Dutch norms for the Strengths and Difficulties Questionnaire (SDQ) - parent form for children aged 2-18 years.

BACKGROUND: Identification of children at risk for psychosocial problems is important to be able to provide supportive and tailored care at an early stage. Due to its brevity and wide age range, the Strengths and Difficulties Questionnaire (SDQ) Parent Form is an appropriate instrument for use in paediatric clinical practice as it facilitates assessment of psychosocial functioning from young childhood into adulthood. The aim of the present study was to provide Dutch normative data for the SDQ Parent Form. METHODS: A sample of 1947 parents with children aged 2-18 years was drawn from a large panel of a Dutch research agency, stratified on Dutch key demographics of the parents. The SDQ Parent Form assesses the child's Emotional symptoms, Conduct problems, Hyperactivity-Inattention, Peer problems and Prosocial behaviour. Summary scores can be calculated: Internalising, Externalising and Total difficulties. Internal consistency (Cronbach's alpha coefficient) and normative scores (mean, median, clinical cut-off scores) of the SDQ- Parent Form were calculated in four age-groups 2-3, 4-5, 6-11 and 12-18 years. Gender differences were tested with independent t-tests. RESULTS: A total of 1174 parents (60.3%) completed the SDQ. In the age-groups 2-3 and 4-5, norm scores are not available for Conduct problems and Peer problems due to insufficient internal consistency. In addition, in age-group 2-3, norm scores for Emotional symptoms and Internalising are not available because of insufficient internal consistency. In the age-groups 6-11 and 12-18, norm scores are available for all scales, with Cronbach's alpha coefficients 0.53-0.86. The comparison by gender revealed that boys had more behavioural problems than girls (0.000 < p < 0.048), most prevalent for Hyperactivity-Inattention, Peer Problems, Prosocial behaviour, Externalising and Total Difficulties. CONCLUSIONS: Dutch normative data by age-group and gender are now available for parent-reported SDQ scores in children aged 2-18 years. Due to insufficient internal consistency, normative scores for 2-5 year-old children could not be presented for several SDQ scales. Yet, the SDQ Total score provides a reliable indication of the psychosocial functioning of younger children. In case of high Total scores in children younger than 6 years, alternatively to scale scores, the answers on the individual items could yield useful clinical information about the child's problems.

Health related quality of life in Dutch infants, toddlers, and young children.

BACKGROUND: The purpose of this study is to provide Dutch normative data and to assess internal consistency and known-groups validity for the TNO AZL Preschool Children Quality of Life (TAPQOL) and the acute version of the generic Pediatric Quality of Life Inventory (PedsQL 4.0) in Dutch young children aged 0-7 years. METHODS: Participants were selected from a panel of a large Dutch market research agency. A sample of 794 parents (response rate 61%, 39% fathers) of children (53% boys) from the general Dutch population, completed an electronic version of the TAPQOL (N = 227 infants aged 0-1 years) or PedsQL 4.0 (N = 293 toddlers aged 2-4 years and N = 274 young children aged 5-7 years). RESULTS: Except for the 'stomach' scale (α = .39), the TAPQOL showed acceptable to excellent internal consistency (α = .60-.88). The PedsQL 4.0 showed acceptable to excellent reliability in children aged 2-4 years (α = .60-.88) and in children aged 5-7 years (α = .76-.90). Children with a chronic health condition had lower scores than healthy children on 3 out of 12 domains of the TAPQOL (p = .001-.013) and on 2 out of 6 domains of the PedsQL 4.0 for children aged 2-4 years (p = .016-.04). The PedsQL 4.0 differentiated on all domains (p < .05) between children aged 5-7 years with and without a chronic health condition. CONCLUSION: In Dutch children aged 0-7 years old, HRQoL can be relialy measured with the TAPQOL and the PedsQL 4.0. However, it remains unclear whether these HRQoL instruments can distinguish between healthy children and children with a chronic health condition under the age of 5.

Anxiety and depression in mothers and fathers of a chronically ill child.

We aimed to determine the levels of anxiety and depression in mothers and fathers of a chronically ill child (0-18 years) and to study which parental and child variables are associated with anxiety and depression. In a cross-sectional design, anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Scores were compared to a Dutch reference group by analysis of variance and logistic regression analysis. Linear regression analyses were performed to examine which variables were associated with anxiety and depression. Mothers of a chronically ill child (n = 566) scored significantly higher than the reference group (p < .001) on anxiety (Mean 5.9 vs 4.8) and depression (Mean 4.5 vs 3.1). Fathers (n = 123) had higher depression scores (Mean 4.5 vs 3.6; p < .05), but fathers' anxiety scores were comparable to the reference group. The percentages of mothers in the clinical range of anxiety (31.8 vs 20.7 %, OR 2.03, 95 % CI 1.46-2.83) and depression (23.0 vs 12.0 %, OR 2.76, 95 % CI 1.84-4.13) were higher (p < .001) than in the reference group. No differences were found for fathers in the clinical range for anxiety and depression. Practical problems in daily life (a: ß = .33, d: ß = .25) and parenting stress (a: ß = .30, d: ß = .32) showed the strongest association with anxiety and depression for parents as a group. Illness-related characteristics of the child were not related. Parents of a chronically ill child, especially mothers, reported high levels of anxiety and depression. Awareness about parental anxiety and depression in pediatrics is important as well as targeted interventions.

Stressors and alcohol consumption.

The objective of this study was to examine the relationship between negative life events and chronic stressors and drinking behaviour. Data suggested that some life events (getting divorced) and some chronic stressors (financial difficulties, unfavourable marital status, and unfavourable employment status) were positively related to abstinence among men and women. Furthermore, some life events (being a victim of a crime, decrease in financial position, divorce or reporting two or more life events) were positively associated with heavy drinking among men. Chronic stressors, such as unfavourable marital status and unfavourable employment status, were also related to heavy drinking among both men and women. Results presented here suggest that people under stressful conditions are more likely to either abstain or drink heavily rather than to drink lightly or moderately.

