Optimal cutoff value of the Japanese shortened version of the Pediatric Symptom Checklist (PSC) Youth Self-Report

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Despite we have devised the 17-item version of the PSC-Youth Self-Report (PSC-17-Y) Japanese version, our subsequent goal is to ascertain its sufficiency through a comparative assessment of the scores between patients and schoolchildren for prevention and early intervention of psychosocial problems with schoolchildren. Methods The subjects were 52 patients with psychosocial problems (23 boys and 29 girls; mean age, 13.6 years) and 64 age-matched schoolchildren (24 boys and 40 girls; mean age, 13.4 years). We compared the total score and each factor score of the Japanese version of the PSC-17-Y. Results The Mann-Whitney U test was then applied to examine the differences between the groups, and the results showed that the patient group was significantly higher than the control group in the all factors and the total score. The cutoff value of the total score between 12 and 13 was considered clinically appropriate. Conclusions These findings supported that the Japanese version of the PSC-17-Y leads to prevention and early intervention of psychosocial problems with schoolchildren. PSC-17-Y Screening Schoolchildren Psychosocial problems Early intervention Prevention Early intervention Figures Figure 1 Background Despite the decrease in COVID-19 cases, the rate of youth suicides remains high in Japan. Japan, among the Group of Seven (G7) nations, stands out as the only developed country where suicide is the leading cause of death among the younger generation, particularly teenagers and those in their 20s [ 1 ]. Moreover, the number of Japanese children unable to attend school has exceeded 290,000 and continues to rise [ 2 ]. Immediate assessment and care are necessary to prevent the onset of mental illness and suicide in affected children; however, the current system for assessing and providing care is not enough. Although parents may be capable of accurately assessing their children's behavioral problems, evaluating their mental health, including depression and anxiety, proves to be challenging [ 3 ]. Thus, it is essential to develop a straightforward self-report scale for children to assess their mental health, not only for the post-COVID-19 era but also for potential future pandemics. The Pediatric Symptom Checklist (PSC) [ 4 , 5 ] is a 35-item screening questionnaire that is completed by parents and designed to help pediatricians in outpatient practice identify school-age children with difficulties in psychosocial functioning. The PSC covers a broad range of emotional and behavioral problems and is meant to provide an assessment of psychosocial functioning. The PSC and a 17-item version of the parent completed PSC form (PSC-17) [ 6 ] have been translated into more than twenty languages and has been widely used in both research and clinical settings. Since its development in 2000, the PSC-Youth Self-Report (PSC-Y) has been utilized in more than 20 studies, with most reporting positive screening rates ranging from 4.2% to 20.0% across diverse samples drawn from schools, outpatient pediatric practices, and other community-based settings [ 7 – 12 ]. In addition, the short form, 17-item version of the PSC-Youth Self-Report (PSC-17-Y) [ 13 ] is a validated measure that assesses psychosocial problems overall and in three major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5–10 min to be completed. The PSC-17-Y have also been translated into several languages [ 14 – 16 ]. Ishizaki et al. [ 17 ] translated the PSC, and Hiratani et al. [ 18 ] translated the PSC-17 into Japanese. Moreover, Higuchi et al. [ 19 ] translated the PSC-17-Y into Japanese and preliminarily demonstrated that the Japanese version of the PSC-17-Y was a reliable and valid screening tool that could be useful in detecting psychosocial problems in children and adolescents. The PSC and the PSC-17 are efficient and short-time screening tools, however, the Japanese version of the PSC-17-Y is not determined the optimal cutoff value for detecting children with psychosocial problems. By establishing optimal cutoff values of the Japanese version of the PSC-17-Y through this study and implementing the Japanese version of the PSC-17-Y response form in school-provided tablet devices, these lead to prevention and early intervention of psychosocial problems with schoolchildren. Thus, this study aims to determine the optimal cutoff value for detecting children with psychosocial problems for prevention and early intervention by comparing patients and normal controls. Methods Participants The study involved the participation of 116 children. 