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1.
J Clin Child Adolesc Psychol ; : 1-10, 2024 May 28.
Article En | MEDLINE | ID: mdl-38805627

OBJECTIVE: Although the significance of the general factor of psychopathology (p) is being increasingly recognized, it remains unclear how to best operationalize and measure p. To test variations in the operationalizations of p and make practical recommendations for its assessment, we compared p-factor scores derived from four models. METHODS: We compared p scores derived from principal axis (Model 1), hierarchical factor (Model 2), and bifactor (Model 3) analyses, plus a Total Problem score (sum of unit-weighted ratings of all problem items; Model 4) for parent- and self-rated youth psychopathology from 24 societies. Separately for each sample, we fitted the models to parent-ratings on the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and self-ratings on the Youth Self-Report (YSR) for 25,643 11-18-year-olds. Separately for each sample, we computed correlations between p-scores obtained for each pair of models, cross-informant correlations between p-scores for each model, and Q-correlations between mean item x p-score correlations for each pair of models. RESULTS: Results were similar for all models, as indicated by correlations of .973-.994 between p-scores for Models 1-4, plus similar cross-informant correlations between CBCL/6-18 and YSR Model 1-4 p-scores. Item x p correlations had similar rank orders between Models 1-4, as indicated by Q correlations of .957-.993. CONCLUSIONS: The similar results obtained for Models 1-4 argue for using the simplest model - the unit-weighted Total Problem score - to measure p for clinical and research assessment of youth psychopathology. Practical methods for measuring p may advance the field toward transdiagnostic patterns of problems.

2.
J Child Psychol Psychiatry ; 63(11): 1297-1307, 2022 11.
Article En | MEDLINE | ID: mdl-35167140

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.


Individuality , Parents , Child , Adolescent , Humans , Parents/psychology , Self Report
3.
Int Psychogeriatr ; 34(5): 467-478, 2022 05.
Article En | MEDLINE | ID: mdl-32883392

OBJECTIVES: To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology. PARTICIPANTS: We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60-102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies. MEASUREMENTS: Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., ). RESULTS: Cronbach's alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0-1-2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%). CONCLUSIONS: The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.


Checklist , Psychopathology , Aged , Analysis of Variance , Humans , Self Report
4.
Res Nurs Health ; 44(4): 681-691, 2021 08.
Article En | MEDLINE | ID: mdl-34125443

The purpose of this study was to test whether a syndrome model of elder psychopathology derived from collateral ratings, such as from spouses and adult children, in the United States would be generalizable in 11 other societies. Societies represented South America, Asia, and Europe. The Older Adult Behavior Checklist (OABCL) was completed by collateral informants for 6141 60- to 102-year-olds. The tested model comprised syndromes designated as Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited. The model was tested using confirmatory factor analyses in each society separately. The primary model fit index showed a good fit for all societies, while the secondary model fit indices showed acceptable to a good fit for all societies. The items loaded strongly on their respective factors, with a median item loading of 0.69 across the 11 societies. By syndrome, the overall median item loadings ranged from 0.47 for Worries to 0.77 for Functional Impairment. The OABCL syndrome structure was thus generalizable across the tested societies. The OABCL can be used for broad assessment of psychopathology for elders of diverse backgrounds in nursing services and research.


Checklist , Internationality , Psychopathology/statistics & numerical data , Syndrome , Aged , Aged, 80 and over , Anxiety/psychology , Cognition/physiology , Female , Humans , Male , Reproducibility of Results
5.
Int J Geriatr Psychiatry ; 35(5): 525-536, 2020 05.
Article En | MEDLINE | ID: mdl-31994777

OBJECTIVES: As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies. METHODS/DESIGN: The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes. RESULTS: In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies. CONCLUSIONS: The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.


