Psychometric Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11–17 Years

Psychometric Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11–17 Years | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11–17 Years Aliashraf Mozafari, Nourrollah Yadegari, Amir Adibi, Alireza Cheraghi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7062586/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives: Early assessment and intervention in adolescent mental health are essential for improving developmental outcomes. This study examined the psychometric properties of the Persian version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure among students aged 11–17 in Ilam, Iran. Methods: A cross-sectional study was carried out in 2024 involving 350 students from schools in Ilam, Iran. The validation process included translation, content and face validity assessments, reliability testing (internal consistency and test-retest), and confirmatory factor analysis (CFA). Results: The average age of participants was 14.23 years (SD = 0.75), with 91.34% from urban areas and 8.57% from rural areas. The overall agreement rates for item relevance and clarity were 96.6% and 94.4%, respectively. Cronbach’s alpha coefficients and intraclass correlation coefficients (ICC) for all domains exceeded 0.80, indicating strong internal consistency and reliability. CFA supported the construct validity of the instrument with satisfactory factor loadings. Conclusion: The Persian DSM-5 Level 1 Cross-Cutting Measure demonstrates strong psychometric properties for identifying mental health issues in Iranian adolescents, supporting its use in school screening programs. Mental health screening DSM-5 validity reliability adolescents Figures Figure 1 Introduction Mental health in children and adolescents is a fundamental pillar of individual and social well-being, significantly influencing their quality of life and future outcomes (1). According to the World Health Organization (WHO), approximately 10% of children and adolescents worldwide experience mental disorders (2), with half of these conditions beginning by the age of 14 (3). These statistics underscore the urgent need for early intervention and the development of appropriate support and treatment infrastructures. Mental health plays a vital role in shaping personality, academic achievement, stress management, the development of healthy social relationships, and positive life decision-making (4). In this context, regular and scientifically grounded assessments can help identify potential issues at early stages, enabling the provision of appropriate support(5). One practical approach is the use of mental health screening questionnaires, which will allow a comprehensive evaluation of individuals' psychological well-being (6). Despite the importance of such assessments, standardized and validated screening tools for mental disorders among children and adolescents remain limited in Iran. Therefore, there is a critical need for a valid, accessible, and freely available screening instrument for adolescents aged 11 to 17 that is suitable for clinical use. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure is a comprehensive screening tool that evaluates 12 mental health domains using only 25 items; however, its psychometric properties in Persian have not yet been assessed. This study aimed to examine the validity and reliability of the Persian version of the DSM-5 Self-Rated Level 1 questionnaire among high school students in Ilam. The findings of this research may contribute to the improvement of mental health screening tools in Iran, facilitating early and effective interventions. Method Study Design and Participants : This cross-sectional study was carried out in 2024 with a sample of 350 high school students in Ilam, Iran. A multistage cluster random sampling method was used. First, the population was divided into clusters based on schools and classrooms. Several clusters were randomly selected, and within those clusters, students were randomly chosen to participate in the study. Translation Procedure : The translation process followed the standard forward–backward translation method. First, two bilingual experts independently translated the original English version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure into Persian. The research team then reviewed and synthesized these translations to produce a preliminary Persian version. For back-translation, two other bilingual individuals, blinded to the original questionnaire, translated the Persian version back into English. The back-translated version was compared with the original to identify discrepancies, and necessary revisions were made to finalize the Persian translation. Data Collection Tool : The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure, consisting of 25 items, was used to screen mental health symptoms among adolescents aged 11 to 17 years. The questionnaire assesses symptoms across 12 psychiatric domains, including somatic symptoms, sleep problems, concentration difficulties, depression, irritability, anger, elevated energy and risky behaviors, psychosis, anxiety, obsessive-compulsive symptoms, substance use, and suicidal ideation. Items are rated on a 5-point Likert scale ranging from "None" to "Severe." Selected items related to substance use and suicidal thoughts are answered in a binary (Yes/No) format. Content Validity : The content validity of the instrument was assessed using the method proposed by Lawshe (7, 8), which involves calculating the Content Validity Index (CVI) to evaluate the relevance and clarity of each item. A panel of 10 experts and researchers with sufficient knowledge and expertise in the field, including three clinical and general psychologists, two methodologists, and five researchers specializing in psychology and questionnaire validation, was invited to evaluate the questionnaire. They were asked to rate each item and the overall instrument for appropriateness, clarity, and comprehensiveness. The experts assessed the relevance, simplicity, clarity, and appropriateness of each item using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). They were also encouraged to provide suggestions for improving specific items. For the CVI analysis, the responses were dichotomized as follows: scores of 1 or 2 were categorized as “disagree” (scored as 0), and scores of 3 or 4 as “agree” (scored as 1). The CVI for each item was calculated as the average of agreement scores across all raters. Items with a Content Validity Ratio (CVR) below the minimum acceptable threshold, based on the number of participating experts, were excluded from the analysis. Face Validity : To evaluate face validity, a panel of 10 experts reviewed the Persian version of the questionnaire. They assessed the clarity and understandability of each item using a 4-point scale, from 1 (strongly disagree) to 4 (strongly agree). Similar to the CVI procedure, the Face Validity Index (FVI) was calculated by recoding responses: ratings of 1 and 2 were labeled as “disagree” (scored as 0), and ratings of 3 and 4 as “agree” (scored as 1). The FVI for each item was determined by the proportion of experts who agreed