52 children with psycho-somatic-social problems such as orthostatic dysregulation, irritable bowel syndrome including missing to school (23 boys and 29 girls aged between 12 to 15 years) and 64 age-matched children with normal controls (24 boys and 40 girls aged between 12 to 15 years) [Table 1 ]. The children with psycho-somatic-social problems were recruited from the Kansai Medical University Medical Center, whereas the control group was recruited from the private junior high school. The children with psycho-somatic-social problems have diagnosed either of the follow symptoms or conditions; various somatic symptoms due to orthostatic intolerance, social maladaptation problems due to autism spectrum disorder and/or attention deficit hyper/activity disorder, non-attendance at school, eating disorder, insomnia, severe obesity, obsessive compulsive disorder. They were regarded as those with psycho-somatic-social problems by specialists in developmental pediatrics when they met in outpatient. The exclusion criteria for both the children with psycho-somatic-social problems and the normal controls included: i) the holders of mental disability or rehabilitation certificate, and ii) the absence of the ability to answer self-report questionnaires due to intellectual or cognitive problems. Table 1 Characteristics of the participants Patients controls N 52 64 sex, M/F 23/29 24/40 Age 13.6 ± 0.9 13.4 ± 1.0 The patients and controls were junior high school students. Measures The PSC-17-Y, as a validated measure, is designed to evaluate psychosocial problems across three major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder) in youths aged between 11 to 17 years¹³⁾. This assessment tool is efficient, requiring only 5–10 minutes to complete. Participants are required to rate the frequency of each symptom on a 3-point Likert scale, which includes the options of 0 = never, 1 = sometimes, and 2 = often. The weighted scores are then summed up to generate a total score that ranges from 0 to 34. In a study conducted by Murphy et al. [ 20 ] with a sample of 80,608 pediatric outpatients, reliability was high (internal consistency 0.89; test–retest 0.85), and a confirmatory factor analysis provided support for the original 3-factor model. Similarly, the Japanese version of the PSC-17-Y showed high reliability (internal consistency 0.85; test–retest 0.86), and a confirmatory factor analysis supported the original 3-factor model [ 19 ]. Results Comparison of the Japanese version of the PSC-17-Y scores between the patient group and the control group First, normality was assessed on each factor for each group on attention factor, internalizing factor, externalizing factor, and the total score of the Japanese version of the PSC-17-Y. The results showed that the scores of the control group were not normally distributed in any of the factors. The Mann-Whitney U test was then applied to examine the differences between the groups, and the results showed that the patient group was significantly higher than the control group in all factors and total scores [Table 2 ]. Table 2 Each of the factor scores and the total score of the Japanese version of the PSC-17-Y NC PT U(114)= ཐ effect size( r ) [95% IC] (n = 64) (n = 53) attention Mean 3 5.48 721.5 p < .001 -0.566 [-0.693, -0.405 ] SD 2.23 2.12 exter- nalizing Mean 2.75 3.77 1300.5 p < .05 -0.218 [-0.409, -0.01 ] SD 2.39 2.71 inter- nalizing Mean 3.14 5.29 950 p < .001 -0.429 [-0.586, -0.242 ] SD 2.87 2.64 Sum Mean 8.89 14.54 816 p < .001 -0.51 [-0.649, -0.336 ] SD 6.04 5.15 The patient group (PT) was significantly higher than the control group (NC) in all factors and total scores. The cutoff value A logistic regression analysis was conducted to examine the predictive utility of the Japanese version of the PSC-17-Y concerning clinical diagnosis. The results revealed that the Japanese version of the PSC-17-Y scores predict clinical diagnosis significantly (β = .172, SEB = .039, 95%IC = [.096,.249], odds ratio = 1.18). This finding is supported by the significant model fit, as indicated by the χ2 statistic (χ2 (144) = 25.35, p < .001) and McFadden's R2 value (.159). These results suggest that the Japanese version of the PSC-17-Y scores are a meaningful predictor of clinical diagnosis and demonstrate the importance of considering psychosomatic symptoms in diagnostic decision-making. To estimate the cutoff value for differentiating between the control group and the patient group using the total score of the Japanese version of the PSC-17-Y, we calculated the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve. The results indicate that the AUC was 0.755, indicating a moderate level of predictive ability for the Japanese version of the PSC-17-Y. The closest top-left index had the Japanese version of the PSC-17-Y total score range between 12 and 13. The results are presented in the Fig. 1 , based on the aforementioned cutoff values. In the patient group, there were 52 participants, out of which 31 tested positive and 21 tested negative. In contrast, in the control group, 17 participants tested positive and 47 tested negative. The accuracy of discrimination is reported as sensitivity (59.6%), specificity (73.4%), positive predictive value (64.6%), and negative predictive value (69.1%). It is important to note that the accuracy of the Japanese version of the PSC-17-Y may not always be high due to the nature of psychosomatic disorders. Some schoolchildren in the control group may have problems, while some patients in the patient group may show improved symptoms. Despite these limitations, the Japanese version of the PSC-17-Y remains an informative tool that can provide important diagnostic information. Discussion In the present study, we compared the Japanese version of the PSC-17-Y scores between the pediatric patients and the normal controls to determine the optimal cutoff value for detecting children with psychosocial problems for