{ "abstract": "Background: The Strengths and Difficulties Questionnaire (SDQ) is a commonly used screening instrument for assessing emotional and behavioral strengths and difficulties among children and adolescents. However, although the SDQ’s psychometric properties have been tested extensively in the literature, its current form is under debate as to whether it is suitable as a tool to assess adolescent mental health, especially among refugees. Therefore, this study aims to validate the SDQ scale among Adolescent Palestinian refugees in the West Bank, Palestine, and Jordan. Methods: The psychometric properties of the original SDQ and other suggested alternatives were tested. First, construct validity for the original SDQ was tested through confirmatory factor analysis (CFA). Then, exploratory factor analysis (EFA) was used to evaluate the latent factorial structure for suggested alternatives, followed by CFA to provide additional evaluation of each alternative. Then, convergent, discriminant, and criterion validity were assessed. Finally, the internal consistency and reliability were assessed using multiple tests. Results: This study included 2,828 adolescent girls living in Palestine refugee camps in the West Bank and Jordan. Of these, 2,725 participants were included in the final analysis based on completion of the SDQ. CFA indicated that the original five-factor SDQ demonstrated poor fit in this sample (CFI/TLI < 0.40; RMSEA = 0.081; SRMR = 0.110), with several items showing low standardized loadings. EFA and CFA analyses supported alternative factorial structures. A four-factor model showed acceptable fit (CFI = 0.896; RMSEA = 0.040; SRMR = 0.039) after removing poorly performing items, but a three-factor solution provided the best overall fit (CFI = 0.942; TLI = 0.930; RMSEA = 0.034; SRMR = 0.033). The final three-factor model retained 15 items representing Emotional Symptoms, Prosocial behavior, and Conduct Problems. The weak correlation between the difficulties did not support convergent validity score and WHO-5 well-being (r = −0.245). Criterion validity analyses showed acceptable discrimination for overall difficulties (AUC = 0.776). Reliability analyses indicated adequate internal consistency for the composite difficulties scale (α = 0.71). Conclusion: The original SDQ structure validity and reliability were not supported for use among Palestinian refugees in the West Bank and Jordan. Instead, the 3-factor and 15-item alternative might be a better alternative, given its superior model fit indices and construct validity. However, it still had limitations in reliability and convergent validity, making it far from being an adequate substitute for the original SDQ. Contexts, culture, and the surrounding environment might influence how adolescents in refugee settings understand, interpret, and respond to SDQ items.", "abstract_shown": true, "affiliations": [ "Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan", "Institute of Community and Public Health, Birzeit University, Birzeit, Occupied Palestinian territory", "Hunter College, The City University of New York, New York, United States of America" ], "article_type": "Research Article", "arxiv": null, "author_total": 3, "authors": [ { "affs": [ 0 ], "name": "Mohammed B. A. Sarhan" }, { "affs": [ 1 ], "name": "Rula Ghandour" }, { "affs": [ 2 ], "name": "Weeam Hammoudeh" } ], "bibtex": "https://research.draconitic.com/paper/9n12d42bzmxvt.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0349999", "fulltext_url": null, "id": "9n12d42bzmxvt", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0349999", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "3203|Child and Adolescent Psychosocial and Emotional Development" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Social cognition/Prosocial behavior" ], [ "plos", "/Biology and life sciences/Psychology/Behavior/Prosocial behavior" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Social cognition/Prosocial behavior" ], [ "plos", "/Biology and life sciences/Psychology/Emotions" ], [ "plos", "/Biology and life sciences/Psychology/Psychometrics" ], [ "plos", "/Biology and life sciences/Psychology/Social psychology/Social cognition/Prosocial behavior" ], [ "plos", "/Medicine and health sciences/Mental health and psychiatry" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Behavioral and social aspects of health" ], [ "plos", "/People and places/Demography/Refugees" ], [ "plos", "/People and places/Geographical locations/Asia/Palestinian territories" ], [ "plos", "/People and places/Population groupings/Age groups/Children/Adolescents" ], [ "plos", "/People and places/Population groupings/Families/Children/Adolescents" ], [ "plos", "/Social sciences/Psychology/Behavior/Prosocial behavior" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Social cognition/Prosocial behavior" ], [ "plos", "/Social sciences/Psychology/Emotions" ], [ "plos", "/Social sciences/Psychology/Psychometrics" ], [ "plos", "/Social sciences/Psychology/Social psychology/Social cognition/Prosocial behavior" ] ], "openalex": "W7214276542", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0349999&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-25", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/9n12d42bzmxvt.ris", "sources": [ { "first_seen": "2026-10-30T12:17:43Z", "native_id": "10.1371/journal.pone.0349999", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0349999" } ], "subjects": [ { "field": "biology", "origin": "plos:neuroscience", "subfield": "neuroscience" }, { "field": "medicine", "origin": "plos:public and occupational health", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:mental health and psychiatry", "subfield": "psychiatry" } ], "title": "Exploring psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) among adolescent Palestinian refugee girls in Palestine and Jordan", "title_text": "Exploring psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) among adolescent Palestinian refugee girls in Palestine and Jordan", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:43Z", "url": "https://research.draconitic.com/paper/9n12d42bzmxvt", "venue": "PLOS One", "versions": [] }