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Table 1 Strengths and difficulties questionnaire in Africa: data extraction

From: The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation

First author (year) Location Age range Study aim Theme SDQ versiona Sample Language Translation process Cut-off scores Differences to UK norms Alpha scores/internal consistency Results from use of the SDQ
Kashala (2005) [25] Kinshasa, Democratic Republic of Congo 7–9 Pilot testing examining stability of the factor structure and reliability of the SDQ Tool validation Teacher 1306 learners assessed by teachers French None mentioned, French version from SDQ site used Overall (gender in article)
TDS = 19
Emo = 6
Conduct = 5
Hyper = 7
Peer = 5
Pros = 3
Somewhat different to British cut offs
Higher cut-off scores for conduct and low cut-off for Pros, but similar to British cut-offs for Hyper, Emo and Peer TSD = .81
Emo = .71
Conduct = .64
Hyper = .66
Peer = .35
Pros = .80
Internal consistency satisfactory on all SDQ scales. Using the 90th percentile, cut-off scores were somewhat higher than the published cut-off scores in this younger sample
Cluver (2006) [26] Cape Town, South Africa 6–19 Examined psychological well-being and mental outcomes of children orphaned by AIDS compared to a matched, non-affected control group HIV/AIDS, orphans, non-orphans Self-report (read aloud in Xhosa or English to participants) 60 children living in informal settlements isiXhosa and English Translated and blind back-translated No SDQ norm cut-offs in SA (possibly used percentages to determine three bands) Using UK cut-off scores high levels of difficulty were found in Peer, Emo and TDS No mention of alpha scores Orphaned children and matched controls scored highly for peer problems, emotional problems and total scores. However, orphans were more likely to view themselves as having no good friends, to have marked concentration difficulties (and to report frequent somatic symptoms but were less likely to display anger through loss of temper. Orphans were more likely to have constant nightmares, and 73% scored above the cut-off for PTSD
Kashala (2006) [27] Kinshasa, Democratic Republic of Congo 7–9 Explore hyperactivity–inattention symptoms and co-existing symptoms of emotional and behavioural problems in African school children and their relationship with health status, socio-demographic factors, and school performance Hyperactivity–inattention, emotional/behavioural problems, children Teacher 357 children: 183 were defined as cases due to abnormal scores on the hyperactivity sub-scale, and 174 with normal hyperactivity sub-scale scores French None mentioned Does not specify which cut-off scores were used Does not specify which cut-off scores were used, nor made a comparison to UK sample No alpha score reported Three quarters of hyperactive-inattentive children had co-existing symptoms using SDQ with conduct problems being most common
Cluver (2007) [28] Cape Town, South Africa 10–19 Investigated psychological consequences of AIDS orphanhood, compared to control groups of children and adolescents orphaned by other causes, and non-orphans HIV/AIDs, orphans, non-orphans Peer and conduct problems subscale (self-report) 1025 children and adolescents isiXhosa None mentioned Applied UK cut-off scores of borderline = 4–5, and abnormal = < 6 for peer problems. 14% of AIDS orphans, 9% other-orphans and 8% non-orphans met abnormal criteria. Conduct problems associated with orphanhood by AIDS. Conduct problems in British cut-off for abnormal was 5, and had 5% of AIDS orphans, 3% other-orphans and 4% non-orphan which was lower than what was found in UK levels of conduct problems Used UK cut-off scores Did not report alpha scores for two sub-scales used Controlling for socio-demographic factors AIDS orphaned children were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children
Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems
Menon (2007) [29] Lusaka, Zambia 11–15 Examined emotional and behavioural difficulties in HIV positive Zambian adolescents HIV, emotional and behavioural difficulties Self-report; parent 127 children and their English and Nyanja Translated and back-translated Applied UK cut off scores Zambian sample was more than twice as likely to score outside the normal range to total difficulties, 3 times more likely to have emotional symptoms and 7 times more likely to score in abnormal range for peer problems when compared with UK sample cut offs Parent form: TDS = .54, Emo = .51, Conduct = .56, Peer = .34, Hyper = .24
Self-report: TDS = .51, Emo = .51, Conduct = .61, Peer = .31 and Hyper = .18
Adolescents who have not disclosed their HIV status were twice as likely to experience high emotional difficulties compared to those who disclosed their HIV status
Okello
(2007) [30]
Gulu District, Uganda 11–19 Assessed psychiatric disorders among war-abducted adolescents in northern Uganda, compared to non-abducted adolescents Psychiatric disorders, war abducted adolescents Self-report 82 war-abducted and 71 non-abducted adolescents Language not specified None mentioned Applied the following cut offs to the TDS (used in Goodman, 2001): 0–15 = normal, 16-19 = borderline, 20-40 = abnormal Using Goodman’s (2001) cut offs 51.2% of the war-abducted and 18.3% of the non-abducted adolescents had significant clinical distress on the TDS No alphas reported War abducted adolescents had poorer emotional and behavioural adjustment as indicated by their total difficulties scores than non-war abducted adolescents