prevention and early identification. The score of each factor and the total score of the Japanese version of the PSC-17-Y with the patient group were significantly higher than those of the normal controls. In addition, the 12/13 cutoff value of the total score showed high sensitivity and specificity for detecting children with psychosocial problems. The difference of the cutoff value between the Japanese version and original version In the present study, we showed the optimal cutoff value (12/13) in the Japanese version of the PSC-17-Y for detecting children with psychosocial problems to prevention and early identification. On the other hand, the cutoff value is 15/16 in the original PSC-17-Y. That is, the Japanese version of the PSC-17-Y employs a relatively lower cutoff value. What could be the potential factors contributing to this difference in cutoff value between the original and Japanese version? Even in a 35-item original version of the PSC, the cutoff value for the Japanese children was significantly lower than that of the original version. Ishizaki et al. [ 21 ] states the reasons for this result are as follows: i) The quality of psychosocial problems is different in Japan and the United States, with the severity being lower in Japan, and ii) Japanese people originally tend to choose the middle answer for questions with three levels (central tendency), and they point out that there are few answers for “often”. The same pattern was observed among the participants in the present study. This can also be considered a limitation, but the following points can also be raised. The scores in normal control group were lower due to the deference implementation. The normal control group answered the Japanese version of the PSC-17-Y in the presence of their peers at school, whereas the patient group completed it alone within the hospital setting. It is plausible that some schoolchildren in the normal control group may have scored below their actual potential due to the situation of answering the Japanese version of the PSC-17-Y in a group setting. Consequently, this situation could have potentially contributed to decreased the Japanese version of the PSC-17-Y total score and subsequently lowered cutoff value than that of the original PSC-17-Y. Other limitations include the small sample size and single center sampling. In the future, it will be necessary to collect and analyze larger samples. Future research While the current study focuses on schoolchildren of junior high school aged 12 to 15 years, further research is needed to examine the validity of the Japanese version of the PSC-17-Y and establish cutoff value for schoolchildren of upper elementary school. Early detection of psychosocial problems and timely intervention can be facilitated by such an approach. In addition, if differences in high factor scores are observed between schoolchildren of elementary and junior high school, tailored interventions may be necessary. Then, children with either low intellectual quotient or those with high-functioning autism spectrum disorder demonstrated significant difficulty in providing accurate responses to the Japanese version of the PSC-17-Y assessment. Children with intellectual and developmental disabilities are more susceptible to experiencing challenges and obstacles. Thus, future research should investigate the possibility of accurate implementation of the assessment the handicapped children by having testers read questions on behalf of the participants or by providing additional clarification regarding the intent of the questions. Finally, an implementation of online screening using the Japanese version of the PSC-17-Y is a frame work of our future research. Michael Murphy et al. [ 22 , 23 ] and Arauz-Boudreau et al. [ 24 ] reported the usefulness of an internet-based approach using PSC-Y and PSC-17 Form. We implemented the Japanese version of the PSC-17-Y response form on school-provided tablet devices in several junior high schools within a single prefecture as part of a pilot initiative. We are also currently investigating the usefulness of online based screening combined AI chat and the Japanese version of the PSC-17-Y [ 25 ]. Several children who exhibited high total score of the Japanese version of the PSC-17-Y response form were subsequently referred for school counseling services. As this initiative is scaled up, it may hold increasing potential to reduce the incidence of non-attendance at school and suicide. This is an attempt to evaluate and improve mental health of children who are self-isolating at home due to the non-attendance at school, and it is expected to be used as a psychosocial screening tool for children who are not attending school to early identification and intervention. Conclusions The score of each factor and the total score of the Japanese version of the PSC-17-Y with the patient group were significantly higher than those of the normal controls. In addition, the 12/13 cutoff value of the total score showed high sensitivity and specificity. We implemented the Japanese version of the PSC-17-Y response form on school-provided tablet devices. As a result, several children who exhibited high total score of the Japanese version of the PSC-17-Y response form were subsequently referred for school counseling services. These findings