on its clarity and understandability. A cutoff value of 0.80 was used to identify acceptable items (9). Reliability Assessment : Internal Consistency To evaluate internal consistency, Cronbach’s alpha coefficients were calculated for each subscale. The questionnaire was administered to a sample of 50 high school students in Ilam. After data collection, Cronbach’s alpha values for each domain were computed using Stata software. A threshold of 0.70 or higher was considered acceptable for internal consistency(9). Test–Retest Reliability Test–retest reliability was assessed by administering the final, translated version of the questionnaire to a second group of 50 students. The same participants completed the questionnaire again 15 days later. To determine the stability of the instrument over time, intraclass correlation coefficients (ICC) were calculated for each domain and each item(10). ICC values ≥ 0.70 indicated satisfactory reliability. Confirmatory Factor Analysis : Confirmatory Factor Analysis (CFA) was performed using AMOS version 18 to evaluate the hypothesized factor structure of the questionnaire, covering key mental health domains. Model fit indices and factor loadings were examined to confirm construct validity. Data Analysis: Data were analyzed using STATA version 12. Descriptive statistics (means, standard deviations, frequencies) and inferential statistics—including chi-square tests and inter-rater agreement indices—were used. Exploratory factor analysis was also performed to examine the underlying structure of the questionnaire. Ethical Considerations : Participants and their guardians were fully informed about the study’s objectives and provided oral informed consent. Confidentiality and voluntary participation were assured. The study protocol was approved by the Ethics Committee of Ilam University of Medical Sciences, with approval code IR.MEDILAM.REC.1402.260. Results Demographic Characteristics of Participants : A total of 350 students participated in the study, including 254 females (72.6%) and 96 males (27.4%). The mean age was 14.23 years (SD = 0.75). Most participants (91.4%) resided in urban areas, while 8.6% lived in rural areas. Regarding school type, 64.3% attended public schools, and 35.7% were enrolled in special or gifted schools. Detailed demographic data are presented in Table 1 Table 1 Demographic Characteristics of the Study Participants (N = 350) Variable Frequency (N) Percentage (%) Gender Female 254 72.6 Male 96 27.4 School Type Public 225 64.3 Special 125 35.7 Residence Urban 320 91.4 Rural 30 8.6 Content and Face Validity Findings : Expert evaluations indicated a high level of agreement regarding the appropriateness and clarity of the questionnaire items. Specifically, the overall content appropriateness was 96.6%, clarity was 94.4%, and the comprehensiveness of the entire instrument reached 99.2%. For face validity, the clarity index was 94.4%, and the simplicity and fluency of the items were 96.6% (Table 2 ). The expert panel assessed the relevance, clarity, and simplicity of each item using a structured content validity form. Agreement rates among experts ranged from 87.5–100%, demonstrating strong consensus on item adequacy. Moreover, intraclass correlation coefficients (ICC) ranged from 0.86 to 0.98, reflecting excellent test–retest reliability across domains and individual items (Table 3 ). Table 2 Summary of Content and Face Validity Indices Index Percentage (%) Interpretation Comprehensiveness 99.2 Excellent Appropriateness 96.6 Excellent Clarity 94.4 Excellent Simplicity and Fluency 96.6 Excellent Note. Percentages represent the level of expert agreement on each criterion. Table 3 Expert Ratings of Item Quality and Inter-Rater Reliability of the Persian DSM-5 Level 1 Measure Item No. Item Description Appropriateness (%) Clarity (%) Simplicity (%) Intraclass Correlation Coefficient (ICC) 1 Been bothered by stomachaches, headaches, or other aches and pains? 100 100 100 0.98 2 Worried about your health or about getting sick? 89 89 87.5 0.92 3 Been bothered by not being able to fall asleep or stay asleep, or by waking up too early? 89 89 87.5 0.90 4 Have you been bothered by not being able to pay attention in class, while reading, or while playing a game? 89 100 100 0.94 5 Had less fun doing things than you used to? 89 89 87.5 0.90 6 Felt sad or depressed for several hours? 100 100 87.5 0.96 7 Felt more irritated or easily annoyed than usual? 89 89 100 0.86 8 Felt angry or lost your temper? 100 100 100 0.94 9 Started more projects than usual or done more risky things? 100 100 87.5 0.96 10 Slept less than usual but still had a lot of energy? 100 100 100 0.92 11 Felt nervous, anxious, or scared? 100 100 100 0.88 12 Not been able to stop worrying? 89 89 87.5 0.92 13 Not been able to do things because they made you feel nervous? 100 100 100 0.94 14 Heard voices when no one was there, speaking to you or about you? 100 100 100 0.96 15 Had visions when fully awake that no one else could see? 100 100 100 0.87 16 Had recurring evil thoughts that something terrible would happen? 100 100 100 0.90 17 Felt the need to check things like doors or the stove repeatedly? 89 100 100 0.88 18 Worried a lot about germs or contamination? 100 100 100 0.92 19 Felt you had to say or do things in a specific way to prevent harm? 100 100 87.5 0.95 20 Had an alcoholic drink (beer, wine, liquor, etc.)? 100 100 100 0.93 21 Used tobacco products (cigarettes, cigars, chewing tobacco, etc.)? 100 100 100 0.91 22 Used illegal drugs (e.g., marijuana, LSD, heroin, inhalants)? 100 100 100 0.90 23 Used prescription medication to get high or alter mood without a prescription? 100 89 100 0.98 24 In the last 2 weeks, have you thought about killing yourself? 100 100 100 0.93 25 In the last 2 weeks, have you attempted suicide? 100 100 100 0.90 26 Have you ever attempted to end your own life? 100 100 100 0.98 Note: ICC = Intraclass Correlation Coefficient. Values above 0.80 indicate strong inter-rater reliability. Internal Consistency : Cronbach’s alpha coefficients ranged from 0.76 to 0.94 across the multi-item domains, indicating good to excellent internal reliability. The highest internal consistency was observed in the Depression domain (α = 0.94), followed by Somatic Symptoms (α = 0.89), Irritability (α = 0.89), Repetitive Thoughts and Behaviors (α = 0.87), Anger (α = 0.87), Mania (α = 0.81), Psychosis (α = 0.81), Substance Use (α = 0.82), Anxiety (α = 0.76), and Suicidal Ideation (α = 0.76). For single-item domains such as Sleep Problems and Inattention, Cronbach’s alpha was not applicable (Table 4 ). Test–Retest Reliability : Temporal stability assessed via Intraclass Correlation Coefficients (ICCs) showed strong reliability across all domains, with ICC values ranging from 0.80 to 0.93. Notably, the Depression, Mania, and Psychosis domains exhibited the highest stability (ICC = 0.93). Single-item domains also demonstrated excellent reliability, with ICCs of 0.85 for Sleep Problems and 0.91 for Inattention. The 95% confidence intervals for ICCs indicate precise estimates of stability (Table 4 ). Table 4 Internal Consistency (Cronbach’s Alpha) and Test–Retest Reliability (ICC with 95% CI) for Each