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WORRIED
Often seems worried, past 6 months

Codes and Frequencies



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Description

For sample children age 4 to 17, WORRIED reports parents' responses to a question about whether, during the past 6 months, the child had many worries or often seemed worried. According to the Field Representative's Manuals for 2001 and 2003 forward, "This question is to get an overall picture of whether the child worries a lot."

The interviewer began this part of the survey by stating, "I am going to read a list of items that describe children. For each item, please tell me if it has been not true, somewhat true, [or] certainly true for [sample child] during the past 6 months," and handed the respondent a flashcard listing the three acceptable responses.

Instructions to Interviewers on Asking this Question 

The 2005 forwardField Representative's Manuals directed:

Some of the items include more than one behavior, such as 'has many worries or often seems worried.' For those questions, emphasize the OR. Be sure that the respondent understands that the question should be answered positively if the child does ANY part of the question.

The 2001 and 2003 forward Manuals provided directions on how interviewers should respond if parents indicated that the child was taking medication:

If the [parent/respondent] indicates that the child is taking medication, [the parent/he/she] should answer the questions as best possible describing [their/the] child's behavior when the child is NOT on the medication. However, do not ask if the child is on medication. Only if the [parent/respondent] states that the child takes medication and they do not know how to respond to the question, inform the [parent/respondent] to answer as best as they can, describing the child when the child is NOT on the medication.

As discussed in more detail in below, WORRIED was intended to be a measure of the child's "emotional symptoms." This question was part of the Strengths and Difficulties Questionnaire Extended (SDQ-EX), which, according to the 2001 and 2003 forward Field Representative's Manuals, was included "to monitor emotional and behavioral problems in children and the impact that these problems have on children's lives."

In 2002 and 2005 forward, a brief version of the Strengths and Difficulties Questionnaire, consisting of just six items, including WORRIED, was included in the sample child section of the NHIS. The elements of, and the interpretation of results from, the abbreviated version of the SDQ-EX in 2002 and 2005 forward are discussed toward the bottom of this variable description, directly before the section devoted to comparability issues.

Strengths and Difficulties Questionnaire Extended

WORRIED is part of a set of 33 questions from the Strengths and Difficulties Questionnaire Extended (SDQ-EX) developed by Dr. Robert Goodman, Institute of Psychiatry, London, England.

 

As the Appendix on SDQ in the 2001 and 2003-2004 Codebook of the NHIS public use files explains:

The parent respondent version of the SDQ was added as a mental health supplement for children ages 4-17 as part of a collaborative agreement between NCHS and the National Institute of Mental Health (NIMH). The first part of the SDQ consists of 25 scale items . . . These items can be divided into five subscales measuring the following psychological attributes or dimensions:
  • emotional symptoms;
  • conduct problems;
  • hyperactive behavior;
  • peer relationships;
  • prosocial behavior.

The survey forms for 2001 and 2003-2004 acknowledged the debt to Dr. Goodman, as follows:

The SDQ questions are copyrighted by Robert Goodman, Ph.D., FRCPsych, MRCP. State and local agencies may use these questions without charge and without seeking separate permission provided the wording is not modified, all the questions are retained, and Dr. Goodman's copyright is acknowledged.

This information was included for legal reasons and was not shared with survey respondents. More information on the SDQ is available at www.sdqinfo.com.

Scoring Responses to SDQ-EX: Emotional Symptoms

As noted in the Appendix on SDQ in the 2001 and 2003-2004 Codebook, WORRIED is an element of the 5-item subscale dealing with emotional symptoms.

 

The other elements of this subscale are:

  • Complains of headaches/stomach-aches or sickness, past 6 months (STOMACHE)
  • Often unhappy, depressed, or tearful, past 6 months (UNHAPPY)
  • Nervous or clingy in new situations, past 6 months (CLINGY)
  • Many fears or easily scared, past 6 months (FEARFUL)

Valid responses for these questions were "not true," "somewhat true," and "certainly true." A response of "not true" for these variables (code 0 in IPUMS NHIS) implies the lowest level of emotional symptoms; a response of "certainly true" for these variables (code 2 in IHIS) implies the highest level of emotional symptoms; and a response of "somewhat true" for these variables (code 1 in IHIS) implies an intermediate level of emotional symptoms. Researchers may choose to use a single variable from this set, but they can also sum the scores across the 5 variables. Summing these elements yields a total score for emotional symptoms ranging from 0 (the lowest level) to 10 (the highest level).