Cluver (2008) [31] Cape Town, South Africa 10–19 Explore mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health, and associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status HIV/AIDs, orphanhood, stigma, community risk factors, psychological problems Self-report peer and conduct problems subscale 1025 children and adolescents isiXhosa None mentioned Did not applied any cut-offs Has not used UK cut-off scores to make comparisons No alpha scores reported for the two sub-scales used AIDS orphanhood was significantly associated with higher peer relationship problems
AIDS orphanhood was significantly related to higher conduct problems but this association was eliminated when stigma was accounted
Cluver (2009) [77] Cape Town, South Africa 10–19 Examine associations between orphanhood, poverty, and psychological distress HIV/AIDS, orphanhood, poverty, psychological problems Peer and conduct problems subscale (assumed self-report) 1025 children and adolescents: 425 AIDS orphaned, 241 non-AIDS orphans, 278 non-orphans isiXhosa None mentioned Did not applied any cut-off scores, used continuous scores Has not used UK cut-off scores to make comparisons No alpha scores reported for the two sub-scales used Orphan hood by AIDS was significantly related to peer problems
Doku (2009) [34] Manya Krobo District, Ghana 10–19 Examine impact of parental HIV/AIDS status and death on child mental health HIV/AIDS Self-report 200 children English Not applicable/none mentioned Applied UK cut-offs did not evaluate validity of SDQ Applied UK SDQ cut-off scores to Ghanaian sample Did not report alpha scores Children whose parents died of AIDS showed very high levels of peer problems whilst both orphaned groups scored similarly high on conduct problems
Hyperactivity showed no difference and was very low in the entire sample
Emotional problems were very high in all the groups except among the non-orphaned children
Elhamid (2009) [32] Minia, Egypt 6–12 To conduct a population prevalence study of emotional and behavioural disorders among children in this region Emotional and behavioural disorders Teacher and parents 1177 children Arabic None undertaken. Authors reference that the Arabic version has been previously validated Applied UK cut-off scores Applied UK cut-off scores No alpha scores reported The prevalence of reported behaviour problems by teachers and parents were much higher in Egypt than in UK
Menon (2009) [35] Lusaka, Zambia 11–15 Assess mental health of HIV positive Zambian adolescents in comparison to a school sample and an age matched British normative sample HIV Self-report 419 school learners in grades 5-9, 93 HIV positive clinical sample English and translated version None mentioned Has not applied any cut-offs Has not used UK cut-offs to make comparisons Did not report alpha scores Zambian HIV positive adolescents scored higher emotional symptoms and peer problems when compared to a British community sample
Bakare (2010) [36] Nigeria 4–18 Assess prevalence and pattern of behavioural problems using the teacher reported SDQ among Nigerian children with intellectual disability, to associate behavioural problems with child socio-demographic variables Behavioural problems Teacher 44 children with intellectual disability Language not specified None mentioned Use UK cut-off scores 47.7% were classified as borderline and abnormal for total difficulties based on TDS cut off of 12-40 Overall alpha reported = .63 47.7% of children were classified as having behavioural problems in the borderline and abnormal categories on total difficulties clinical scale of SDQ using the cut-off point recommended by Goodman
Mild intellectual disability (ID) as compared to moderate, severe and profound ID was associated with highest total difficulties mean score
Males were more likely to exhibit conduct and hyperactivity behavioral problems compared to the females
Doku (2010) [37] Ghana 10–18 Assess psychosocial adjustment of children affected by HIV/AIDS HIV/AIDS, psychosocial Self-report 50 AIDS orphans, 51 orphans due to other causes, 48 children living with HIV-infected parents, 51 children who did not have HIV/AIDS related deaths in family English Not applicable/None mentioned Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons Did not report alpha scores Total difficulties fort children whose parents died of AIDS but not children whose parents died of causes other than AIDS and children whose parents are infected with HIV/AIDS, scored significantly higher than non-orphaned children whose parents are not known to be infected with HIV/AIDS
Mueller (2011) [38] Knysna, South Africa 8–18 Evaluated efficacy of the make a difference about art programme HIV/AIDS Self-report 297 children English, Afrikaans and isiXhosa Translations performed by bilingual translators and back-checked for accuracy by a second bilingual translator Did not applied any cut-off scores Has not used UK cut-off scores to make comparisons Presents other study’s alpha scores but not their own Community-based art therapy intervention had no effect on emotional and behavioural problems among children affected by HIV
