The Nordic advantage in child mental health: separating health differences from reporting style in a cross‐cultural comparison of psychopathology
Open accessAbstract
Background: The use of similar standardised measures of psychopathology for population surveys permits cross‐cultural comparisons. However, interpretation of findings can be challenging because rating thresholds may differ across cultures. By combining questionnaire and interview data, we explore whether lower questionnaire scores in Norway as compared to Britain reflect genuine differences in child mental health, or simply different reporting thresholds. Methods: Information from the Strengths and Difficulties Questionnaire (SDQ) and the Development and Well‐Being Assessment (DAWBA) interview were compared across recent population surveys in Norway and Britain. The Norwegian study (2002–03) had questionnaire data for 6,658 and interview data for 1,024 8–10‐year‐old children. The British dataset included questionnaire and interview data for 4,898 children of the same age range from two independent surveys (1999 and 2004). Results: Norwegian children had lower SDQ scores on all problem scales (emotional, behavioural, hyperactive and peer relationship) according to parents as well as teachers. DAWBA information showed that the Norwegian prevalence of externalising disorders (behavioural and hyperactivity) was about half that found in Britain, whereas rates of emotional disorders were similar. Norwegian and British children with non‐emotional disorders had similar questionnaire scores and rates of problem‐recognition by parents and teachers. By contrast, questionnaire scores and problem‐recognition were all lower in Norwegian children with emotional disorders. Conclusions: Lower Norwegian questionnaire scores for externalising problems appear to reflect real and substantial differences between the two countries. By contrast, lower questionnaire scores for emotional problems seem to reflect under‐reporting/under‐recognition by Norwegian adults, and not a genuinely lower prevalence of emotional disorders. This illustrates that cross‐cultural differences in psychopathology based only on questionnaire data may be misleading. Nevertheless, careful use of questionnaire and interview data can focus mental health research on cross‐cultural variations likely to reflect genuine health differences.
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Adverse childhood experiences, such as psychological and physical abuse and neglect, parental substance abuse and mental illness, all increase the risk of both physical and mental health problems, as well as health risk behaviours.
“Adverse childhood experiences, such as psychological and physical abuse and neglect, parental substance abuse and mental illness, all increase the risk of both physical and mental health problems, as well as health risk behaviours [36-41].”
From Mental disorders in foster children: a study of prevalence, comorbidity and risk factors (2013) · cites this paper as [39]
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- Authors
- Heiervang, E., Goodman, A., & Goodman, R.
- Affiliations
- University of Bergen (NO)
- London School of Hygiene & Tropical Medicine (GB)
- King's College London (GB)
- Corresponding author
- Heiervang, Einar
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2008-05-19
- Volume
- 49
- Issue
- 6
- Pages
- 678-685
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2140127409
- Cited by
- 137
- References
- 25
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 1 · 2019: 9 · 2018: 7 · 2017: 12 · 2016: 9 · 2015: 10 · 2014: 13 · 2013: 16 · 2012: 6
- FWCI
- 12.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Norges Forskningsråd
- Haukeland Universitetssjukehus
- Medical Research Council
- Economic and Social Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- child mental health, cross-cultural comparison, psychopathology, Strengths and Difficulties Questionnaire, Development and Well-Being Assessment, reporting thresholds, underreporting, emotional disorders, externalizing disorders, hyperactivity, peer relationships, parent and teacher ratings, prevalence, Norway, Great Britain
- MeSH terms
- Mental Disorders, Child, Cross-Sectional Studies, Cross-Cultural Comparison, Data Collection, Female, United Kingdom, Humans, Interview, Psychological, Male, Norway, Personality Assessment, Psychometrics, Psychopathology, Bias
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