Domain of the Persian DSM-5 Level 1 Self-Rated Measure Domain Number of Items Cronbach’s Alpha ICC (95% Confidence Interval) Somatic Symptoms 2 0.89 0.84 (0.72–0.91) Sleep Problems 1 Not applicable (single-item) 0.85 (0.73–0.91) Inattention 1 Not applicable (single-item) 0.91 (0.84–0.95) Depression 2 0.94 0.93 (0.87–0.96) Anger 2 0.87 0.80 (0.62–0.88) Irritability 2 0.89 0.84 (0.72–0.91) Mania 2 0.81 0.93 (0.87–0.96) Anxiety 3 0.76 0.83 (0.70–0.90) Psychosis 2 0.81 0.93 (0.87–0.96) Repetitive Thoughts & Behaviors 4 0.87 0.80 (0.62–0.88) Substance Use 4 0.82 0.82 (0.59–0.87) Suicidal Ideation 3 0.76 0.80 (0.74–0.87) Note: ICC = Intraclass Correlation Coefficient; CI = Confidence Interval. Cronbach’s alpha is not applicable for single-item domains. To examine the factorial structure of mental health components, a confirmatory factor analysis (CFA) was conducted using Amos version 18. The factor loadings generally ranged from 0.63 to 0.80. Items such as Q5, Q11, and Q26 showed high factor loadings (0.79, 0.79, and 0.80, respectively) and low measurement errors (0.38, 0.38, and 0.36, respectively), indicating excellent measurement precision (Fig. 1 ). Discussion This study aimed to evaluate the psychometric properties of the Persian translation of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure among adolescents aged 11 to 17 years in Ilam, Iran. The findings indicate that the Persian version exhibits acceptable and robust validity and reliability. Specifically, indices assessing item clarity, simplicity, and relevance exceeded 90%, demonstrating strong cultural alignment with the Iranian adolescent population. The instrument also showed satisfactory content coverage, with comprehensiveness ratings consistently above 80% across various studies (11). These results support the suitability of the questionnaire for mental health screening in Iranian adolescents. Consistent findings from previous research further reinforce this conclusion. For example, Nilay Gul et al. (2021) validated the Turkish version of the same instrument, reporting item agreement rates above 90%, closely paralleling the current study’s outcomes (12). Similarly, Iranian studies by Mazaheri, Soltani-Nejad, and Karimi have documented high internal consistency for the instrument, with Cronbach’s alpha values ranging from 0.75 to 0.95. This consistency across clinical and non-clinical populations enhances the tool’s generalizability and confirms its applicability in diverse psychological screening contexts(13–15). Overall, the Persian version of the DSM-5 Self-Rated Level 1 questionnaire emerges as a valid and reliable instrument for identifying mental health concerns among adolescents, with strong cultural relevance and sound psychometric performance. Regarding reliability, Cronbach's alpha coefficients across domains ranged from 0.76 to 0.94, indicating good to excellent internal consistency. Furthermore, intraclass correlation coefficients (ICCs) for all components exceeded 0.80, reflecting a high degree of stability and coherence in assessing various psychological constructs. These findings are aligned with psychometric standards and are consistent with the results of international studies such as those conducted by Narrow et al. (2013) and da Rocha et al. (2020)(6, 16) Moreover, the intraclass correlation coefficient (ICC) for all components exceeded 0.80, indicating a high degree of agreement among participants. The highest ICC value was observed in the domains of depression, mania, and psychosis (0.93), suggesting that these components demonstrated strong consistency and stability in assessment. According to the criteria proposed by Koo et al., ICC values above 0.75 are indicative of strong reliability(17). In another study conducted by Gharraee et al. in Tehran, the validity and reliability of the Persian version of the DSM-5 Self-Rated Personality Questionnaire (SCID-5-SPQ) were examined in a clinical population with psychiatric disorders. The findings indicated that the questionnaire demonstrated acceptable face and content validity, and the Cronbach’s alpha coefficient was reported as 0.93, reflecting high internal consistency. These results are consistent with the findings of the present study(18). Confirmatory Factor Analysis (CFA) further supported the conceptual structure of the Persian version of the questionnaire, demonstrating a good fit with the collected data. The factor loadings of the items ranged from 0.63 to 0.80, with most exceeding 0.70, indicating strong loadings and adequate representation of the latent constructs. According to psychometric literature, factor loadings above 0.70 are considered strong indicators of construct validity(6). In this study, most items surpassed this threshold, with items such as Q5, Q11, and Q26 showing particularly high loadings (0.79 to 0.80), providing substantial support for their respective latent factors. Moreover, item measurement error, calculated using the formula λ² – 1, revealed that the majority of items had error variances below 0.50, reflecting satisfactory measurement precision and adequate conceptual coverage of the latent dimensions. These CFA findings are consistent with previous research. For instance, da Rocha et al. (2020) reported a similar model fit and factor loadings above 0.70 in their validation of the Brazilian version of the DSM-5 instrument Likewise, Narrow et al. (2013), in the field testing phase of the original instrument, confirmed acceptable confirmatory factor structures across domains such as depression, anxiety, and obsessive thoughts(6). Nonetheless, some limitations must be acknowledged. The self-report nature of the instrument may introduce biases such as social desirability or individual differences in interpreting psychological constructs. Moreover, conducting the study solely in Ilam limits the generalizability of findings to other regions and more diverse populations. Future research should employ larger, more heterogeneous samples and incorporate cross-cultural comparative analyses to enhance robustness and generalizability. Conclusion The findings demonstrate that the Persian version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure exhibits robust psychometric properties, including strong content validity, face validity, and reliability. High factor loadings, appropriate item clarity and simplicity, along with acceptable Cronbach’s alpha (α) and intraclass correlation coefficient (ICC) values, collectively confirm the tool’s scientific rigor and practical utility for assessing psychological symptoms in Persian-speaking populations. These results not only validate the instrument’s effectiveness in evaluating multidimensional mental health constructs but also support its applicability in epidemiological research, clinical screening, and mental healthcare settings across Iran. In summary, the cross-culturally adapted Persian version of this scale can be reliably implemented as a valid assessment tool for DSM-5 cross-cutting symptoms. Declarations Acknowledgements : We sincerely thank all the participants for the data material and the researchers who freely shared the data. Author contributions : RM was responsible for