Puffer (2012) [39] Muhuru Bay, Kenya 10–18 Examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya HIV, orphan status, mental health, social support Self-report 325 children Dholuo Translated and back-translated Did not applied any cut-off scores Has not used UK cut-off scores to make comparisons Overall alpha score reported = .59 Orphans reported poorer mental health, less social support, and fewer material resources
They did not differ from non-orphans on HIV risk indicators
Longer time since parental death was associated with poorer outcomes
Orphan status was significantly associated with emotional problems
Abbo (2013) [40] Lira, Tororo, Kaberamaido and Gulu, Uganda 3–19 investigated prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents Anxiety disorders Self-report and parent 420 households with children and adolescents Translated into 4 dialects (not named) Authors attempted to ensure semantic equivalence between English and local dialects. Forward and back-translation was undertaken for each dialect two teams of mental health professionals were created. The first team translated tools into the local dialect, the second team, blind to the English version, translated the local dialect version into English. A consensus meeting with the two teams was held to resolve any major differences by discussion Assessed total difficulties score where a score of 16 and above indicated psychological distress Used a cut-off of above 16 for TDS as an indication of ‘caseness’ No alpha scores reported Prevalence of anxiety disorders among children and adolescents were higher when having emotional and behavioural problems when measured using SDQ and when having an abnormal or borderline score on emotional symptoms scale
Atilola (2013) [41] Nigeria, India, Serbia, Turkey and Indonesia 13–19 Evaluated the prevalence, pattern, and sociodemographic correlates of self-reported mental health problems among adolescents from five countries, to inform the methodology and design of a larger scale study Mental health Self-report 1894 adolescents from Nigeria, India, Serbia, Turkey and Indonesia Not specified Authors mention that culturally adapted versions of the SDQ for each language and culture in the participating countries were obtained from the SDQ website, “among other sources”. No further explanation of the latter statement Used UK cut-off scores 4 Applied standard cut offs as recommended in Goodman (1997) Did not report alpha scores The prevalence of self-reported mental health problems was 10.5% (range 5.8–15) with conduct and emotional problems being the most prevalent
Cortina (2013) [42] Mpumalanga, South Africa 10–12 Examine prevalence of psychological problems in children, as well as possible risk and protective factors psychological functioning Teacher and self-report 1025 children in the 4th and 6th grade English and Shangaan Translation, back-translation and adjustment to ensure linguistic equivalence. Two members of the research team native to the area and fluent in Shangaan, one with a Master’s degree in mental health and the other a research officer, translated the questionnaires into Shangaan. Each item was discussed in detail to determine an appropriate translation. A 3rd member of the team also fluent in Shangaan back-translated the items Did not specify which cut-off scores were used Teachers ratings found 40% of children as having significant difficulties compared to 10% in UK samples and 17% had reported difficulties in prosocial behaviour compared to 13% in UK samples TDS = .75, Pros = .80 Teachers reported high levels of behavioural, emotional, conduct and attention problems, with the TDS score from the teacher report SDQ showing that over 40% of children had significant difficulties
Poorer psychological outcomes were associated with socio demographic factors like living with a single mother; lower maternal education level; and being from a former refugee family (identified a risk factor)
Kinyanda (2013) [43] Lira, Gulu, Tororo, and Kaberamaido in Uganda 3–19 Examined prevalence and risk factors of depression in childhood and adolescence in a community sample derived from four disadvantaged districts in north-eastern Uganda Psychosocial, depression Self-report, parent 1587 children Translated into four dialects, but dialects not named Forward and back-translation was undertaken
For each of the four main dialects
Two teams of mental health professionals were created. The first team translated tools into the local dialect and the second team blind to the initial English version translated the local dialect version into English. A consensus meeting with the two teams to resolve major differences by discussions was held
Assessed total difficulties score where a score of 16 and above indicated psychological distress Used a cut-off of above 16 for TDS as an indication of ‘caseness’ No alpha scores reported Psychiatric co-morbidities/psychiatric problems of emotional distress (assessed by the SDQ), were independently significantly associated with depressive disorder syndromes
Marais (2013) [44] Mangaung, South Africa 7–11 Investigated the relationship between housing conditions and the socio-emotional health of orphans and vulnerable children in South Africa OVC Self-report, parent and teacher 466 orphans, 143 other vulnerable children (non-orphaned) Sesotho Following guidelines, the SDQ was translated independently into Sesotho by 2
Sesotho native speakers, who agreed upon a version, which a third native speaker back-translated into English.