Aggregate comparisons of self-reported versus nonself-reported drinking in a general population survey.

Insight is gained into the validity of self-reported drinking in the general population by comparing self-reports and nonself-reports on the aggregate level. Married and cohabiting respondents of a general population survey (N = 2,169) were asked about both their own and their spouses' drinking behavior. It was found that on the aggregate level, distribution of "moderate" drinking and usual frequency of drinking is similar between self- and nonself-reports. Self-reported "heavy" drinking, however, is lower than nonself-reported "heavy" drinking among women in general, older women, and women with a lower education. Among men in general and older men in particular, however, self-reported occasional "heavy" drinking was found to be higher. The similar distribution of "moderate" drinking and usual frequency of drinking between self- versus nonself-reports gives reassurance about the validity of self-reported drinking behavior. The discordance in self-reported versus nonself-reported "heavy" drinking, however, raises questions about the validity. Interpretation of the discordance is not conclusive: more research (experimental and qualitative) has to be done to disentangle this issue.

Cervical cancer screening: spatial associations of outcome and risk factors in Rotterdam.

OBJECTIVE: Obtaining insight into the geographic distribution of attendance and smear test results at the cervical cancer screening program in Rotterdam neighbourhoods, associated with socio-economic status, marital status and the percentage migrants. DESIGN: Ecological analysis was carried out on data on cervical cancer screening outcome and population figures, provided by the Rotterdam Local Health Information System, in which health information is collected at neighbourhood level. SETTING: The cervical cancer screening program in the city of Rotterdam. PARTICIPANTS: Fifty-three neighbourhoods, with overall 569,105 inhabitants, of whom 70,621 women between 1992 and 1994 were invited for the screening program. MAIN RESULTS: Between neighbourhoods a large difference in attendance rate and the percentage positive smears exists. A high socio-economic level of a neighbourhood, and a low percentage migrants, single or divorced women correspond with high attendance. A high socio-economic status of a neighbourhood and a low percentage migrants correspond with a low percentage smear test Pap 3B or higher. Socio-economic status, percentage migrants and marital status are highly interrelated on neighbourhood level. Multivariate analysis showed a negative correlation between the attendance rate and the percentage of single and divorced women, and a positive correlation between the percentage migrants and the percentage of positive smears (Pap 3B or higher). CONCLUSION: Various risk groups, showing low attendance or a high percentage of positive smears, are clustered in neighbourhoods and can be identified by socio-economic status, marital status and nationality. Activities to improve attendance can be focused towards these neighbourhoods.

Alcohol use and problem drinking: prevalences in the general Rotterdam population.

Research was done on the distribution of abstinence, excessive drinking, alcohol-related problems, and problem drinking among the general population of Rotterdam, Netherlands in 1994. Prevalences are assessed among the total population and subpopulations defined by sex, age, marital status, educational level, daily activities, and income. A general population survey was conducted among a random sample of 8,000 Dutch inhabitants of Rotterdam in the 16-69 age range. The response rate was 44% (N = 3,537). The majority of the respondents were "light" or "moderate" drinkers. Prevalences of excessive drinking, alcohol-related problems (1 or more), and problem drinking in the total population were 8, 28, and 9%, respectively. It is shown that women tend to report many alcohol-use-related problems considering their relatively low consumption pattern; young men have a high prevalence of problem drinking; being single, being unemployed, and being declared unfit to work are associated with problematic drinking. The results found for socioeconomic status appear to be inconsistent.

The Dutch instant lottery: prevalence and correlates of at-risk playing.

After a long and contentious political debate, the instant lottery was introduced in the Netherlands in 1994. One of the conditions for allowing the introduction was that an evaluation study should be conducted with regard to possible negative side effects of the instant lottery in terms of excessive playing or addiction. This article reports on the main results of this evaluation study. In a random sample of 4497 instant lottery players, at-risk players were differentiated from recreative players on the basis of level of involvement in the instant lottery, impaired control and the experienced negative consequences of playing. Of the sample, 4.1% could be classified as an at-risk player. Actual problems resulting from playing in the instant lottery were experienced by 0.7% of the players. At-risk players and recreative players did not only differ substantially in their playing behaviour, but also with regard to their socio-economic background, playing motivation, participation in other games of chance, and involvement in alcohol use and use of marijuana. To summarize, at-risk players were more likely to come from a poor socio-economic background, to play the instant lottery with a negative playing motivation, to be heavily involved in other forms of gambling, to have used marijuana and to drink alcohol excessively.

Qualitative health research and health promotion at the local level.

The Municipal Health Service for Rotterdam area in the Netherlands has developed a health research strategy with special focus on qualitative methods. This article describes one of the first and most instructive cases in which this strategy has been applied: a local health study in "Feijenoord." The research in Feijenoord was carried out between 1989 and 1990 making it possible to look both at the short-term and long-term effects. Quantitative data were used to describe the neighborhood health situation. Qualitative data were used to expand on this description. The qualitative information was obtained from residents and workers in health care and welfare using focused interviews and nominal group interviews. The results and effects of the research presented were influential. The research started a train of activity that could not have been predicted, and of which the Municipal Health Service had little control at first. An important effect in the short-term was that, as bringer of unpleasant news, the Municipal Health Service was unfavorably regarded. In the long-term, the Municipal Health Service participated significantly in the activities set up within the health framework. After evaluating these effects it was possible to formulate the conditions for an effective use of qualitative methods in public health research.