Summing the values for these variables yields valid totals only if the analyst excludes not in universe cases (persons other than sample children age 4-17, code 6 in IHIS) and cases with missing information (codes 7, 8, and 9 in IHIS).

As discussed in more detail below, for results that exclude not in universe and unknown cases, one rough guideline to interpreting the summed score for "Emotional Symptoms" is Normal (0-3), Borderline (4), and Abnormal (5-10).

Scoring Responses to SDQ-EX: Combining 4 Subscales

The SDQ-EX includes 5 subscales for measuring different aspects of child mental health. The five subscales (i.e., emotional symptoms, conduct problems, hyperactivity behavior, peer relationships, and prosocial behavior) can be scored separately to look at specific psychological characteristics (as described above, for the "emotional symptoms" subscale). Alternatively, items in four of the five subscales (emotional symptoms, conduct problems, hyperactivity behavior, and peer relationships) can be added for an overall score from 0 to 40.

 

Variables from the SDQ-EX receive codes in IHIS that facilitate this scoring process. More specifically, the response that corresponds to the lowest likelihood of a psychological problem is coded as 0 in IHIS; the response that corresponds to the highest likelihood of a psychological problem is coded 2 in IHIS; and the response that corresponds to an intermediate level likelihood of a psychological problem is coded 1 in IHIS.

This coding strategy to facilitate scoring means that a given parental response of "not true" or "certainly true" may be sometimes coded as 0 and sometimes coded as 2. (Responses of "somewhat true" are always coded 1.) For example, the question, "During the past 6 months, has [child] often complained of headaches, stomach aches, or sickness?" presupposes that "not true" (coded 0 in IHIS) implies less emotional symptomology than a response of "certainly true" (coded 2 in IHIS). However, with the question, "During the past 6 months, has [child had] at least one good friend?," a response of "not true" implies poorer peer relationships than a response of "certainly true." In the latter case (for the variable HASFRIEND), responses of "not true" are coded 2 in IHIS, and responses of "certainly true" are coded 0 in IHIS.

Once analysts exclude not in universe cases (persons who are not sample children age 4-17, IHIS code 6) and cases with missing information (IHIS codes 7, 8, and 9), they may sum the values for the following SDQ-EX variables for an overall score of 0 (least likely to have psychological problems) to 40 (most likely to have psychological problems). In addition to the 5 variables (including WORRIED) used to measure "Emotional Symptoms," as described in the previous section, the variables whose values may summed are:

For measuring "Conduct Problems"
  • Often loses temper, past 6 months (BADTEMPER)
  • Often fights or bullies kids, past 6 months (BULLIES)
  • Often lies or cheats, past 6 months (LIECHEAT)
  • Steals from home, school, or elsewhere, past 6 months (STEALS)
For measuring "Hyperactivity Behavior"
  • Restless or overactive, past 6 months (OVERACTIVE)
  • Constantly fidgeting, past 6 months (FIDGETY)
  • Good attention span and finishes tasks, past 6 months (GOODATTEN)
For measuring "Peer Relationships"
  • Prefers to be alone, past 6 months (SOLITARY)
  • Had at least 1 good friend, past 6 months (HASFRIEND)
  • Liked by other kids, past 6 months (KIDSLIKE)
  • Was picked on or bullied, past 6 months (PICKEDON)
  • Gets along better with adults than kids, past 6 months (GETALONGAD)

Interpreting Symptom Scores from SDQ-EX

The www.sdqinfo.com website provides guidelines for "interpreting symptom scores and defining 'caseness' from symptom scores."

 

According to these guidelines:

Although SDQ scores can often be used as continuous variables, it is sometimes convenient to classify scores as normal, borderline, or abnormal. Using the bandings shown below, an abnormal score on . . . the total difficulties score can be used to identify likely 'cases' with mental health disorders. This is clearly only a rough and ready method for detecting disorders . . . Approximately 10% of a community sample scores in the abnormal band on any given score, with a further 10% scoring in the borderline band. The exact proportions vary according to country, age and gender--normative SDQ data are available from the website. You may want to adjust banding and caseness criteria for these characteristics, setting the threshold higher when avoiding false negatives is of paramount importance, and setting the threshold lower when avoiding false negatives is more important.

