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

Journal Article


Journal Title

Child and Adolescent Psychiatry and Mental Health

Journal ISSN
Volume Title

BioMed Central


University of Cape Town

Background: Child and adolescent mental health in Africa remains largely neglected. Quick and cost-efective ways for early detection may aid early intervention. The Strengths and Difculties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa. Methods: A comprehensive scoping review methodology was used to identify all peer-reviewed studies ever pub lished that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies. Results: Fifty-four studies from 12 African countries were identifed, most from South Africa. Many diferent lan guages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in diferent clinical populations, and was most frequently used in the evaluation of children and adolescents afected by HIV/ AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where ‘caseness’ was defned in studies, UK cut-of scores were used in all but one of the studies. Conclusions: The SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psycho metric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-of values and ensuring cultural equivalence of the instrument.