Volume 28, Issue 1 (Spring 2022)                   IJPCP 2022, 28(1): 106-121 | Back to browse issues page

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Ghahremani S, Ahmadian Vargahan F, Khanjani S, Farahani H, Fathali Lavasani F. Psychometric Properties of the Mental Health and Social Inadaptation Assessment in Iranian Adolescents. IJPCP 2022; 28 (1) :106-121
URL: http://ijpcp.iums.ac.ir/article-1-3292-en.html
1- Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
2- Research Center Cognitive Sciences and Behavioral in Police, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran.
3- Department of Psychology, Faculty of Humanities Sciences, Tarbiat Modares University, Tehran, Iran.
4- Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran. , lavasani.f@gmail.com
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Recent studies show that adolescent mental health problems are growing [3, 4, 5, 6]. However, in many cases, their problems remain undetected. If mental health problems in adolescents are not identified on time, they may hinder the emergence of their potential abilities and affect the quality of their personal and social life [7, 12, 13]. One way to diagnose and manage adolescent mental health problems quickly is to use screening instruments [1516]. However, the majority of the existing instruments suffer from a few limitations: they do not meet the diagnostic criteria for the latest classification of mental disorders (DSM-V), most of them evaluate only one or more disorders [17], and they mainly consider problems that are common among children and adolescents and do not take into account disorders that emerge or intensify exclusively during adolescence [2021], and in most of them, screening is based on a categorical approach, and the severity of adolescent problems is ignored [202122]. Considering the abovementioned limitations, Cote et al. [24] designed a self-report questionnaire for mental health assessment and social maladaptation in adolescents (MIA). Although they examined some of the psychometric properties of the MIA questionnaire, such as the internal consistency, construct validity, and other psychometric properties, including that test-retest reliability and concurrent validity, are still unexplored. Therefore, this study aimed to investigate the construct and concurrent validity and reliability of the instrument. 
This study was conducted in two phases. The study population of the first phase included all students aged 11-17 years living in Islamshahr City, Iran, in the 2019- 2020 academic year. Accordingly, 604 adolescents were selected using the cluster sampling method. The average age of the sample was 15.70 ±1.10 years. A total of 530 students (87.7%) lived with both parents, 16 (2.6%) with their father, 46 (7.6) with their mother, and 12 (2%) with others. Also, 124 students (20.5%) had a history of receiving mental health services, while 480 (79.5%) had no history of receiving health services. The sample of the study’s second phase was selected conveniently from adolescents referred to the medical center of Tehran Institute of Psychiatry (from October 2019 to March 2020). In this phase, 44 adolescents (age range=14-17, Mean±SD=16.14±1.09 years) were participants from whom 29 (65.9%) were boys and 15 (34.1%) were girls. Thirty-nine people (88.7%) lived with both parents, 2 (4.5%) with a father, 1 (2.3) with a mother, and 2 (4.5%) with others. Twenty-five students (56.8%) had a history of receiving mental health services, while 19 (43.2%) had no history of receiving mental health services. Confirmatory factor analysis (CFA) was used to investigate the structural validity of the questionnaire. Moreover, The concurrent validity of the questionnaire was checked with the strength and difficulties questionnaire (SDQ). Finally, the obtained data were analyzed considering descriptive statistics, correlation coefficients, and CFA using SPSS V. 22 and LISERL 8.8.
To investigate the CFA model, 1-factor and 2-factor structural models were hypothesized for the psychopathology scale, and the scales related to dysfunction were analyzed using a separate factor structure. The hypothesized models were analyzed using LISREL 8.8. Table 1 summarizes the results of the CFA models.

The results showed a good fit of the hypothesized 1-factor and 2-factor models to the data. However, the model fit of the dysfunction scale is moderate (Table 1).
Furthermore, the internal consistency and test-retest reliability indices support the instrument’s reliability. The Cronbach α coefficients for the overall score of psychopathological, externalizing, and internalizing behavior scales were good (0.86<α<0.94). In addition,  except for the two scales of eating disorder and psychopathy, which had the lowest value (α=0.57), the α coefficients of the other scales of psychopathology and dysfunction were good (0.73<α<0.89). The test-retest reliability showed good intra-class correlation coefficient (ICC) indices for the overall score of psychopathology (ICC=0.78) and intrinsic behaviors (ICC=0.81). However, the correlation coefficient of median internalizing behaviors was moderate (0.67). Moreover, except for the three scales of psychopathy, eating disorder, and an eating disorder, with low correlation coefficients (0.42, 0.48, and 0.38, respectively), the correlation coefficient of other scales of psychopathology was moderate to good (0.54 to 0.90). Results of the concurrent validity support a significant positive relationship (P<0.05) between the overall score of  MIA psychopathology scales and those of SDQ psychopathology. In addition, the correlation coefficient among the internalizing and externalizing factors and their subscales, as well as the subscales of SDQ psychopathology, were significantly positive (P<0.05). Moreover, the significantly negative relationship between the MIA scores and its related subscales, such as prosocial behavior in SDQ, supported the concurrent validity of the questionnaire.
This study aimed to investigate the validity and reliability of MIA by assessing the concurrent and construct validity as well as the internal consistency and test-retest reliability of the questionnaire. In line with the original study’s findings [24], our findings support the 2-factor structural model for the questionnaire. In addition, 1-factor structural model for psychopathology was confirmed. The results of the analysis show a good α coefficient for the overall score of psychopathology, externalizing and internalizing, and factors (0.86<α<0.94). The Cronbach α coefficient for other scales other than eating disorders and psychopathy is acceptable, though lower than the original study [24]. Moreover, the correlation coefficient of the total scores of psychopathology and externalizing behavior was good (the questionnaires were tested at a time interval of two weeks). However, the correlation coefficient of the scores of the internalizing behaviors was mediocre. Results of the concurrent validity showed a positive correlation (P<0.05) between the scales of the MIA questionnaire and the scales of SDQ with similar concepts. MIA scales also negatively correlated (P<0.05) with the prosocial behavior scale, which was a different concept. Overall, CFA, internal consistency, and correlation coefficient indices of all the scales (except for psychopathy and eating disorder) support the validity and reliability of the questionnaire to be used as a screening tool in adolescents.

Ethical Considerations
Compliance with ethical guidelines

This research was conducted with the code of ethics IR.IUMS.1398.1192 and informed consent of the participants. All participants were aware of the confidentiality of the information and their willingness to cooperate in the research or withdraw from it.

This research was conducted with the financial support of the Iran University of Medical Sciences.

Authors contributions
Conceptualization and writing of the draft: Fahima Fethali Lavasani, Sosan Garhami; Data collection: Fahima Ahmadian Varghan and Sosan Garhami; Writing and editing the text of the article: Sosan Ghahrani and Fahima Fathali Lavasani; Data analysis: Sajjad Khanjani and Hojatullah Farahani.

Conflicts of interest
The authors declared no conflict of interest.

The authors of this article thank and appreciate all the participants in the research and the people who provided the necessary background for conducting this research.

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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2020/07/3 | Accepted: 2021/01/31 | Published: 2022/04/1

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