Cross-Cultural Comparison , Geriatric Assessment/methods , Mental Disorders/diagnosis , Psychopathology , Aged , Aged, 80 and over , Anxiety/ethnology , Asia , Cognition , Depression/ethnology , Ethnicity , Europe , Female , Humans , Male , Memory , Middle Aged , Problem Behavior/psychology , Psychopathology/statistics & numerical data , Reproducibility of Results , Syndrome , United States
6.
Epilepsy Behav ; 92: 171-175, 2019 03.
Article En | MEDLINE | ID: mdl-30660968

OBJECTIVES: Childhood emotional/behavioral problems in children with epilepsy have been reported to be higher compared with those with typical development or with other nonneurologic health conditions. Increasing interest towards understanding these behavioral comorbidities is reflected in literature. However, longitudinal investigations regarding the course of behavioral problems in children with newly diagnosed epilepsy and normal development are rare, and majority of them involve school-aged children. We aimed to study the behavioral comorbidities of preschool children with newly diagnosed epilepsy and to explore the changes of behavioral problems after one year from the diagnosis in comparison with the healthy group and subsequently, to elucidate the potential developmental, neurologic, and social risk factors associated with these difficulties. METHODS: Participants were 83 patients, aged between 18 and 59 months, 43 of them were children with new-onset epilepsy, and 40 of them were healthy children as the comparison group. The Child Behavior Check List-1 1/2-5 (CBCL) was used to evaluate emotional/behavioral problems of the children. Maternal anxiety was analyzed by The State-Trait Anxiety Inventory (STAI). The general development of children was evaluated by the Denver-II-Developmental Screening Test (D-II-DST). Sociodemographic characteristics were also collected for all participants. Each evaluation was repeated after one year from the diagnosis. RESULTS: Internalizing, externalizing, and total problem scores were higher in children with epilepsy than the control group at baseline, and despite some reduction in several scales, the differences continued across groups after one year. The analysis for the course revealed that behavior problem scores reduced in children with new-onset epilepsy over a year, but it did not change in healthy children. Among the possible factors related to behavior problem scores, in correlation analysis, the duration of screen viewing, socioeconomic status, and maternal education were associated with behavior problem scores. There was no significant association between epilepsy-related variables and the behavior problem scores and the course. Among all possible risk factors in the regression analyses, maternal trait anxiety level was found to be significantly related to the total problems, internalizing, and externalizing scores in the group with epilepsy. CONCLUSION: Behavioral comorbidities of epilepsy are present very early and can be seen at the time of the diagnosis, however, they do not worsen over time in preschool children. Maternal anxiety should be considered as a risk factor for behavioral problems in preschool children with epilepsy. Assisting children and parents and ensuring necessary guidance and support should be a crucial part of epilepsy treatment initiated as soon as the time of diagnosis.


Child Behavior Disorders/complications , Epilepsy/complications , Problem Behavior/psychology , Child Behavior Disorders/psychology , Child, Preschool , Emotions , Epilepsy/psychology , Female , Follow-Up Studies , Health Status , Humans , Infant , Male , Prospective Studies , Risk Factors
7.
J Clin Child Adolesc Psychol ; 48(4): 596-609, 2019.
Article En | MEDLINE | ID: mdl-29364720

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.


Parents/psychology , Psychopathology/methods , Societies/standards , Adolescent , Child , Female , Humans , Male , Syndrome
8.
Infant Ment Health J ; 37(2): 151-9, 2016.
Article En | MEDLINE | ID: mdl-26891759

Emotional availability (EA) is a method to assess early parent-child dyadic interactions for emotional awareness, perception, experience, and expression between child and parent that describe global relational quality (Z. Biringen & M. Easterbrooks, 2012). The current study aimed to examine the effects of an infant's diagnosis of autism spectrum disorders (ASDs), other psychiatric disorders (OPD), and developmental delay (DD) on the maternal EA Scale (EAS; Z. Biringen & M. Easterbrooks, 2012; Z. Biringen, J.L. Robinson, & R.N. Emde, 2000) scores and the relative contributions of infant's age, gender, diagnosis, developmental level, and maternal education on EAS scores in a clinical Turkish sample. Three hundred forty-five infant-mother dyads participated in this study. Results of the research indicated that EAS adult scores were associated with maternal education and infant's diagnosis whereas child scores were associated with infant's age, diagnosis, and developmental level. Infants' involvement and responsiveness to the mother were lower in the group with ASD. Children with OPD, particularly when their mothers have lower education, might be at increased risk of having problems in parent-child interactions. Young ASD subjects with developmental delay are in greatest need of support to increase reactions toward their mother. These findings underscore the importance of using all of the EA dimensions rather than only one measure on children in high-risk populations.


