Emotional and Behavioural difficulties (EBD) among adolescents in Brunei: can the SDQ and YSR be helpful in identifying prevalence rates?

Abstract

In most epidemiological studies, one in every five children and adolescents are said to display Emotional and Behavioural Difficulties (EDB), with greater risk of school and wider social exclusion (Brauner & Stephens 2006; Costello, Egger & Angold 2005). Although no formal statistics are currently available with regards EBD in Brunei, there was a formal report stating that quite a number of young people are now being referred to professionals for assistance and support for EBD. There is currently no assessment tool for EBD in Brunei and no ‘Brunei Malay’ translation for most of the Western design measures. Although some of these measures have Malay translations, it was formally back-to-back translated among professionals from Malaysia, who are known to speak slightly different standard Malay language than those Malays who reside in Brunei. Despite the differences in some technical language, Malays in Brunei and Malaysia share a very similar culture and geography. The aim of this study was twofold, to explore the responses of parents, teachers and adolescents in Brunei using the translation of the Western designed assessment tool for EBD as well as to determine how useful the original subscales of those measures are in reporting problems associated with EBD in Brunei Darussalam, a Malay speaking country based in the South East Asian region. A single phase cross sectional survey of 11-16 year-old adolescents attending mainstream public (i.e. government) schools in Brunei was carried out. Responses of parents and teachers were measured using the Strength and Difficulties Questionnaires (SDQ) and a subsample of the participants received a second copy of Child Behaviour Checklist (CBCL) and Teacher Report Form (TRF) of Achenbach measures. Responses from adolescents were measured using the Youth Self Report (YSR) of Achenbach measure. In total, responses were obtained from 396 parent version SDQ and 92 parent version of CBCL; 329 teacher version of SDQ and 71 teacher version of TRF; and 282 adolescent Youth Self Report (YSR) were obtained for analyses. Results indicated that there are some differences in the three different groups of respondents in Brunei in relation to the identification of EBD and that this differed somewhat from Western population studies. It is suggested that this may be due to differences in interpreting behavioural norms and that this might be linked to cultural differences. It was found that the YSR did not produce factor structure like that of the original study and this might indicate necessary refinement to ensure better fit as revealed by the psychometric analyses. Teachers’ responses to the SDQ items were more similar to those of teachers in other evaluation of the SDQ, whilst parents differed more in their responses when compared to those of Western respondents. Despite the clear differences in their responses when describing EBD using these Western measures, exploration of other statistical tests offered some possible reasons for continuing using the measures to report the prevalence of the problems. Previous studies have also highlighted some critical insights into the use of the measures in other cultures, which are discussed in the finding of this study. Some age and gender differences also appeared in responses, and there were a tendency for parents and adolescents in Brunei to report higher Total Difficulties Score (TDS) among girls than boys. The cut-off scores that were adjusted based on the criteria advocated by the founder of these measures indicated slight differences in the level of point describing the clinical range. This again served to highlight the possible cultural behavioural expectation that varies from one country to another. This exploratory study suggests that reporting a prevalence rate of a given culture using a measure that was designed elsewhere might pose risk of wrongly describing problems of a particular nature without investigating the way in which it has been understood by the respondent. The study stresses that it is important to understand cultural determinants of respondents when reporting EBD of adolescents and points out the necessity of planning and networking across social context to meet young people mental health needs.