The extent to which child- and parent-report Revised Children's Anxiety and Depression Scale, short Mood and Feeling Questionnaire, Strength and Difficulty Questionnaire and child-report KIDSCREEN identify the same young people as at risk of mental health conditions

Background: We rely heavily on cut-off points of brief measures of psychological distress in research and clinical practice to identify those at risk of mental health conditions; however, few studies have compared the performance of different scales.

Aim: To determine the extent to which the child- and parent-report Strength and Difficulty Questionnaire (SDQ), Revised Children's Anxiety and Depression Scale (RCADS), short Mood and Feeling Questionnaire (sMFQ) and child-report KIDSCREEN correlated and identified the same respondents above cut-off points and at risk of mental health conditions.

Method: A cross-sectional survey was conducted among 231 children aged 11-16 years and 289 parents who completed all the above measures administered via a mobile app, MyJournE, including the SDQ, RCADS and sMFQ.

Results: The psychopathology measures identified similar proportions of young people as above the cut-off point and at risk of depression (child report 14.7% RCADS, 19.9% sMFQ, parent report 8.7% RCADS, 12.1% sMFQ), anxiety (child report 24.7% RCADS, 26.0% SDQ-Emotional subscale, parent report 20.1% RCADS, 26% SDQ-Emotional subscale) and child-report internalising problems (26.8% RCADS, 29.9% SDQ). Despite strong correlations between measures (child report 0.77-0.84 and parent report 0.70-0.80 between the SDQ, sMFQ and RCADS) and expected directions of correlation with KIDSCREEN and SDQ subscales, kappa values indicate moderate to substantial agreement between measures. Measures did not consistently identify the same children; half ( n = 36, 46%) of those on child report and a third ( n = 30, 37%) on parent report, scoring above the cut-off point for the SDQ-Emotional subscale, RCADS total or sMFQ, scored above the cut-off point on all of them. Only half ( n = 46, 54%) of the children scored above the cut-off point on child report by the SDQ-Internalising and RCADS total scales.

Conclusion: This study highlights the risk of using a screening test to 'rule out' potential psychopathology. Screening tests should not be used diagnostically and are best used together with broad assessment.