Autism Spectrum Disorder/psychology , Developmental Disabilities/psychology , Emotions , Mother-Child Relations/psychology , Mothers/psychology , Adult , Autism Spectrum Disorder/diagnosis , Developmental Disabilities/diagnosis , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Severity of Illness Index , Young Adult
9.
Turk Psikiyatri Derg ; 25(4): 234-43, 2014.
Article En | MEDLINE | ID: mdl-25487621

OBJECTIVE: This study aimed to investigate and compare emotional and behavioral problems in Turkish adoptees and non-adopted peers raised by their biological parents. MATERIALS AND METHODS: The study included 61 adopted children (34 female and 27 male) aged 6-18 years and 62 age- and gender-matched non-adopted children (35 female and 27 male). Parents rated their children's problem behaviors using the Child Behavior Checklist/6-18, temperament characteristics using the School Age Temperament Inventory, their own personality traits using the Basic Personality Traits Inventory, and their parenting styles using the Measure of Child Rearing Styles. Children rated their parents' availability and reliability as attachment figures using the Kerns Security Scale and parenting styles using the Measure of Child Rearing Styles. Adolescents aged 11-18 years self-rated their problem behaviors using the Youth Self Report. Group differences and correlations were analyzed. RESULTS: There were non-significant differences in all scale scores between the adopted and non-adopted groups. In contrast to the literature, age of the children at the time of adoption was not associated with problem behaviors or attachment relationships. On the other hand, the findings indicate that as the age at which the children learned that they had been adopted increased emotional and behavioral problems increased. CONCLUSION: Adoption alone could not explain the problem behaviors observed in the adopted children; the observed problem behaviors should be considered within the context of the developmental process.


Anxiety Disorders/psychology , Family , Object Attachment , Parenting , Stress, Psychological/psychology , Adolescent , Child , Female , Humans , Male , Psychometrics , Turkey
10.
J Clin Child Adolesc Psychol ; 43(4): 627-42, 2014.
Article En | MEDLINE | ID: mdl-24787452

Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies.


Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Faculty , Parents , Adolescent , Child , Cross-Cultural Comparison , Female , Humans , Male , Observer Variation , Reproducibility of Results
11.
J Clin Child Adolesc Psychol ; 42(2): 262-73, 2013.
Article En | MEDLINE | ID: mdl-23009025

We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) Do levels of parent-adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent-adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent-adolescent dyads within each society agree on the adolescent's deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR-CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent-adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent-adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples.


Adolescent Behavior/psychology , Child Behavior/psychology , Parent-Child Relations , Parents/psychology , Adolescent , Child , Cross-Cultural Comparison , Female , Humans , Male , Self Report , Surveys and Questionnaires
12.
Matern Child Health J ; 17(1): 68-75, 2013 Jan.
Article En | MEDLINE | ID: mdl-22273835

The aim of the present study was to examine the association between emotional and behavioral problems in preschool children and maternal attitudes. The predictor variables were parental attitudes, maternal depression and anxiety symptoms. Our sample consisted of the mothers of 204 preschool children attending different preschools in Ankara, Turkey. Mothers were asked to complete the parental attitude research instrument, the beck depression inventory, the trait anxiety inventory, and the child-behavior checklist. Hierarchical regression analysis revealed that when considered jointly, maternal anxiety but not maternal depression explained variability in preschool children internalizing and externalizing their problems. Mothers rejecting attitudes towards family life and child-raising styles were also found to be closely associated with the emotional and behavioral problems in their children. The findings demonstrate that the importance of maternal anxiety is above and beyond the importance of rejecting the maternal role when it comes to preschool problems in children.