All translators met and agreed on the final version
Applied UK cut-offs Applied UK cut-offs No alphas reported Orphaned and vulnerable children (OVC) who used other types of toilet facilities (bucket or none) were less likely to have a clinically diagnosable total difficulty score when compared to those using a flush toilet
OVC living in a crowded household were more likely to be clinically diagnosed by teachers with a high total difficulties score
Bhana (2014) [45] Durban, South Africa 10–13 Evaluate a pilot randomized control trial at 2 clinical sites HIV/AIDS, adolescent, mental health Self-report 74 families with a child between 10–14 years of age isiZulu Translated into isiZulu using standard procedures for translation and back-translation Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons Inter-item reliability = .42–.54 Pre-adolescents who formed part of a family-based, 10 session, intervention saw improvements in mental health, HIV knowledge and adherence to medication
Devries (2014) [46] Luwero District, Uganda 11–14 To report the prevalence of corporal punishment on children in Uganda and its effects on child mental health and educational outcomes Violence, corporal punishment Self-report 3706 students Unclear if both English and Luganda versions of SDQ were used All items translated into Luganda and reviewed by a panel of teachers and “Raising Voices” staff to ensure that they would be appropriate for Ugandan child participants and school staff. Thereafter items were cognitively tested and refined iteratively in a sample of ~ 40 children and 20 school staff members from Kampala primary schools to ensure understanding and that meanings of original items were adequately captured. They then surveyed a larger sample of 697 children and 40 staff from Kampala schools to test distributions of items and to test study procedures Cut-off scores used were highest decile formed the ‘high difficulties’, the next decile formed ‘medium difficulties’ and the remaining 80% formed the ‘low difficulties’ Has not used UK cut-off scores to make comparisons TDS = .70 For girls exposure to physical violence in the past week was associated with higher levels of poor mental health using the SDQ
Escueta (2014) [47] Ethiopia, Kenya, Tanzania, India, Cambodia 6–12 Examined relationship between psychosocial well-being and cognitive development orphans and abandoned children (OAC) relative to non-OAC in 5 LMICs to understand factors associated with success in learning Orphans, psychosocial well-being, cognitive development Self-report, parent 1480 orphaned and abandoned children Not specified None mentioned Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons Overall alpha score reported = .73 An increase in emotional difficulties was found to be associated with delays in cognitive development
Lachman (2014) [48] KwaZulu-Natal, South Africa 10–17 Examined the relationship between HIV/AIDS and positive parenting HIV/AIDS, parenting Parent 685 parent–child dyads with AIDS-ill caregiver and 184 caregiver-child dyad orphaned by AIDS isiZulu Translated into isiZulu and back-translated into English Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons TDS = .71 Families who had caregivers who had AIDS or AIDS-orphaned children were significantly related to less positive parenting, higher poverty, higher depression and higher child total difficulties when compared to non-affected families
Marais (2014) [49] Mangaung, South Africa 7–11 Assess community-based responses to well-being of OVC, compared with their actual mental health to evaluate South African government’s funding approach to CBOs supporting and caring for OVC OVC, mental health Self-report, parent, and teacher 465 orphans and 142 other vulnerable children Sesotho Adapted and translated in accordance with published guidelines for the translation of instruments in cross-cultural research Made use of cut-offs to present  % of 3 groupings of total difficulties Does not specify which cut-off scores were used TDS = .72 Orphaned and vulnerable children with access to medical care reported lower total difficulties than those who had no access to medical care
The more a household used its expenditure on food the higher the total difficulties
Skeen (2014) [51] Malawi 4–13 Explore use of developmental screening tools to measure outcomes of children affected by HIV/AIDS attending community-based organisations (CBO) and to determine what types of CBO provision received by these children HIV/AIDS, community based organizations Carers completed a short 10- item version of the SDQ 979 children from South Africa (824) and Malawi (155) as well as 979 caregivers/parents. Language not specified None mentioned Total difficulties score ranged from 0 to 20, higher scores indicating greater behavioural and emotional pathology Has not used UK cut-off scores to make comparisons No alpha scores reported Being a younger child was associated with emotional/behavioural difficulties. Boys were more likely to have higher emotional/behavioural problem scores than girls in both South Africa and Malawi
Sharp (2014) [50] Free State, South Africa 7–11 To evaluate the construct validity of the caregiver, teacher, and self-report versions of the SDQ Tool validation Self-report, teacher, and parent 466 orphans Sesotho Adapted and translated in accordance with published guidelines for translation of instruments in cross-cultural research Parent-form: TDS = 13.5
