Behavioral Health Assessment in Recent Immigrant Hispanic-Latino Mothers and Children at Vista Community Clinic.
Background : More research is needed in unique Hispanic-Latino communities regarding prevalence of pediatric behavioral disorders as well as culturally patterned manifestations of disorder. While the Strengths and Difficulties Questionnaire (SDQ) serves as a foremost instrument around the world for pediatric behavioral health screening in pediatric clinics, little information exists regarding subscale reliability in Latino immigrant or continental population subgroups. Methods : Surveys including the parent-response SDQ were administered to Mexican immigrant mothers (n=208) of 3-17yo children and adolescents visiting Vista Community Clinic, a community health clinic in Vista, California, from August 2012 to February 2013. Vista survey responses were compared to parent-SDQ data in multiple subgroups from the National Health Interview Survey (NHIS) 2004 data set, with subgroups including US Latino and non-Hispanic white populations. Analysis included confirmatory factor analysis (CFA) of multiple literature-based SDQ factor constructs, with factor intercorrelations (FI). Results : Similarities within a ~5% margin were seen across samples for abnormalities on SDQ behavioral subscales. For the traditional five-factor SDQ model, CFA showed only marginal model fit at best across samples (RMSEA ~0.05, CFI and TLI ~0.90), but did show similar factor loadings and directionality across all samples. Stronger model fit was seen for bifactor models incorporating a 25-item 'General Difficulties' factor (RMSEA<0.05, CFI>0.95, TLI~0.95). Factor intercorrelations were high (>0.5) across multiple SDQ factors, especially 'conduct symptoms' and 'emotional symptoms.' Conclusion : Although no CFA evidence fully disproved utilization of the SDQ survey for Hispanic-Latino youth in community health screening settings, broader constructs with larger values of variables-per-factor performed stronger across all cultural groups and sample sizes, possibly due to the intercorrelations between 'externalizing' and 'intern.