Anxiety/psychology , Attitude , Child Behavior Disorders/diagnosis , Child Rearing/psychology , Depression/psychology , Mothers/psychology , Adult , Affective Symptoms/psychology , Anxiety/diagnosis , Child Behavior Disorders/psychology , Child, Preschool , Cross-Sectional Studies , Depression/diagnosis , Female , Humans , Infant , Male , Middle Aged , Mother-Child Relations , Parents/psychology , Personality Inventory , Psychiatric Status Rating Scales , Regression Analysis , Socioeconomic Factors , Surveys and Questionnaires , Turkey
13.
J Clin Child Adolesc Psychol ; 40(3): 456-67, 2011.
Article En | MEDLINE | ID: mdl-21534056

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.


Affective Symptoms/psychology , Child Behavior Disorders/psychology , Child Behavior/psychology , Cross-Cultural Comparison , Affective Symptoms/ethnology , Age Factors , Checklist , Child Behavior/ethnology , Child Behavior Disorders/ethnology , Child, Preschool , Female , Humans , Male , Psychiatric Status Rating Scales , Sex Factors
14.
J Am Acad Child Adolesc Psychiatry ; 49(12): 1215-24, 2010 Dec.
Article En | MEDLINE | ID: mdl-21093771

OBJECTIVE: To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies. METHOD: Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society. RESULTS: The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA. CONCLUSIONS: The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture-general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data.


Checklist , Cross-Cultural Comparison , Mass Screening/statistics & numerical data , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Personality Assessment/statistics & numerical data , Affective Symptoms/diagnosis , Affective Symptoms/epidemiology , Affective Symptoms/psychology , Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Child Behavior Disorders/psychology , Child, Preschool , Cross-Sectional Studies , Female , Humans , Incidence , Infant , Male , Mental Disorders/psychology , Models, Psychological , Psychometrics/statistics & numerical data , Reproducibility of Results , Social Behavior Disorders/diagnosis , Social Behavior Disorders/epidemiology , Social Behavior Disorders/psychology , Syndrome
15.
Eur Child Adolesc Psychiatry ; 19(2): 113-24, 2010 Feb.
Article En | MEDLINE | ID: mdl-19644732

The objectives of the study are (i) to describe and compare the epidemiology of emotional/behavioral problems and associated risk/protective factors among nationally representative samples of institutionally reared and similarly aged community-based adolescents brought up in their natural homes by means of youth self-reports, caregiver/parent, and teacher informants; and (ii) to identify mental health service needs and utilization. A cross-sectional survey was conducted between November 2005 through April 2006 using an equal probability cluster sample of 11-18 year old adolescents in institutional care settings (N = 350; 163 males, 187 females) and results were compared with similarly aged community sample of youth living in their natural homes (N = 2,206). The Sociodemographic Information Form, Youth Self Report (YSR), Child Behavior Checklist (CBCL) by caregivers for institutional sample and parents for the community sample, and Teacher's Report Form (TRF) were used to obtain standardized data on demographic characteristics, emotional/behavioral problems, and risk/protective factors. The prevalence of problems behaviors by YSR, caregiver/parent CBCL, and TRF were: 47, 15.1, 20.5% for the institutional versus 10.1, 7.5 and, 9.5% for the community samples, respectively (p < 0.05). Youth self-reports were fourfold, and all informant reports were twofold higher for institutional versus community comparisons. Furthermore, institutional sample had consistently higher rates, not only of Externalizing, but Internalizing, Social Problems, Attention Problems, and Thought Problems, as well as discrete DSM-oriented scales, suggesting that labeling of institutional youth as simply aggressive and delinquent contributes to their further marginalization and does not comprehensively address their mental health needs. In terms of protective factors, we found that: perceived social support, high competency scores, supportive caregiving, getting along well with peers and relatives (positive relationships), and problem solving skills were significantly protective of mental health. On the other hand fatalistic beliefs, cigarette and alcohol use were significantly associated with increased risk for problem behaviors (p < 0.05). The primary reason for institutional placement was family disruption (68.9%), poverty (15.7%), abandonment (8.4%), and physical or sexual abuse (5.4%). Only 31.2% of the youth were in fact true orphans (loss of one or both parents). It is therefore remarkable that in terms of service use, despite consistently high prevalence of problem behaviors across all informant sources, only 2.4% of the youth had received any speciality mental health services during institutional care. In conclusion, there is a pressing need to transform the social and health care policy and to provide family and community-based alternatives for youth currently in institutional care in Turkey. Before this goal is achieved, it is necessary to address their mental health needs urgently and comprehensively. The highest rates of problems by youth self-report also support the view that the youths' own voices ought to be heard and need to inform the reform process regarding their future care.


