Cross-Cultural Comparison of the Strengths and Difficulties Self-Report Questionnaire in 12 Asian and European Countries Publisher Pubmed



A Sourander ANDRE ; M Westerlund MINJA ; H Kaneko HITOSHI ; E Heinonen EMMI ; A Brunsteinklomek ANAT ; S How Ong SAY ; S Fossum STURLA ; Ga Kolaitis Gerasimos A ; S Lesinskiene SIGITA ; L Li LIPING
Source: Journal of the American Academy of Child and Adolescent Psychiatry Published:2025

Abstract

Objective: The self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries. Method: This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N = 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country. Results: Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales. Conclusion: The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally. Plain language summary: Using a sample of 26,306 adolescents from 12 European and Asian countries, this study examined how well the Strengths and Difficulties Questionnaire (SDQ), a commonly used measure to assess child and adolescent mental health, can be used to compare child and adolescent mental health between different countries. In addition, the authors also measured adolescent mental health symptoms across the 12 countries. The study findings suggested that in all countries, girls scored higher than boys on prosocial behaviors and internalizing problems such as symptoms of depression and anxiety. However, the extent to which genders differed on these features varied across cultures. © 2025 Elsevier B.V., All rights reserved.