conceptualization, methodology, formal analysis, and writing original draft. ACH, AA and AM participated in investigation. RM, AM and NY contributed to manuscript revisions. AM and KS supervised the research and provided critical review. All authors have read and approved the final version submitted and take public responsibility for all aspects of the work. Funding : This work was supported by the Research Center for Psychosocial Injuries (code IR.MEDILAM.REC.1402.260). Informed consent was obtained from the participants to take part in the study. Ethics approval and consent to participate : Participants and their guardians were fully informed about the study’s objectives and provided oral informed consent. Confidentiality and voluntary participation were assured. The study protocol was approved by the Ethics Committee of Ilam University of Medical Sciences approval codeIR.MEDILAM.REC.1402.260. Clinical trial number: not applicable Competing interests : The authors declare no competing interests. Author details : 1 Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran. 2 Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran. 3 Department of Child and Adolescent Psychiatry, Ilam University of Medical Sciences, Ilam, Iran. 4 Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran. 5 Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran. Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran, 6 Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran. 7* Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran. * E-mail: [email protected] References Aminibagh A, Salimi J. Explaining the dimensions and components of ethical leadership in schools with a meta-synthesis approach. Quarterly Journal of New Advances in Educational Management. 2025;6(1):1–23. 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Gharrae B, Masoumian S, Zamirinejad S, Yaghmaeezadeh H. Psychometric Properties of the Persian Version of the Self-report Personality Questionnaire for Personality Disorders of DSM-5 (SCID-5-SPQ) in Clinical Samples. Iranian Journal of Psychiatry and Clinical Psychology. 2022;27(4):508–19. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Menati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYLCDAx8YGBKIUcjYAKGZGQ7OIFkLMw8xWszb258/+JmzTc6c/fzBw7Ztdnn87A2MHz7m4NYic+aMYWPvttvGlj3JDIdz25KLJXsOMEvO3IZbi4REDmMD77bbiRsOgLUwJ264kcDGzItXS/rDxr/bbtdvOP+Y4bBlWz0xWhIMm4G2JBjcANrC2HaYCC08Zwxny267bbjhxmODgz3njifO7DnYjN8v7O0PPr7ddlve4Hzi4w8/yqoT+9mbD374iEcLKmBkA5MNxKoHgT+kKB4Fo2AUjIKRAgCG9Fp/PUP/YAAAAABJRU5ErkJggg==","orcid":"","institution":"Psychosocial Injuries Research Center, Ilam University of medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Rostam","middleName":"","lastName":"Menati","suffix":""}],"badges":[],"createdAt":"2025-07-07 07:38:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7062586/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7062586/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89591906,"identity":"a5108f7e-5a96-4392-bc44-1dca8b2c7220","added_by":"auto","created_at":"2025-08-21 16:09:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":246224,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConfirmatory Factor Analysis (CFA) Model of Mental Health Components.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7062586/v1/f852907730a7c7e84062c7b9.png"},{"id":91048135,"identity":"1404ae72-d43a-4fdf-b43e-c695f9a56201","added_by":"auto","created_at":"2025-09-11 06:09:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1260229,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7062586/v1/f6c2947e-8461-4c88-aa72-7e295886a057.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePsychometric Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11–17 Years\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health in children and adolescents is a fundamental pillar of individual and social well-being, significantly influencing their quality of life and future outcomes (1). According to the World Health Organization (WHO), approximately 10% of children and adolescents worldwide experience mental disorders (2), with half of these conditions beginning by the age of 14 (3). These statistics underscore the urgent need for early intervention and the development of appropriate support and treatment infrastructures.\u003c/p\u003e\u003cp\u003eMental health plays a vital role in shaping personality, academic achievement, stress management, the development of healthy social relationships, and positive life decision-making (4). In this context, regular and scientifically grounded assessments can help identify potential issues at early stages, enabling the provision of appropriate support(5). One practical approach is the use of mental health screening questionnaires, which will allow a comprehensive evaluation of individuals' psychological well-being (6).\u003c/p\u003e\u003cp\u003eDespite the importance of such assessments, standardized and validated screening tools for mental disorders among children and adolescents remain limited in Iran. Therefore, there is a critical need for a valid, accessible, and freely available screening instrument for adolescents aged 11 to 17 that is suitable for clinical use. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure is a comprehensive screening tool that evaluates 12 mental health domains using only 25 items; however, its psychometric properties in Persian have not yet been assessed.\u003c/p\u003e\u003cp\u003eThis study aimed to examine the validity and reliability of the Persian version of the DSM-5 Self-Rated Level 1 questionnaire among high school students in Ilam. The findings of this research may contribute to the improvement of mental health screening tools in Iran, facilitating early and effective interventions.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eStudy Design and Participants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThis cross-sectional study was carried out in 2024 with a sample of 350 high school students in Ilam, Iran. A multistage cluster random sampling method was used. First, the population was divided into clusters based on schools and classrooms. Several clusters were randomly selected, and within those clusters, students were randomly chosen to participate in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTranslation Procedure\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe translation process followed the standard forward–backward translation method. First, two bilingual experts independently translated the original English version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure into Persian. The research team then reviewed and synthesized these translations to produce a preliminary Persian version. For back-translation, two other bilingual individuals, blinded to the original questionnaire, translated the Persian version back into English. The back-translated version was compared with the original to identify discrepancies, and necessary revisions were made to finalize the Persian translation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Tool\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure, consisting of 25 items, was used to screen mental health symptoms among adolescents aged 11 to 17 years. The questionnaire assesses symptoms across 12 psychiatric domains, including somatic symptoms, sleep problems, concentration difficulties, depression, irritability, anger, elevated energy and risky behaviors, psychosis, anxiety, obsessive-compulsive symptoms, substance use, and suicidal ideation. Items are rated on a 5-point Likert scale ranging from \"None\" to \"Severe.