Affective Symptoms/epidemiology , Child Behavior Disorders/epidemiology , Mental Health , Orphanages , Adolescent , Adolescent Behavior/psychology , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Chi-Square Distribution , Child , Child Behavior/psychology , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Female , Health Status , Humans , Internal-External Control , Male , Multivariate Analysis , Prevalence , Quality of Life , Risk Factors , Social Behavior , Social Support , Stress, Psychological/psychology , Surveys and Questionnaires , Turkey/epidemiology
16.
Turk Psikiyatri Derg ; 19(3): 235-46, 2008.
Article Tr | MEDLINE | ID: mdl-18791876

OBJECTIVE: We examined the prevalence of emotional and behavioral problems, and associated factors in children and adolescents aged 6-18 years that were reared in orphanages. We aimed to compare these children and adolescents with a nationally representative age-matched sample that were raised by their own families and to identify mental health service needs in orphanages. METHOD: This cross-sectional study included 674 children and adolescents aged 6-18 years that were selected from orphanages using stratified and probability cluster sampling. A socio-demographic information form, and the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and Youth Self-Report Form (YSR) were used for data collection. RESULTS: According to the information provided by caregivers, teachers, and youths, the prevalence of problem behaviors ranged between 18.3% and 47% among those in institutional care versus between 9% and 11% among the national sample. Among those in institutional care, the prevalence of externalizing problems (21.4%-41.9%) was significantly higher than the prevalence of internalizing problems (6.2%-40.1%). At the syndrome level, the prevalence of social problems (5.7%-11.7%), thought disorders (7.2%-18.4%), and attention problems (7.7%-31.4%) among the youths in institutional care was higher than among the national sample (1.6%-5.8%). Age at first admission, receiving institutional care because of neglect and abuse, moves 2 or more times between institutions, recurrent physical illness, receiving poor quality care, lack of regular contact with parents or relatives, lack of regular contact with teachers and the institutional staff, poor problem-solving skills, fatalistic beliefs, tobacco and alcohol use, the feeling of stigmatization, and low-level competency were significantly associated with an increased risk of behavioral and emotional problems. In this representative study, only 2.4% of the children received any mental health care services. CONCLUSION: There is an urgent need to develop alternative care models and routine screening for mental health. The training of professionals and development of mental health services for children in institutional care should be a priority.


Affective Symptoms/epidemiology , Behavioral Symptoms/epidemiology , Child Behavior Disorders/epidemiology , Child, Orphaned/psychology , Internal-External Control , Mental Health Services/organization & administration , Adolescent , Affective Symptoms/psychology , Behavioral Symptoms/psychology , Case-Control Studies , Child , Child Behavior , Child Behavior Disorders/psychology , Cluster Analysis , Cross-Sectional Studies , Female , Health Services Needs and Demand , Health Surveys , Humans , Male , Mental Health Services/standards , Orphanages , Psychometrics , Turkey/epidemiology
17.
J Atten Disord ; 11(5): 538-45, 2008 Mar.
Article En | MEDLINE | ID: mdl-18192617

OBJECTIVE: To evaluate the epidemiology of attention problems using parent, teacher, and youth informants among a nationally representative Turkish sample. METHOD: The children and adolescents, 4 to 18 years old, were selected from a random household survey. Attention problems derived from the Child Behavior Checklist (CBCL) (N = 4,488), Teacher Report Form (TRF) (N = 2,360), and the Youth Self Report (YSR) (N = 2,206) were examined. RESULTS: The CBCL and TRF attention problems scores were higher among young male children, whereas the YSR reported scores were higher among older adolescents without a gender effect. The CBCL and YSR scores were also higher by urban residence. CONCLUSION: Compared with other European samples, our national sample had higher mean attention problems scores than the Scandinavian but lower mean scores than the former Soviet Union samples. In addition to elucidating the profile of attention problems in Turkey, our results also contribute to understanding the comparative global epidemiology of attention problems.


Attention Deficit Disorder with Hyperactivity/epidemiology , Adolescent , Age Distribution , Catchment Area, Health , Child , Child, Preschool , Female , Humans , Male , Prevalence , Risk Factors , Sex Distribution , Surveys and Questionnaires , Turkey/epidemiology
18.
J Consult Clin Psychol ; 75(5): 729-38, 2007 Oct.
Article En | MEDLINE | ID: mdl-17907855

As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11-18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child Behavior Checklist (Achenbach & Rescorla, 2001) and the teacher-completed Teacher's Report Form (Achenbach & Rescorla, 2001) from many societies. Separate CFAs by gender and age group supported the 8-syndrome model for boys and girls and for younger and older youths within individual societies. The findings provide initial support for the taxonomic generalizability of the 8-syndrome model across very diverse societies, both genders, and 2 age groups.


Affective Symptoms/diagnosis , Child Behavior Disorders/diagnosis , Cross-Cultural Comparison , Personality Inventory/statistics & numerical data , Social Adjustment , Somatoform Disorders/diagnosis , Adolescent , Affective Symptoms/psychology , Child , Child Behavior Disorders/psychology , Female , Humans , Male , Models, Statistical , Psychometrics/statistics & numerical data , Reproducibility of Results , Somatoform Disorders/psychology , Syndrome
19.
J Clin Child Adolesc Psychol ; 36(3): 405-17, 2007.
Article En | MEDLINE | ID: mdl-17658984

There is a growing need for multicultural collaboration in child mental health services, training, and research. To facilitate such collaboration, this study tested the 8-syndrome structure of the Child Behavior Checklist (CBCL) in 30 societies. Parents' CBCL ratings of 58,051 6- to 18-year-olds were subjected to confirmatory factor analyses, which were conducted separately for each society. Societies represented Asia; Africa; Australia; the Caribbean; Eastern, Western, Southern, and Northern Europe; the Middle East; and North America. Fit indices strongly supported the correlated 8-syndrome structure in each of 30 societies. The results support use of the syndromes in diverse societies.


Child Behavior Disorders/diagnosis , Cross-Cultural Comparison , Ethnicity/psychology , Personality Assessment/statistics & numerical data , Adolescent , Child , Child Behavior Disorders/psychology , Female , Humans , Male , Psychometrics/statistics & numerical data , Reproducibility of Results , Statistics as Topic
20.
J Consult Clin Psychol ; 75(2): 351-8, 2007 Apr.
Article En | MEDLINE | ID: mdl-17469893

In this study, the authors compared ratings of behavioral and emotional problems and positive qualities on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) by adolescents in general population samples from 24 countries (N = 27,206). For problem scales, country effect sizes (ESs) ranged from 3% to 9%, whereas those for gender and age ranged from less than 1% to 2%. Scores were significantly higher for girls than for boys on Internalizing Problems and significantly higher for boys than for girls on Externalizing Problems. Bicountry correlations for mean problem item scores averaged .69. For Total Problems, 17 of 24 countries scored within one standard deviation of the overall mean of 35.3. In the 19 countries for which parent ratings were also available, the mean of 20.5 for parent ratings was far lower than the self-report mean of 34.0 in the same 19 countries (d = 2.5). Results indicate considerable consistency across 24 countries in adolescents' self-reported problems but less consistency for positive qualities.


Personality Disorders/ethnology , Adolescent , Female , Global Health , Humans , Incidence , Male , Personality Disorders/diagnosis , Personality Disorders/epidemiology , Prevalence
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