Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents

BACKGROUND

Depression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents.

METHOD

Stratified random sampling was conducted. Participants were 2235 students (M = 14.49, SD =1.76, range= 12-18 years), 52.9 % were female, from 34 secondary schools in Spain. Several previously validated self-reported questionnaires of mental health and psychopathology were administrated.

RESULTS

The unidimensional factorial model of the PHQ-9 items showed adequate goodness of fit indices. Strong measurement invariance across gender was found. Omega for the PHQ-9 total score was 0.87. The PHQ-9 total score was positively associated with anxiety symptoms and emotional and behavioral problems, and negatively associated with prosocial behavior and quality of life.

CONCLUSIONS

The PHQ-9 is a brief, easy, and reliable tool for assessing self-reported depressive symptoms in both clinical and school settings. PHQ-9 may be used as a screening tool for universal early detection and monitorization of depression symptoms during adolescence.

Social inequalities, green and blue spaces and mental health in 6-12 years old children participating in the INMA cohort

Availability of green and blue spaces in the area of residence has been related to various health outcomes during childhood, including mental health. These environmental exposures are not evenly distributed among socioeconomic groups, which may increase social inequalities in mental health. The mechanisms through which natural environments may promote mental health are numerous and diverse. This study aimed to explore 1) the potential associations of socioeconomic variables (SES and maternal education attainment) with mental health scores and residential greenness, blueness and NO2 metrics, and, 2) the association between greenness and blueness metrics and mental health scores of children in the Spanish INfancia y Medio Ambiente (INMA) birth cohort at two different time points. The study samples were composed of 1738 six-to eight-year-olds (49% female) and 1449 ten-to twelve-year-olds (living in Asturias, Gipuzkoa, Sabadell and Valencia, Spain. Individual Normalized Difference Vegetation Index (NDVI) values in 100-, 300- and 500-m buffers and availability of green and blue spaces >5000 m2 in 300-m buffers were calculated using Geographic Information Systems software. Residential NO2 values were estimated using land use regression models. Internalizing, externalizing and total problems scores were obtained with the Strengths and Difficulties Questionnaire (SDQ). Linear and logistic mixed-effects models revealed unequal distribution of environmental exposures by SES and maternal education but did not show statistically significant associations between greenness and blueness metrics and mental health indicators. The protective effect of green and blue spaces on children's mental health could not be confirmed in this study and therefore further research is required.