supported that the Japanese version of the PSC-17-Y leads to the prevention and early intervention of psychosocial problems with schoolchildren. Abbreviations PSC The Pediatric Symptom Checklist PSC-17-Y 17-item version of the PSC-Youth Self-Report AUC Area Under the Curve ROC Receiver Operating Characteristic Declarations Ethical approvals: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Kansai Medical University (No. 2020015). Consent to participants and consent for publication: Prior to administering the PSC-17-Y to the control group, we provided a written explanation of the experimental procedures to their parents. We confirmed their willingness to participate in the study and obtained written informed consent from the participants. Availability of data and materials: All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing interests: The authors declare that they have no competing interests. Funding: This work was supported by the Health and Labour Sciences Research Grants in Japan (No. H30-Sukoyaka-Ippan-004). In addition, this study was partly funded by the Nakatani Foundation, Japan. Authors’ contributions: All authors contributed to the study conception and design. Data collection was performed by Takahiro Higuchi, Yuko Ishizaki, Hiroyuki Uenishi, and Yoshitoki Yanagimoto. Formal analysis was performed by Takahiro Higuchi and Hiroyuki Uenishi. Funding acquisition was performed by Yuko Ishizaki. Investigation was performed by Takahiro Higuchi, Yuko Ishizaki, Hiroyuki Uenishi, Yoshitoki Yanagimoto and Mayuko Ono. Project administration was Yuko Ishizaki. Supervision was performed by Haruhiko Ishiza and Kazunari Kaneko. The first draft of the manuscript was written by Takahiro Higuchi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8488914","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583767887,"identity":"6f81f4fe-4804-45cb-a300-e208685d1783","order_by":0,"name":"Takahiro Higuchi","email":"","orcid":"","institution":"Kansai Medical University","correspondingAuthor":false,"prefix":"","firstName":"Takahiro","middleName":"","lastName":"Higuchi","suffix":""},{"id":583767895,"identity":"d43fbe6c-10c1-4546-b1cc-2859d3c62e45","order_by":1,"name":"Yuko Ishizaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBACNgYehgMMDAkM/AwMzAwJBgwGcAmCWiTbiNXCANTCANJicAyoBQgM8CiFAD7+swcP/qhJS9x8v/mxwYMCBmPdGQmMH34w8OXhdJhEXsIBiWM5iduOsRknAB1mZnYjgVmyh4GtGLcWHoMDBmwVQC0MxgeAWmyAWhikgRKJDbi08J8xOJDwryJxcxv7Z5gW5t94tTDkGBw42JaTuIGNB+4wNvy2SOQYHGzsSzOecSyn2CDBQMLY7MzDNsseA9x+ke8/Y/zxx7dk2f7m45slf/yxMdx2PPnwjR8Vx3CGGAw4Qp0hAcSMQLbBsQRCWuzRBWoIahkFo2AUjIIRAwDXBVUKnnMirQAAAABJRU5ErkJggg==","orcid":"","institution":"Kansai Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yuko","middleName":"","lastName":"Ishizaki","suffix":""},{"id":583767901,"identity":"f27dd738-ebfd-42d2-8535-64054e96b13b","order_by":2,"name":"Hiroyuki Uenishi","email":"","orcid":"","institution":"Osaka Ohtani University","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Uenishi","suffix":""},{"id":583767902,"identity":"770d9d41-a08e-4610-8727-cbfca6ae9c2b","order_by":3,"name":"Yoshitoki Yanagimoto","email":"","orcid":"","institution":"Kansai Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yoshitoki","middleName":"","lastName":"Yanagimoto","suffix":""},{"id":583767907,"identity":"a18c5188-b311-4d1d-b87f-09dbc736deb4","order_by":4,"name":"Mayuko Ono","email":"","orcid":"","institution":"Kansai University","correspondingAuthor":false,"prefix":"","firstName":"Mayuko","middleName":"","lastName":"Ono","suffix":""},{"id":583767909,"identity":"1cda384e-f4fe-41c1-9112-c671d8de4716","order_by":5,"name":"Haruhiko Ishida","email":"","orcid":"","institution":"Kansai University","correspondingAuthor":false,"prefix":"","firstName":"Haruhiko","middleName":"","lastName":"Ishida","suffix":""},{"id":583767910,"identity":"a3b8b499-34f3-4a4c-80f6-0e06a3bd2029","order_by":6,"name":"Kazunari Kaneko","email":"","orcid":"","institution":"Kansai Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kazunari","middleName":"","lastName":"Kaneko","suffix":""}],"badges":[],"createdAt":"2025-12-31 10:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8488914/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8488914/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-026-04652-w","type":"published","date":"2026-04-28T15:57:31+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101657554,"identity":"37ffc8f4-ac19-4cf8-b48e-f5303a0366df","added_by":"auto","created_at":"2026-02-02 10:19:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49778,"visible":true,"origin":"","legend":"\u003cp\u003eThe Receiver Operating Characteristic (ROC) curve by the results of the PSC-17-Y total score. The accuracy of discrimination is reported as sensitivity (59.6%), specificity (73.4%), positive predictive value (64.6%), and negative predictive value (69.1%).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8488914/v1/77d9f21096a578a6ec196c5e.jpg"},{"id":108437854,"identity":"d6d2942b-3f8d-428b-954a-c3de881a9a13","added_by":"auto","created_at":"2026-05-04 16:03:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":277132,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8488914/v1/b4e8fd48-da27-4415-a0b9-1fb164cd5100.pdf"},{"id":101657555,"identity":"515e2761-efde-4ae4-8a94-fda470dd041d","added_by":"auto","created_at":"2026-02-02 10:19:25","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":51296,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalmaterial.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8488914/v1/e383afcb6eecdb5dcbe15c3b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimal cutoff value of the Japanese shortened version of the Pediatric Symptom Checklist (PSC) Youth Self-Report","fulltext":[{"header":"Background","content":"\u003cp\u003eDespite the decrease in COVID-19 cases, the rate of youth suicides remains high in Japan. Japan, among the Group of Seven (G7) nations, stands out as the only developed country where suicide is the leading cause of death among the younger generation, particularly teenagers and those in their 20s [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Moreover, the number of Japanese children unable to attend school has exceeded 290,000 and continues to rise [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Immediate assessment and care are necessary to prevent the onset of mental illness and suicide in affected children; however, the current system for assessing and providing care is not enough. Although parents may be capable of accurately assessing their children's behavioral problems, evaluating their mental health, including depression and anxiety, proves to be challenging [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thus, it is essential to develop a straightforward self-report scale for children to assess their mental health, not only for the post-COVID-19 era but also for potential future pandemics.\u003c/p\u003e \u003cp\u003eThe Pediatric Symptom Checklist (PSC) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] is a 35-item screening questionnaire that is completed by parents and designed to help pediatricians in outpatient practice identify school-age children with difficulties in psychosocial functioning. The PSC covers a broad range of emotional and behavioral problems and is meant to provide an assessment of psychosocial functioning. The PSC and a 17-item version of the parent completed PSC form (PSC-17) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] have been translated into more than twenty languages and has been widely used in both research and clinical settings. Since its development in 2000, the PSC-Youth Self-Report (PSC-Y) has been utilized in more than 20 studies, with most reporting positive screening rates ranging from 4.2% to 20.0% across diverse samples drawn from schools, outpatient pediatric practices, and other community-based settings [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, the short form, 17-item version of the PSC-Youth Self-Report (PSC-17-Y) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] is a validated measure that assesses psychosocial problems overall and in three major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5\u0026ndash;10 min to be completed. The PSC-17-Y have also been translated into several languages [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Ishizaki et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] translated the PSC, and Hiratani et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] translated the PSC-17 into Japanese. Moreover, Higuchi et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] translated the PSC-17-Y into Japanese and preliminarily demonstrated that the Japanese version of the PSC-17-Y was a reliable and valid screening tool that could be useful in detecting psychosocial problems in children and adolescents. The PSC and the PSC-17 are efficient and short-time screening tools, however, the Japanese version of the PSC-17-Y is not determined the optimal cutoff value for detecting children with psychosocial problems. By establishing optimal cutoff values of the Japanese version of the PSC-17-Y through this study and implementing the Japanese version of the PSC-17-Y response form in school-provided tablet devices, these lead to prevention and early intervention of psychosocial problems with schoolchildren. Thus, this study aims to determine the optimal cutoff value for detecting children with psychosocial problems for prevention and early intervention by comparing patients and normal controls.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study involved the participation of 116 children. 52 children with psycho-somatic-social problems such as orthostatic dysregulation, irritable bowel syndrome including missing to school (23 boys and 29 girls aged between 12 to 15 years) and 64 age-matched children with normal controls (24 boys and 40 girls aged between 12 to 15 years) [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]. The children with psycho-somatic-social problems were recruited from the Kansai Medical University Medical Center, whereas the control group was recruited from the private junior high school. The children with psycho-somatic-social problems have diagnosed either of the follow symptoms or conditions; various somatic symptoms due to orthostatic intolerance, social maladaptation problems due to autism spectrum disorder and/or attention deficit hyper/activity disorder, non-attendance at school, eating disorder, insomnia, severe obesity, obsessive compulsive disorder. They were regarded as those with psycho-somatic-social problems by specialists in developmental pediatrics when they met in outpatient. The exclusion criteria for both the children with psycho-somatic-social problems and the normal controls included: i) the holders of mental disability or rehabilitation certificate, and ii) the absence of the ability to answer self-report questionnaires due to intellectual or cognitive problems.