Emo = 4.5/5.5
Conduct = 3.5
Hyper = 4.5
Peer = not used in this paper
Pros = not used in this paper
Self-report: TDS = 11.5
Emo = 4.5
Conduct = 1.5
Hyper = 2.5
Peer = not used in this paper
Pros = not used in this paper
UK cut-offs: parent-form: TDS = 17
Emo = 5
Conduct = 4
Hyper = 7
Self-report: TDS = 20
Emo = 7
Conduct = 5
Hyper = 7
Teacher-form
TDS = 16
Emo = 6
Conduct = 4
Hyper = 7
Alphas: parent-form: TDS = .72, Emo = .60, Conduct = .66, Hyper = .30; Self-report: TDS = .62, Emo = .50, Conduct = .34, Hyper = .26; teacher-form: TDS = .84, Emo = .77, Conduct = .70, Hyper = .67 Orphan care-givers reported cut-offs that were in line with UK cut-offs for emotional symptoms and conduct problems, but less for ADHD and total problems
The orphans self-reported cut-offs were significantly lower when compared to UK cut-offs, and teacher reported cut-offs were also lower
Waller (2014) [52] Western Cape and Mpumalanga, South Africa 10–17 Examined significant risk factors for antisocial behaviour and substance use identified in high income countries (e.g., abuse and poverty), and to determine whether they had predictive effects among South African youth Antisocial behaviour, substance use Self-report: conduct problem subscale used only 3515 children isiXhosa, isiZulu, Swati, Sotho and Shangaan Translated and back-translated into the five languages Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons Conduct sub-scale alpha score (included items merged from the Child Behaviour Checklist Youth Self-report) = time 1 = .71; time 2 = .65 4 items from the conduct problems sub-scale was used to assess antisocial behaviour among youth that was associated with substance use over time during Time 1 of the study
Experience of abuse and community violence at Time 1 predicted antisocial behaviour at Time 2
Being older and male had a significant effect on the increase in antisocial behaviour
Asante (2015) [53] Accra, Ghana 8–19 Determine the association between psychological functioning and social and health risk behaviours in Ghanian homeless youth Homeless youth, psychological functioning Self-report (interviewer administered due to low literacy) 227 homeless children and adolescents Twi and Ga None mentioned Applied UK cut-offs Applied UK cut-offs Overall alpha score reported = .72 Only 12.5% of the participants were not exhibiting any psychological symptoms emotional problems were reported by 68.9%, conduct problems by 73.8%, hyperactivity/inattention problems by 53.9% and 88.6% reported peer relationship problems among the homeless youth
Casale (2015) [33] KwaZulu-Natal, South Africa 10–17 Examined role of caregiver social support as a protective factor for adolescent emotional and behavioural problems HIV/AIDS, caregiver support Parent version 2477 adolescent-caregiver dyads isiZulu Translated into isiZulu and back-translated into English Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons TDS = .71; Pros = .69 Higher caregiver education is a socio-demographic variable associated with fewer adolescent emotional and behavioral problems for all four TDS subscales
Adolescent children who were female and/or orphaned had more emotional problems, while adolescents with older caregivers had fewer conduct problems
Caregivers living in the urban sites reported more adolescent child peer and conduct problems, and less prosocial behaviour
Lower household socio-economic status was also associated with more adolescent peer problems and less prosocial behaviour
Chirwa-Mwanza (2015) [62] Lusaka, Zambia 10–16 Explore associations between relational aggression and psychological well-being among perpetrators in schools in Lusaka Aggression, psychological well-being Self-report 170 students in grades 6 and 8, 51% were male Not specified None mentioned Not specified Did not specify cut-off scores and no comparison made to UK norms Reported previously published study alpha scores No significant gender differences were found, however a significant positive associations was found between relational aggression and psychological well-being of perpetrators. Perpetrators of relational aggression were found to have higher conduct problems, peer problems and hyperactivity
Collishaw (2015) [54] Cape Town, South Africa 10–19 Identify predictors of resilient adaptation at child, family and community levels within a group of AIDS-orphaned children, and to consider their collective influence HIV/AIDS, orphans Conduct subscale (self-report)S 1025 orphaned children and adolescents isiXhosa Translated, back-translated and piloted Applied UK cut-off scores of borderline = 4–5, and abnormal = < 6 for conduct Used UK cut-off scores Conduct = wave 1 = .32, wave 2 = .47; Peer only used in wave 1 = .47 Resilient adaptation is associated with influences across the child, family and community level
Hermenau (2015) [55] Tanzania 6–15 Investigate orphans’ experiences of maltreatment and stigmatization to identify factors that relate to their psychological distress Psychological distress, maltreatment stigmatization orphans Self-report 89 orphaned and 89 non-orphaned children Swahili Translated into Swahili and back-translated into English, using established international guidelines Did not apply any cut-off scores Has not used UK cut-off scores to make comparisons TDS = .63 The main effect of neglect, abuse, and stigmatization correlated significantly positively with orphans’ internalizing and externalizing problems