\" Selected items related to substance use and suicidal thoughts are answered in a binary (Yes/No) format.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContent Validity\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe content validity of the instrument was assessed using the method proposed by Lawshe (7, 8), which involves calculating the Content Validity Index (CVI) to evaluate the relevance and clarity of each item. A panel of 10 experts and researchers with sufficient knowledge and expertise in the field, including three clinical and general psychologists, two methodologists, and five researchers specializing in psychology and questionnaire validation, was invited to evaluate the questionnaire. They were asked to rate each item and the overall instrument for appropriateness, clarity, and comprehensiveness. The experts assessed the relevance, simplicity, clarity, and appropriateness of each item using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). They were also encouraged to provide suggestions for improving specific items. For the CVI analysis, the responses were dichotomized as follows: scores of 1 or 2 were categorized as “disagree” (scored as 0), and scores of 3 or 4 as “agree” (scored as 1). The CVI for each item was calculated as the average of agreement scores across all raters.\u003c/p\u003e\u003cp\u003eItems with a Content Validity Ratio (CVR) below the minimum acceptable threshold, based on the number of participating experts, were excluded from the analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFace Validity\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eTo evaluate face validity, a panel of 10 experts reviewed the Persian version of the questionnaire. They assessed the clarity and understandability of each item using a 4-point scale, from 1 (strongly disagree) to 4 (strongly agree). Similar to the CVI procedure, the Face Validity Index (FVI) was calculated by recoding responses: ratings of 1 and 2 were labeled as “disagree” (scored as 0), and ratings of 3 and 4 as “agree” (scored as 1). The FVI for each item was determined by the proportion of experts who agreed on its clarity and understandability. A cutoff value of 0.80 was used to identify acceptable items (9).\u003c/p\u003e\u003cp\u003e\u003cb\u003eReliability Assessment\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInternal Consistency\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTo evaluate internal consistency, Cronbach’s alpha coefficients were calculated for each subscale. The questionnaire was administered to a sample of 50 high school students in Ilam. After data collection, Cronbach’s alpha values for each domain were computed using Stata software. A threshold of 0.70 or higher was considered acceptable for internal consistency(9).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTest–Retest Reliability\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTest–retest reliability was assessed by administering the final, translated version of the questionnaire to a second group of 50 students. The same participants completed the questionnaire again 15 days later. To determine the stability of the instrument over time, intraclass correlation coefficients (ICC) were calculated for each domain and each item(10). ICC values ≥ 0.70 indicated satisfactory reliability.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eConfirmatory Factor Analysis\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eConfirmatory Factor Analysis (CFA) was performed using AMOS version 18 to evaluate the hypothesized factor structure of the questionnaire, covering key mental health domains. Model fit indices and factor loadings were examined to confirm construct validity.\u003c/p\u003e\u003ch2\u003eData Analysis:\u003c/h2\u003e\u003cp\u003eData were analyzed using STATA version 12. Descriptive statistics (means, standard deviations, frequencies) and inferential statistics—including chi-square tests and inter-rater agreement indices—were used. Exploratory factor analysis was also performed to examine the underlying structure of the questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e Participants and their guardians were fully informed about the study’s objectives and provided oral informed consent. Confidentiality and voluntary participation were assured. The study protocol was approved by the Ethics Committee of Ilam University of Medical Sciences, with approval code IR.MEDILAM.REC.1402.260.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic Characteristics of Participants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eA total of 350 students participated in the study, including 254 females (72.6%) and 96 males (27.4%). The mean age was 14.23 years (SD\u0026thinsp;=\u0026thinsp;0.75). Most participants (91.4%) resided in urban areas, while 8.6% lived in rural areas. Regarding school type, 64.3% attended public schools, and 35.7% were enrolled in special or gifted schools. Detailed demographic data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of the Study Participants (N\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchool Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eContent and Face Validity Findings\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eExpert evaluations indicated a high level of agreement regarding the appropriateness and clarity of the questionnaire items. Specifically, the overall content appropriateness was 96.6%, clarity was 94.4%, and the comprehensiveness of the entire instrument reached 99.2%. For face validity, the clarity index was 94.4%, and the simplicity and fluency of the items were 96.6% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The expert panel assessed the relevance, clarity, and simplicity of each item using a structured content validity form. Agreement rates among experts ranged from 87.5\u0026ndash;100%, demonstrating strong consensus on item adequacy. Moreover, intraclass correlation coefficients (ICC) ranged from 0.86 to 0.98, reflecting excellent test\u0026ndash;retest reliability across domains and individual items (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Content and Face Validity Indices\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInterpretation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComprehensiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAppropriateness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClarity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSimplicity and Fluency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eNote.\u003c/b\u003e Percentages represent the level of expert agreement on each criterion.