\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\u003eCharacteristics of the participants\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=\"left\" 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\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esex, M/F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24/40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eThe patients and controls were junior high school students.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe PSC-17-Y, as a validated measure, is designed to evaluate psychosocial problems across three major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder) in youths aged between 11 to 17 years\u0026sup1;\u0026sup3;⁾. This assessment tool is efficient, requiring only 5\u0026ndash;10 minutes to complete. Participants are required to rate the frequency of each symptom on a 3-point Likert scale, which includes the options of 0\u0026thinsp;=\u0026thinsp;never, 1\u0026thinsp;=\u0026thinsp;sometimes, and 2\u0026thinsp;=\u0026thinsp;often. The weighted scores are then summed up to generate a total score that ranges from 0 to 34. In a study conducted by Murphy et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] with a sample of 80,608 pediatric outpatients, reliability was high (internal consistency 0.89; test\u0026ndash;retest 0.85), and a confirmatory factor analysis provided support for the original 3-factor model. Similarly, the Japanese version of the PSC-17-Y showed high reliability (internal consistency 0.85; test\u0026ndash;retest 0.86), and a confirmatory factor analysis supported the original 3-factor model [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cem\u003eComparison of the Japanese version of the PSC-17-Y scores between the patient group and the control group\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFirst, normality was assessed on each factor for each group on attention factor, internalizing factor, externalizing factor, and the total score of the Japanese version of the PSC-17-Y. The results showed that the scores of the control group were not normally distributed in any of the factors. The Mann-Whitney U test was then applied to examine the differences between the groups, and the results showed that the patient group was significantly higher than the control group in all factors and total scores [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\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\u003eEach of the factor scores and the total score of the Japanese version of the PSC-17-Y\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU(114)=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eཐ\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eeffect\u003c/p\u003e \u003cp\u003esize(\u003cem\u003er\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c10\" namest=\"c8\" rowspan=\"2\"\u003e \u003cp\u003e[95% IC]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e 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\u003cp\u003e[-0.693,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eexter-\u003c/p\u003e \u003cp\u003enalizing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1300.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e[-0.409,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003einter-\u003c/p\u003e \u003cp\u003enalizing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e[-0.586,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e[-0.649,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eThe patient group (PT) was significantly higher than the control group (NC) in all factors and total scores.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eThe cutoff value\u003c/h3\u003e\n\u003cp\u003eA logistic regression analysis was conducted to examine the predictive utility of the Japanese version of the PSC-17-Y concerning clinical diagnosis. The results revealed that the Japanese version of the PSC-17-Y scores predict clinical diagnosis significantly (β\u0026thinsp;=\u0026thinsp;.172, SEB\u0026thinsp;=\u0026thinsp;.039, 95%IC = [.096,.249], odds ratio\u0026thinsp;=\u0026thinsp;1.18). This finding is supported by the significant model fit, as indicated by the χ2 statistic (χ2 (144)\u0026thinsp;=\u0026thinsp;25.35, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and McFadden's R2 value (.159). These results suggest that the Japanese version of the PSC-17-Y scores are a meaningful predictor of clinical diagnosis and demonstrate the importance of considering psychosomatic symptoms in diagnostic decision-making.