Mental Health Screening and Service Implications for Chinese Youth: Applying the Interrai Child and Youth Mental Health Screener (ChYMH-S) in Schools

Background and Purpose:

Youth mental health has become an emerging issue in Chinese culture. The young population in China (age 0–14) totals 233 million, representing 12% of the world’s youth population. Growing up under China’s one-child policy, massive rural-to-urban migration, and increasing divorce rate, many Chinese youth live in migrant, left-behind, and single-parent families that impose mental health risks. Amongst them, 85% (197 million) are at school age (6–18 years), who face even higher mental health risks due to high family expectations for the only child and academic stress. Research has reported high mental health problems in Chinese school-age children, ranging 11%–28%; one in ten Chinese school-age children is estimated to have psychiatric disorders that warrant treatment.

Despite the urgent mental health need of school-age children in China, current research has two gaps: 1) lacking internationally validated instruments for assessment, which impedes global comparison; 2) lacking professional mental health early assessment tools.

This study applies the International Resident Assessment Instruments (interRAI) Child and Youth Mental Health Screener (ChYMH-S)—a standardized mental health screening tool developed by an international network—to Chinese school-age youth. We focus on a high-risk population: rural-to-urban migrant youth. Our objectives are to: 1) examine the cross-cultural applicability and suggest necessary adaptations of ChYMH-S; 2) provide service recommendations for comprehensive assessment and early detection of mental health issues in Chinese youth.

Method:

190 school-age youth were recruited from Grade 4–9 in migrant schools in Shenzhen City through convenience sampling. Each participant was interviewed by trained assessors during school hours using the interRAI ChYMH-S instrument, which consists of mental state indicators, substance use, harm to self/others, behavioral symptoms, stress and trauma, and so forth. To establish convergent validity, 60 randomly selected participants’ caregivers and teachers were invited to complete Child Behavior Checklist and Strengths and Difficulties Questionnaire. Correlations between ChYMH-S and these criterion measures were analyzed.

Results:

The ChYMH-S showed strong correlation with both Child Behavior Checklist and Strengths and Difficulties Questionnaire scores. Conduct problems, anxiety, and problems video gaming were found to be relatively more prevalent among Chinese migrant youth than other symptoms. In contrast, substance use and problematic sexual behaviors were rarely identified in the sampled youth. The ChYMH-S instrument that was developed by an international network appears to be valid for Chinese youth.  

 

Implications:

The findings provide important implications for adopting comprehensive assessment tools and promoting early detection of mental health issues in Chinese youth, which is particularly relevant for those at high risk. In this study, we will focus on youth from rural migrant families, who amount to 35.81 million in China. These migrant children are challenged by multi-dimensional vulnerability, such as low family income, perceived discrimination, adjustment difficulties, and exclusion from social resources. Consequently, they present significantly higher mental health problems than their local peers: depression, suicidal ideation, self-injury behaviors, social anxiety, hyperactivity, conduct problems, and maladaptive behaviors. Focusing on this high-risk population, this study confirms the instrument sensitivity and informs future evidence-based interventions for such highly vulnerable populations.