Mazzucato (2015) [56] Angola, Ghana, Nigeria 11–21 To analyse survey data on the psychological well-being of school children and young adults living in transnational families by comparing them with those living with their parents in their countries of origin Psychological well-being, parent migration Self-report 2760 students from Ghana, 2243 students from Angola and 2168 students from Nigeria English and Portuguese None mentioned Did not specify which cut-off scores were used Does not specify which cut-offs were used No alphas score reported Children from transnational families (at least one member of the nuclear family lives in a different country) have higher levels of psychological distress than children who live with their parents
Okewole (2015) [78] Abeokuta, Nigeria 15.4 (mean age) Establish the relationship between prodromal psychotic symptoms and psychological distress Prodromal symptoms, mental health Self-report 508 secondary school students in the 10th–12th grades. English Not applicable/None mentioned Applied UK cut-off scores No comparison to UK norms were used Overall Cronbach alpha score = .63 The prevalence of prodromal symptoms was 20.9 and 11.8% scored abnormal scores on the emotional sub-scale, while 6% scored abnormal scores on the conduct problems sub-scale and 6% for both hyperactivity and peer problems sub-scales. Prodromal symptoms was predicted by higher total difficulty scores and difficulty sub-scales
Pappin (2015) [57] Mangaung, South Africa 7–11 Investigated the relationship between socio-economic status and emotional well-being and mental health of orphans Emotional well-being, orphans Self-report, parent, and teacher 500 orphans Not specified None mentioned TDS cut-offs: Teacher (normal = 0–11, borderline = 12–15, abnormal/clinically diagnosable = 16 and above); Caregiver (normal = 0–13; borderline = 14–16; abnormal/clinically diagnosable = 17 and above) Applied UK cut-off scores Teacher form: TDS = .89
Caregiver form: TDS = .72
Having a female caregiver, 2 daily meals were significantly associated with higher care-giver reported total difficulty scores of orphans
Four daily meals, households with higher monthly expenditure and access to medical care associated with lower care-giver reported total difficulty scores of orphans
Care-giver with secondary education, employed adult in home and being an older child was associated with lower teacher-reported total difficulties scores
Living in a household were a family member receives an old age pension was associated with higher teacher-reported total difficulties scores
Profe (2015) [58] Cape Town, South Africa 12–17 Examine association between mother, father, and closest grandparent involvement with South African adolescents’ mental health and substance use Substance use, parent involvement, grandparent involvement Self-report 512 adolescents English, Afrikaans and isiXhosa None mentioned Applied UK cut-offs for TDS and Pros Applied UK cut-offs Internalising problems (Emo and Peer) = .66, externalising problems (Conduct and Hyper) = .76, Pros = .66 Mother and father involvement were both significantly negatively associated with adolescents’ internalizing and externalizing problems
Closest grandparent involvement was not significantly associated with adolescents’ internalizing or externalizing problems
Mother involvement was significantly positively associated with prosocial behaviour
Closest grandparent involvement was positively associated with prosocial behaviour
Abdulmalik (2016) [59] Ibadan, Nigeria 9–14 Assessed effect of interventions on aggressive behaviour among male primary school learners Aggressive behaviour Teacher 37 Male students in the ‘primary five’ school level assigned to an intervention and control group Not specified None mentioned No cut-off scores mentioned Does not mention which cut-off scores were used and no comparison to UK norms No mention of alpha scores The intervention group scored higher for conduct scores than the control group, yet the differences were not significant
Bella-Awusah (2016) [60] Ibadan, Nigeria 14–17 Determine the effects of a CBT programme on depressed adolescents Depressed adolescents Self-report: impact supplement of the SDQ 40 Adolescents who scored 18 or more on the Beck Depression Inventory assigned to an intervention and control group Both English and Yoruba. All chose English version Iterative back-translation procedure Impact score of 2 or more suggest difficulties in psycho-social functioning Did not use UK cut-off scores to make comparisons Impact = .72 No significant differences between intervention and control group between baseline and post-intervention, however, improvement in psycho-social functioning/impact 16 weeks follow-up post intervention
Bhana (2016) [61] KwaZulu-Natal, South Africa 9–14 Determine resilience in perinatal HIV positive adolescents in South Africa Resilience perinatal HIV + adolescents Parent 177 caregiver-child dyads who were perinatally HIV infected isiZulu version None mentioned, isiZulu versions from SDQ site used No cut-off scores mentioned Does not mention which cut-off scores were used and no comparison to UK norms Pros = .56
TDS = .71
Lower total difficulty scores were associated with decreased caregiver depression, lower caregiver communication difficulties, and increased self-esteem in children. Higher prosocial scores were associated with increased caregiver communication, and the use of wishful (resilient) thinking for coping in children
Cortina (2016) [63] South Africa 10–12 Examine cognitive interpretations and psychological functioning of children in rural South Africa Resilience, HIV/AIDS Prosocial behaviour subscale (self-report)
Total difficulties score (teacher version)
1025 students from a rural, socioeconomic disadvantaged area (40% were from former refugee households) Shangaan Translated into Shangaan, and back-translated No cut-off scores mentioned Does not mention which cut-off scores were used and no comparison to UK norms Did not provide alpha scores for SDQ sub-scales Children who had more negative cognitive interpretations had greater reported difficulties and less pro-social behaviour
Dow (2016) [64] Moshi, Tanzania 12–24 Establish the prevalence and severity of mental health difficulties among HIV-positive adolescents and to examine the associations between mental health difficulties, stigma, ART adherence and CD4 cell count HIV/AIDS, ART adherence Self-report 182 HIV-positive adolescents, just over half were female (54%) and most were attending school (75.8%) Swahili Translated into Swahili, and back-translated A score of 17 or greater for TDS indicated mental health difficulties Did not use UK cut-off scores to make comparisons Reported previously published studies alpha scores, but not specific to this study Mental health difficulties were prevalent in HIV-positive adolescents, and were associated with incomplete adherence to ART and stigma
Doku (2016) [65] Lower Manya Krobo District, Ghana 10–18 Explore prevalence of child labour and the association with psychological well-being Child labour, Orphaned and vulnerable children (OVC), HIV/AIDS Self-report
Parent
291 children and adolescents, 51% were female Not specified None mentioned Not specified No comparison to UK norms Not specified Psychological symptoms were higher among children and adolescents who were orphaned by AIDS/caregivers were affected by HIV/AIDS. Children affected by HIV/AIDS (OVC) has significantly more domestic chores and care responsibilities. Child labour mediated the association between orphan status and psychological difficulties
Hecker (2016) [66] Tanzania 6–15 Examine associations between harsh discipline, internalising mental health problems and cognitive functioning (working memory and scholastic performance) Harsh discipline, cognitive functioning Peer problem and emotional symptoms subscales (self-report) 409 primary school students, 52% were male Swahili Translated into Swahili, and blind back-translation Peer: a score of 4-5 indicates “enhanced levels” of peer problems, and 6 indicates abnormal levels of peer problems
Emo: a score of 6 indicates “enhanced levels” of emotional problems, and a score higher than 6 indicates abnormal levels of emotional symptoms
Did not use UK cut-off scores to make comparisons Combined alpha score of.67 was presented A strong relationship was established between harsh discipline and internalising problems, and were associated with lower working memory and scholastic performance
Hensels (2016) [67] South Africa and Malawi 4–13 Examine the effect of gender on the development of children attending a community-based organisation in high HIV-affected areas and to examine associations in community-based organisation attendance and changes in gender differences Gender differences Parent 979 children from high HIV-affected communities Not specified None mentioned Not specified Cut-off score not specified and made no comparison to UK norms Not specified Males experienced more violence, performed worse at school and more behavioural problems were prevalent than for females at baseline. At follow-up, gender differences persisted, but males reported worse quality of life than females and males were found to experience poorer educational outcomes and behaviour problems
Lentoor (2016) [68] Eastern Cape, South Africa 31.38–92.78 months (caregivers were 18 or older) Explore associations in primary caregiver depressive symptomology and psychological functioning of children infected with HIV Parent depression, HIV/AIDS, psychological well-being Parent 152 caregiver-child dyads, children were HIV-positive, 87 girls and 65 boys Not specified None mentioned Not specified Cut-off score not specified and made no comparison to UK norms Overall alpha score of .73 Depressive symptomology in caregivers were associated with poor psychological functioning in their children
Levetan (2016) [69] Cape Town, South Africa 13.96 (mean age) Examine differences in maternal grandmother involvement in grandchildren between those who co-reside and those who do not, and to examine associations between co-residence status, grandmother involvement, adolescent internalising and externalising problems as well as prosocial behaviour Grandmother involvement, adjustment Self-report 384 mixed race and black African Grade 8 and 9 learners, 58% were females and 27% lived in 3 generation households with grandmother Not specified None mentioned Not specified Cut-off score not specified and made no comparison to UK norms Presented alpha scores from previously published studies No significant differences were established between involvement of co-residing and non-residing grandmothers. Furthermore, greater maternal grandmother involvement was associated with more adolescent prosocial behaviour, and fewer internalising behaviour problems in three generation households
Okewole (2016) [71] Abeokuta, Nigeria 11.6 (mean age – children)
40.4 (mean age – mothers)
Examine the association between maternal depression and child psychopathology Maternal mental health, child psychopathology Self-report 100 mother–child dyads attending a child and adolescent neuropsychiatric hospital Yoruba None mentioned, Yoruba version from the SDQ site used Not specified Did not specify cut-off scores to make comparisons Not specified 23% of mothers had a diagnosis of major depressive disorder. 25% of children had abnormal total difficulty scores. A diagnosis of major depressive disorder in mothers were associated with poor total difficulty SDQ scores and poor scores on all SDQ sub-scales except emotional problems
Puffer (2016) [72] Migori County, Kenya 10–16 Evaluate intervention aimed at improving family relationships, reduce HIV risk and promote mental health HIV/AIDS, family relationships, mental health Version not specified 124 families (237 adolescents and 203 caregivers) from four churches Not specified None mentioned Not specified Did not specify cut-off scores to make comparisons Not specified No effects were found for the intervention on secondary outcomes such as parenting, social support and mental health
Skeen (2016) [73] South Africa and Malawi 4–13 Establish the relationship between violence exposure and mental health among HIV-affected children HIV/AIDS, violence, mental health Version not specified 989 children (834 from South Africa and 155 from Malawi) attending community-based organisations Not specified None mentioned Not specified Did not specify cut-off scores to make comparisons Not specified HIV-negative children who lived with a HIV-positive person experienced more violence, and was followed by HIV-positive children. Interpersonal violence in the home and community predicted internalising and externalising behaviour problems. Harsh physical discipline also predicted behavioural problems in children
Sherr (2016) [74] South Africa and Malawi 4–13 Examine the effects of caregiver and household HIV on child development HIV/AIDS, child development Version not specified 808 caregiver – child dyads, compared over having a HIV caregiver, having HIV in the household and no HIV Not specified None mentioned Not specified Did not specify cut-off scores to make comparisons Not specified Many negative child developmental outcomes was associated by HIV burden, and was mediated by caregiver depression levels. The familial burden of HIV at baseline affected child behavioural problem as follow indirectly as a result of depression of the caregiver. Both internalising and externalising behaviour problems were indirectly affected by familial HIV burden and caregiver depression
Thumann (2016) [75] Luwero District, Uganda 7–18 Examine whether individual and contextual factors in the school environment were associated with mental health difficulties, including the association of mental health difficulties with violence exposure and differences by gender School environment, violence, mental health Self-report 3565 primary school students Not specified None mentioned Binary variable created for those above and below the 80th percentile Did not compare to UK norms but applied rule that those above the 80th percentile would be categorised as “borderline/abnormal” as outlined by Goodman, Meltzer and Bailey (1998) Overall Cronbach alpha score = .69 Experiences of violence by staff or students were associated with mental health difficulties. Low school connectedness also increased the odds of mental health difficulties. Effect of violence on mental health difficulties were not mediated by school connectedness and there were no significant differences across gender. Attending an urban school increased the odds of mental health difficulties
Tucker (2016) [76] KwaZulu-Natal, South Africa 10–17 (children)
Over 18 (caregiver)
Establish the impact of caregiver ill-health and child orphan status on prosociality in HIV-affected settings HIV/AIDS, orphans, prosocial behaviour Prosocial behaviour sub-scale only: self-report and parent versions only 2136 child-caregiver dyads in an HIV-epidemic community English and isiZulu None mentioned Applied UK cut-off scores Used UK cut-off scores but no comparison to UK norms Pros (Self-report) = .89
Pros (parent version) = .69
Differences were found in the rating of prosocial behaviour in households where caregivers were ill and children were orphaned due to AIDS. Caregivers reported low prosocial behaviour in children, while the children rated high prosocial behaviour
Mazzucato (2017) [70] Ghana 11–21 Explore whether being in a transnational family is associated with psychological well-being Transnational families, psychological well-being Self-report 2760 secondary school students from areas of high out-migration rates Not specified None mentioned Not specified, just indicated that higher number indicate more psychological distress Did not specify cut-off scores to make comparisons The alpha scores for the sub-scales ranged from .70–.73 Being in a transnational family was associated with lower levels of psychological well-being, only in families where parents were divorced or separated
  1. TDS total difficulties score, Emo emotional symptoms, Conduct conduct problems, Hyper hyperactivity/inattention, Peer peer problems, Pros prosocial behaviour
  2. aSelf-report, parent or teacher version
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