\u003c/p\u003e \u003cp\u003eTo estimate the cutoff value for differentiating between the control group and the patient group using the total score of the Japanese version of the PSC-17-Y, we calculated the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve. The results indicate that the AUC was 0.755, indicating a moderate level of predictive ability for the Japanese version of the PSC-17-Y. The closest top-left index had the Japanese version of the PSC-17-Y total score range between 12 and 13. The results are presented in the Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, based on the aforementioned cutoff values. In the patient group, there were 52 participants, out of which 31 tested positive and 21 tested negative. In contrast, in the control group, 17 participants tested positive and 47 tested negative. The accuracy of discrimination is reported as sensitivity (59.6%), specificity (73.4%), positive predictive value (64.6%), and negative predictive value (69.1%). It is important to note that the accuracy of the Japanese version of the PSC-17-Y may not always be high due to the nature of psychosomatic disorders. Some schoolchildren in the control group may have problems, while some patients in the patient group may show improved symptoms. Despite these limitations, the Japanese version of the PSC-17-Y remains an informative tool that can provide important diagnostic information.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we compared the Japanese version of the PSC-17-Y scores between the pediatric patients and the normal controls to determine the optimal cutoff value for detecting children with psychosocial problems for prevention and early identification.\u003c/p\u003e \u003cp\u003eThe score of each factor and the total score of the Japanese version of the PSC-17-Y with the patient group were significantly higher than those of the normal controls. In addition, the 12/13 cutoff value of the total score showed high sensitivity and specificity for detecting children with psychosocial problems.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe difference of the cutoff value between the Japanese version and original version\u003c/h2\u003e \u003cp\u003eIn the present study, we showed the optimal cutoff value (12/13) in the Japanese version of the PSC-17-Y for detecting children with psychosocial problems to prevention and early identification. On the other hand, the cutoff value is 15/16 in the original PSC-17-Y. That is, the Japanese version of the PSC-17-Y employs a relatively lower cutoff value. What could be the potential factors contributing to this difference in cutoff value between the original and Japanese version?\u003c/p\u003e \u003cp\u003eEven in a 35-item original version of the PSC, the cutoff value for the Japanese children was significantly lower than that of the original version. Ishizaki et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] states the reasons for this result are as follows: i) The quality of psychosocial problems is different in Japan and the United States, with the severity being lower in Japan, and ii) Japanese people originally tend to choose the middle answer for questions with three levels (central tendency), and they point out that there are few answers for \u0026ldquo;often\u0026rdquo;. The same pattern was observed among the participants in the present study.\u003c/p\u003e \u003cp\u003eThis can also be considered a limitation, but the following points can also be raised. The scores in normal control group were lower due to the deference implementation. The normal control group answered the Japanese version of the PSC-17-Y in the presence of their peers at school, whereas the patient group completed it alone within the hospital setting. It is plausible that some schoolchildren in the normal control group may have scored below their actual potential due to the situation of answering the Japanese version of the PSC-17-Y in a group setting. Consequently, this situation could have potentially contributed to decreased the Japanese version of the PSC-17-Y total score and subsequently lowered cutoff value than that of the original PSC-17-Y.\u003c/p\u003e \u003cp\u003eOther limitations include the small sample size and single center sampling. In the future, it will be necessary to collect and analyze larger samples.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFuture research\u003c/h3\u003e\n\u003cp\u003eWhile the current study focuses on schoolchildren of junior high school aged 12 to 15 years, further research is needed to examine the validity of the Japanese version of the PSC-17-Y and establish cutoff value for schoolchildren of upper elementary school. Early detection of psychosocial problems and timely intervention can be facilitated by such an approach. In addition, if differences in high factor scores are observed between schoolchildren of elementary and junior high school, tailored interventions may be necessary.\u003c/p\u003e \u003cp\u003eThen, children with either low intellectual quotient or those with high-functioning autism spectrum disorder demonstrated significant difficulty in providing accurate responses to the Japanese version of the PSC-17-Y assessment. Children with intellectual and developmental disabilities are more susceptible to experiencing challenges and obstacles. Thus, future research should investigate the possibility of accurate implementation of the assessment the handicapped children by having testers read questions on behalf of the participants or by providing additional clarification regarding the intent of the questions.\u003c/p\u003e \u003cp\u003eFinally, an implementation of online screening using the Japanese version of the PSC-17-Y is a frame work of our future research. