Mohammad S. I. Mullick

Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka

Abstract A computerised algorithm was developed to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from Strengths and Difficulties Questionnaires (SDQs) completed by parents, teachers and young people. The predictive algorithm generates “unlikely”, “possible” or “probable” ratings for four broad categories of disorder, namely conduct disorders, emotional disorders, hyperactivity disorders, and any psychiatric disorder. The algorithm was applied to patients attending child mental health clinics in Britain (N=101) and Bangladesh (N=89). The level of chance-corrected agreement between SDQ prediction and an independent clinical diagnosis was substantial and highly significant (Kendalls tau b between 0.49 and 0.73; p < 0.001). A “probable” SDQ prediction for any given disorder correctly identified 81–91% of the children who definitely had that clinical diagnosis. There were more false positives than false negatives, i.e. the SDQ categories were over-inclusive. The algorithm appears to be sufficiently accurate and robust to be of practical value in planning the assessment of new referrals to a child mental health service.

Questionnaire screening for mental health problems in Bangladeshi children: a preliminary study.

Abstract  Background: In the developing world, child psychiatric disorders are common but child mental health professionals are scarce. A cheap and effective method for detecting child psychiatric problems would be useful. The present study examined the potential suitability of the Strengths and Difficulties Questionnaire (SDQ) for this role. Methods: SDQs were administered to the parents and teachers of 261 Bangladeshi 4–16 year olds: 99 drawn from a psychiatric clinic and 162 drawn from the community. Self-report SDQs were completed by 11–16 year olds. Children from the clinic sample were assigned psychiatric diagnoses blind to their SDQ scores. Results: SDQ scores distinguished well between community and clinic samples, and also between children with different psychiatric diagnoses in the clinic sample. A simple algorithm based on SDQ scores was used to predict whether children had hyperkinesis, conduct disorders, emotional disorders or any psychiatric disorder – rates of predicted disorder varied markedly between clinic and community samples. Conclusions: Predictions based on multi-informant SDQs potentially provide a cheap and easy method for detecting children in the developing world with significant mental health problems. The potential effectiveness of any such screening programme should be evaluated on a broad range of children, using both international and culture-specific assessments.

The prevalence of psychiatric disorders among 5–10 year olds in rural, urban and slum areas in Bangladesh

BackgroundNo previous epidemiological studies of child mental health have been conducted in Bangladesh, partly due to lack of suitable measures.MethodsA Bangla translation of a standardised child psychiatric interview, the Development and Well-Being Assessment (DAWBA), was validated against routine clinical diagnoses on a consecutive series of 100 referrals to a child mental health service. A two-phase study of prevalence was applied to random samples of 5- to 10-year-olds (N=922) drawn from three contrasting areas: a rural area, a moderately prosperous urban area, and an urban slum.ResultsThere was substantial agreement between the DAWBA and the independent clinic diagnosis (kappa=0.63–0.94). The estimated prevalence of any ICD-10 diagnosis was 15% (95% CI 11–21%). The rate of obsessive–compulsive disorder was higher than in previous studies. Children from the slum area were significantly more likely to have serious behavioural problems, and marginally more likely to have post-traumatic stress disorder.ConclusionA conservative extrapolation is that around 5 million Bangladeshi children and adolescents have psychiatric disorders. In a country with very few child mental health professionals, there is a vast gap between need and provision that must be addressed.

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence.

PurposeTo examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally.MethodsWe used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of “caseness indicators” based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of ‘definite’ or ‘severe’ difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA’s creator, working in conjunction with experienced local professionals.ResultsAs judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8–56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators.ConclusionsThe relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.

Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education

The study was aimed to examine beliefs among 320 attendees of a large University Hospital in Dhaka about Jinn, black magic and evil eye among Muslims in Bangladesh, using a self-completed questionnaire. The majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Women were more likely than men to believe in the existence of Jinn and to cite religious figures as the treating authority for diseases attributed to affliction by black magic. Participants with a higher educational attainment were less likely than those with lower attainment to believe in jinn possession; or to believe that Jinn, black magic, or evil eye could cause mental health problems. Mental health care practitioners need to be mindful of these beliefs to achieve the best outcome for their patients.