For "Parent Completed" results (as in the NHIS), the www.sdqinfo.com website suggests the following interpretation of the "Total Difficulties Score" (summing results from the "Emotional Symptoms," "Conduct Problems," "Hyperactivity Behavior," and "Peer Relationships" subscales): Normal (score 0-13), Borderline (14-16), and Abnormal (17-40). As noted above, for the "Emotional Symptoms Score" (which includes WORRIED), the www.sdqinfo.com website suggests: Normal (0-3), Borderline (4), Abnormal (5-10). For the "Conduct Problems Score," the www.sdqinfo.com website suggests: Normal (0-2), Borderline (3), Abnormal (4-10). For the "Hyperactivity Score," the www.sdqinfo.com website suggests: Normal (0-5), Borderline (6), Abnormal (7-10). Finally, for the "Peer Problems Score," the www.sdqinfo.com website suggests: Normal (0-2), Borderline (3), Abnormal (4-10).

According to the 2004 Codebook Appendix, "Validation studies among U.S. children aged 4-14 years are not yet available."

Brief Strengths and Difficulties Questionnaire

In 2002 and 2005 forward, six items from the SDQ-EX were included in the sample child section of the NHIS, again with the permission of Dr. Robert Goodman. According to Appendix V of the NHIS Survey Description Document for 2002 and 2005 forward, the abbreviated SDQ, "constructed to save time and space in the questionnaire, was added for children of ages 4-17 as a part of a collaborative agreement between NCHS and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH)."

 

In the brief version of the questionnaire used in the 2002 and 2005 forward NHIS, one or two items were chosen from each of the 4 subscales making up the Strengths and Difficulties Questionnaire Extended (SDQ-EX). WORRIED was selected from the "emotional symptoms" subscale and, according to Appendix V, "correlates 0.71" with the full "SDQ emotion score." UNHAPPY (Often unhappy, depressed, or tearful, past 6 months) was also selected from the "emotional symptoms" subscale and, according to Appendix V, "correlates 0.64" with the full "SDQ emotion score." WELLBEHAVED (Generally well behaved, past 6 months) was selected from the "conduct problems" subscale and, according to Appendix V, "correlates 0.69" with the full "SDQ conduct score." GETALONGAD (Gets along better with adults than kids, past 6 months) was selected from the "peer relationships" subscale and, according to Appendix V, "correlates 0.69" with the full "SDQ peer problems score." GOODATTEN (Good attention span and finishes tasks, past 6 months) was selected from the "hyperactivity behavior" subscale and, according to Appendix V, "correlates 0.72" with the full "SDQ hyperactivity-inattention score."

As with the SDQ-EX, variables from the brief version of the SDQ receive codes in IHIS that allow researchers to add codes across items for a meaningful overall score. More specifically, the response that corresponds to the lowest likelihood of a psychological problem is coded as 0 in IHIS; the response that corresponds to the highest likelihood of a psychological problem is coded 2 in IHIS; and the response that corresponds to an intermediate level likelihood of a psychological problem is coded 1 in IHIS.

Once analysts exclude not in universe cases (persons who are not sample children age 4-17, IHIS code 6) and cases with missing information (IHIS codes 7, 8, and 9), they may sum the values for the aforementioned six SDQ variables for an overall score of 0 (least likely to have psychological problems) to 10 (most likely to have psychological problems). According to Appendix V in both 2002 and 2005 forward, "all values are summed to produce a total score. A total score from 1 to 5 correlates 0.84 with the full [long] SDQ total difficulties score."

Comparability

The variable WORRIED is completely comparable over time. As mentioned above, this variable is an element of both the extended version of the SDQ, which was fielded for sample children in the NHIS in 2001, 2003, and 2004, and an element of the short version of SDQ, which was fielded for sample children in 2002 and 2005 forward.

Other Variables on Child Mental Health 

From 1997-2000, the NHIS used questions from the Child Behavioral Checklist (CBCL) developed by Dr. Thomas Achenbach to measure children's emotional and behavioral problems. For 2001 forward, the NHIS retained the CBCL questions for children age 2-3, but replaced the CBCL survey with the Strengths and Difficulties Questionnaire (SDQ) for older children.

For the most part, the public use files of the NHIS data include only summary recodes for the CBCL questions, calculated separately for male and female children age 2-3 (MTODMHI, FTODMHI), for male and female children age 4-11 (MKIDMHI, FKIDMHI), and for male and female children age 12 to 17 (MTEENMHI, FTEENMHI). The one exception to this generalization is that variables from the CBCL relating to whether the child had been unhappy or depressed in recent months (TODDEPRES, KIDDEPRES, TEENDEPRES) appear in the NHIS public files.

Universe

  • 2001-2007, 2010-2016 2017 2018: Sample children age 4 to 17.

Availability

  • 2001-2007, 2010-2018

Weights