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eExpert Ratings of Item Quality and Inter-Rater Reliability of the Persian DSM-5 Level 1 Measure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem Description\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAppropriateness (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClarity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSimplicity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIntraclass Correlation Coefficient (ICC)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBeen bothered by stomachaches, headaches, or other aches and pains?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorried about your health or about getting sick?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBeen bothered by not being able to fall asleep or stay asleep, or by waking up too early?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you been bothered by not being able to pay attention in class, while reading, or while playing a game?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHad less fun doing things than you used to?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt sad or depressed for several hours?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt more irritated or easily annoyed than usual?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt angry or lost your temper?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStarted more projects than usual or done more risky things?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSlept less than usual but still had a lot of energy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt nervous, anxious, or scared?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot been able to stop worrying?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot been able to do things because they made you feel nervous?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeard voices when no one was there, speaking to you or about you?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHad visions when fully awake that no one else could see?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHad recurring evil thoughts that something terrible would happen?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt the need to check things like doors or the stove repeatedly?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorried a lot about germs or contamination?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFelt you had to say or do things in a specific way to prevent harm?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHad an alcoholic drink (beer, wine, liquor, etc.)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsed tobacco products (cigarettes, cigars, chewing tobacco, etc.)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsed illegal drugs (e.g., marijuana, LSD, heroin, inhalants)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsed prescription medication to get high or alter mood without a prescription?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn the last 2 weeks, have you thought about killing yourself?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn the last 2 weeks, have you attempted suicide?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you ever attempted to end your own life?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote: ICC\u0026thinsp;=\u0026thinsp;Intraclass Correlation Coefficient. Values above 0.80 indicate strong inter-rater reliability.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInternal Consistency\u003c/strong\u003e:\u003c/p\u003e\u003cp\u003eCronbach\u0026rsquo;s alpha coefficients ranged from 0.76 to 0.94 across the multi-item domains, indicating good to excellent internal reliability. The highest internal consistency was observed in the Depression domain (α\u0026thinsp;=\u0026thinsp;0.94), followed by Somatic Symptoms (α\u0026thinsp;=\u0026thinsp;0.89), Irritability (α\u0026thinsp;=\u0026thinsp;0.89), Repetitive Thoughts and Behaviors (α\u0026thinsp;=\u0026thinsp;0.87), Anger (α\u0026thinsp;=\u0026thinsp;0.87), Mania (α\u0026thinsp;=\u0026thinsp;0.81), Psychosis (α\u0026thinsp;=\u0026thinsp;0.81), Substance Use (α\u0026thinsp;=\u0026thinsp;0.82), Anxiety (α\u0026thinsp;=\u0026thinsp;0.76), and Suicidal Ideation (α\u0026thinsp;=\u0026thinsp;0.76). For single-item domains such as Sleep Problems and Inattention, Cronbach\u0026rsquo;s alpha was not applicable (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTest\u0026ndash;Retest Reliability\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eTemporal stability assessed via Intraclass Correlation Coefficients (ICCs) showed strong reliability across all domains, with ICC values ranging from 0.80 to 0.93. Notably, the Depression, Mania, and Psychosis domains exhibited the highest stability (ICC\u0026thinsp;=\u0026thinsp;0.93). Single-item domains also demonstrated excellent reliability, with ICCs of 0.85 for Sleep Problems and 0.91 for Inattention. The 95% confidence intervals for ICCs indicate precise estimates of stability (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInternal Consistency (Cronbach\u0026rsquo;s Alpha) and Test\u0026ndash;Retest Reliability (ICC with 95% CI) for Each Domain of the Persian DSM-5 Level 1 Self-Rated Measure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCronbach\u0026rsquo;s Alpha\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eICC (95% Confidence Interval)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomatic Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.84 (0.72\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot applicable (single-item)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.85 (0.73\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInattention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot applicable (single-item)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.91 (0.84\u0026ndash;0.95)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.93 (0.87\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80 (0.62\u0026ndash;0.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrritability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.84 (0.72\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.93 (0.87\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.83 (0.70\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.93 (0.87\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRepetitive Thoughts \u0026amp; Behaviors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80 (0.62\u0026ndash;0.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstance Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.82 (0.59\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80 (0.74\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eNote: ICC\u0026thinsp;=\u0026thinsp;Intraclass Correlation Coefficient; CI\u0026thinsp;=\u0026thinsp;Confidence Interval. Cronbach\u0026rsquo;s alpha is not applicable for single-item domains.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo examine the factorial structure of mental health components, a confirmatory factor analysis (CFA) was conducted using Amos version 18. The factor loadings generally ranged from 0.63 to 0.80. Items such as Q5, Q11, and Q26 showed high factor loadings (0.79, 0.79, and 0.80, respectively) and low measurement errors (0.38, 0.38, and 0.36, respectively), indicating excellent measurement precision (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to evaluate the psychometric properties of the Persian translation of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure among adolescents aged 11 to 17 years in Ilam, Iran. The findings indicate that the Persian version exhibits acceptable and robust validity and reliability. Specifically, indices assessing item clarity, simplicity, and relevance exceeded 90%, demonstrating strong cultural alignment with the Iranian adolescent population. The instrument also showed satisfactory content coverage, with comprehensiveness ratings consistently above 80% across various studies (11).\u003c/p\u003e\u003cp\u003eThese results support the suitability of the questionnaire for mental health screening in Iranian adolescents. Consistent findings from previous research further reinforce this conclusion. For example, Nilay Gul et al. (2021) validated the Turkish version of the same instrument, reporting item agreement rates above 90%, closely paralleling the current study\u0026rsquo;s outcomes (12). Similarly, Iranian studies by Mazaheri, Soltani-Nejad, and Karimi have documented high internal consistency for the instrument, with Cronbach\u0026rsquo;s alpha values ranging from 0.75 to 0.95. This consistency across clinical and non-clinical populations enhances the tool\u0026rsquo;s generalizability and confirms its applicability in diverse psychological screening contexts(13\u0026ndash;15).\u003c/p\u003e\u003cp\u003eOverall, the Persian version of the DSM-5 Self-Rated Level 1 questionnaire emerges as a valid and reliable instrument for identifying mental health concerns among adolescents, with strong cultural relevance and sound psychometric performance.\u003c/p\u003e\u003cp\u003eRegarding reliability, Cronbach's alpha coefficients across domains ranged from 0.76 to 0.94, indicating good to excellent internal consistency. Furthermore, intraclass correlation coefficients (ICCs) for all components exceeded 0.80, reflecting a high degree of stability and coherence in assessing various psychological constructs. These findings are aligned with psychometric standards and are consistent with the results of international studies such as those conducted by Narrow et al. (2013) and da Rocha et al. (2020)(6, 16)\u003c/p\u003e\u003cp\u003eMoreover, the intraclass correlation coefficient (ICC) for all components exceeded 0.80, indicating a high degree of agreement among participants. The highest ICC value was observed in the domains of depression, mania, and psychosis (0.93), suggesting that these components demonstrated strong consistency and stability in assessment. According to the criteria proposed by Koo et al., ICC values above 0.75 are indicative of strong reliability(17).\u003c/p\u003e\u003cp\u003eIn another study conducted by Gharraee et al. in Tehran, the validity and reliability of the Persian version of the DSM-5 Self-Rated Personality Questionnaire (SCID-5-SPQ) were examined in a clinical population with psychiatric disorders. The findings indicated that the questionnaire demonstrated acceptable face and content validity, and the Cronbach\u0026rsquo;s alpha coefficient was reported as 0.93, reflecting high internal consistency. These results are consistent with the findings of the present study(18).\u003c/p\u003e\u003cp\u003eConfirmatory Factor Analysis (CFA) further supported the conceptual structure of the Persian version of the questionnaire, demonstrating a good fit with the collected data. The factor loadings of the items ranged from 0.63 to 0.80, with most exceeding 0.70, indicating strong loadings and adequate representation of the latent constructs. According to psychometric literature, factor loadings above 0.70 are considered strong indicators of construct validity(6). In this study, most items surpassed this threshold, with items such as Q5, Q11, and Q26 showing particularly high loadings (0.79 to 0.80), providing substantial support for their respective latent factors.\u003c/p\u003e\u003cp\u003eMoreover, item measurement error, calculated using the formula λ\u0026sup2; \u0026ndash; 1, revealed that the majority of items had error variances below 0.50, reflecting satisfactory measurement precision and adequate conceptual coverage of the latent dimensions. These CFA findings are consistent with previous research. For instance, da Rocha et al. (2020) reported a similar model fit and factor loadings above 0.70 in their validation of the Brazilian version of the DSM-5 instrument Likewise, Narrow et al. (2013), in the field testing phase of the original instrument, confirmed acceptable confirmatory factor structures across domains such as depression, anxiety, and obsessive thoughts(6).\u003c/p\u003e\u003cp\u003eNonetheless, some limitations must be acknowledged. The self-report nature of the instrument may introduce biases such as social desirability or individual differences in interpreting psychological constructs. Moreover, conducting the study solely in Ilam limits the generalizability of findings to other regions and more diverse populations. Future research should employ larger, more heterogeneous samples and incorporate cross-cultural comparative analyses to enhance robustness and generalizability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings demonstrate that the Persian version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure exhibits robust psychometric properties, including strong content validity, face validity, and reliability. High factor loadings, appropriate item clarity and simplicity, along with acceptable Cronbach\u0026rsquo;s alpha (α) and intraclass correlation coefficient (ICC) values, collectively confirm the tool\u0026rsquo;s scientific rigor and practical utility for assessing psychological symptoms in Persian-speaking populations. These results not only validate the instrument\u0026rsquo;s effectiveness in evaluating multidimensional mental health constructs but also support its applicability in epidemiological research, clinical screening, and mental healthcare settings across Iran. In summary, the cross-culturally adapted Persian version of this scale can be reliably implemented as a valid assessment tool for DSM-5 cross-cutting symptoms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the participants for the data material and the researchers who freely shared the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRM was responsible for conceptualization, methodology, formal analysis, and writing original draft. ACH, AA and AM participated in investigation. RM, AM and NY contributed to manuscript revisions. AM and KS supervised the research and provided critical review. All authors have read and approved the final version submitted and take public responsibility for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Research Center for Psychosocial Injuries (code IR.MEDILAM.REC.1402.260).\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the participants to take part in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants and their guardians were fully informed about the study\u0026rsquo;s objectives and provided oral informed consent. Confidentiality and voluntary participation were assured. The study protocol was approved by the Ethics Committee of Ilam University of Medical Sciences approval codeIR.MEDILAM.REC.1402.260.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003ePsychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Department of Child and Adolescent Psychiatry, Ilam University of Medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003ePsychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003e Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003eDepartment of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran,\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e6\u003c/sup\u003ePsychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e7*\u003c/sup\u003e Psychosocial Injuries Research Center, Ilam University of medical Sciences, Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e* E-mail: [email protected] \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eAminibagh A, Salimi J. Explaining the dimensions and components of ethical leadership in schools with a meta-synthesis approach. Quarterly Journal of New Advances in Educational Management. 2025;6(1):1\u0026ndash;23.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eMaerlender A, Bray PG. Adolescent Mental Health in the Twenty-First Century. Adolescent Public Mental Health: Why Systems Need Changing and How a Public Mental Health Approach Can Work: Springer; 2024. p. 11\u0026ndash;33.. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular psychiatry. 2022;27(1):281\u0026ndash;95.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSalimi J. Explaining the dimensions and components of ethical leadership in schools with a meta-synthesis approach.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEDITION F. Diagnostic and statistical manual of mental disorders. American psychiatric association, Washington, DC. 1980:205\u0026ndash;24.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNarrow WE, Clarke DE, Kuramoto SJ, Kraemer HC, Kupfer DJ, Greiner L, et al. DSM-5 field trials in the United States and Canada, Part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5. American Journal of Psychiatry. 2013;170(1):71\u0026ndash;82.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eLawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRomero Jeldres M, D\u0026iacute;az Costa E, Faouzi Nadim T, editors. A review of Lawshe\u0026rsquo;s method for calculating content validity in the social sciences. Frontiers in Education; 2023: Frontiers Media SA.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eYusoff MSB. ABC of response process validation and face validity index calculation. Educ Med J. 2019;11(10.21315).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWeir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. The Journal of Strength \u0026amp; Conditioning Research. 2005;19(1):231\u0026ndash;40.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTerwee CB, Bot SD, de Boer MR, Van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of clinical epidemiology. 2007;60(1):34\u0026ndash;42.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eBal NG, Tosun H, S\u0026aacute;nchez-Rodr\u0026iacute;guez R. Validation and reliability process of the preliminary form of the Maternal Burnout Scale in Turkish Mothers (T-MBS). Dusunen Adam. 2023;36(2):103\u0026ndash;12.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eKarimi M, Rahnejat A, Dabaghi P, Taghva A, Majdian M, Donyavi V, et al. The psychometric properties of the post-traumatic stress disorder symptom scale\u0026ndash;interview based on DSM-5, in military personnel participated in warfare. Iranian Journal of War and Public Health. 2020;12(2):115\u0026ndash;24.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSoltani E, Bazrafshan A, Sarani EM, Hedayati A, Sheikholeslami SS. Psychometric properties of the Persian Version of Youth anxiety measure for DSM-5 (YAM-5) in nonclinical sample. Archives of Psychiatry and Psychotherapy. 2020;4:58\u0026ndash;65.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eMazhari S, Karamooz A, Shahrbabaki ME, Jahanbakhsh F, Dollfus S. Validity and reliability of a Persian version of the self-evaluation of negative symptoms (SNS). BMC psychiatry. 2021;21:1\u0026ndash;5.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSHEREMET V. Maladaptive Daydreaming in the Context of Depression, Anxiety, and OCD: A Review of the Literature.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eKoo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155\u0026ndash;63.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eGharrae B, Masoumian S, Zamirinejad S, Yaghmaeezadeh H. Psychometric Properties of the Persian Version of the Self-report Personality Questionnaire for Personality Disorders of DSM-5 (SCID-5-SPQ) in Clinical Samples. Iranian Journal of Psychiatry and Clinical Psychology. 2022;27(4):508\u0026ndash;19.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental health screening, DSM-5, validity, reliability, adolescents","lastPublishedDoi":"10.21203/rs.3.rs-7062586/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7062586/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly assessment and intervention in adolescent mental health are essential for improving developmental outcomes. This study examined the psychometric properties of the Persian version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure among students aged 11–17 in Ilam, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was carried out in 2024 involving 350 students from schools in Ilam, Iran. The validation process included translation, content and face validity assessments, reliability testing (internal consistency and test-retest), and confirmatory factor analysis (CFA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average age of participants was 14.23 years (SD = 0.75), with 91.34% from urban areas and 8.57% from rural areas. The overall agreement rates for item relevance and clarity were 96.6% and 94.4%, respectively. Cronbach’s alpha coefficients and intraclass correlation coefficients (ICC) for all domains exceeded 0.80, indicating strong internal consistency and reliability. CFA supported the construct validity of the instrument with satisfactory factor loadings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Persian DSM-5 Level 1 Cross-Cutting Measure demonstrates strong psychometric properties for identifying mental health issues in Iranian adolescents, supporting its use in school screening programs.\u003c/p\u003e","manuscriptTitle":"Psychometric Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11–17 Years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 16:09:05","doi":"10.21203/rs.3.rs-7062586/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f77804df-445b-4dd4-9867-219b8e2674bb","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T06:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 16:09:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7062586","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7062586","identity":"rs-7062586","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}