Rapid mental health screening in conflict zones: a translation and cross-cultural adaptation into Arabic of the shortened Revised Child Anxiety and Depression Scale (RCADS-25)

Abstract

BackgroundDuring conflict, children and adolescents are at increased threat of mental health pathology and in particular, anxiety and depression. However, mental health screening in conflict settings is problematic and carries risk making the need for fast, easy-to-administer, screening instruments paramount. The shortened version of the Revised Child Anxiety and Depression Scale (RCADS-25) is one method of rapidly assessing anxiety and depressive symptoms in youths. This self-report questionnaire demonstrates good internal consistency and diagnostic capacity in clinical and non-clinical populations. Nevertheless, few studies have tested the psychometric properties of translated versions of the RCADS-25 limiting its applicability worldwide.ObjectivesTo expand the reach and utility of the RCADS-25, the present study sought to develop an Arabic version of the instrument (RCADS25-Arabic) and to explore its reliability and underlying factor structure. In light of changes to DSM classification, the effects of removing indicator variables for obsessive-compulsive disorder on the psychometrics of the RCADS25-Arabic were also explored.MethodThe scale was back translated into Modern Standard Arabic and administered to 250 Arabic speaking schoolchildren between 8-15 years of age. Mean and standard deviation were used to characterise the sample and summarize scores. The reliability and factor structure of the RCADS25-Arabic was explored using confirmatory factor analysis.ResultsFemales were 127 and mean age was 12.11 ± SD 2.35. Males scored lower on anxiety (M 15.05 SD ± 8.0, t(248) = -3.15, p = .003, d = 0.39) and internalizing factors (M 26.1 SD ± 13.1, t(248) = -2.36, p = .0160, d = 0.31) with no statistical gender difference recorded for depression (t(248) = -1.27, p = .202). Fit statistics were good for two- and one-factor solutions (χ2/df =1.65, RMSEA 0.051, CFI .91, TLI .90 and χ2/df =1.64 and RMSEA 0.051, CFI .91 and TLI .89 respectively). DIFFTEST showed no significant difference between models (χ2diff (1)=0.03, p<0.86) indicating a one-factor (internalizing) solution was preferable. No improvement in scale integrity was found after deleting obsessive-compulsive disorder items.ConclusionThe RCADS25-Arabic is useful for rapid screening of depression and anxiety but is better used to identify a one-factor internalizing construct. Obsessive-compulsive disorder items should be retained in the RCADS-25.

Household food insecurity, family size and their interactions for depression prevalence among teenage pregnant girls in Ghana, a multi-stage cluster sampling survey.

“…Household Food Insecurity Access Scale (HFIAS) developed by Food and Nutrition Technical Assistance (FANTA) Program of the U.S. Agency for International Development describes into details elsewhere [32], was used to measure participants household insecurity. Furthermore, Child Anxiety and Depression Scale (RCADS-25) [33] also describes in details elsewhere was used to assess the prevalence of depression among teenaged pregnant girls in our study. The questionnaire used in this study were pre-tested among 20 individuals before the main data collection.…”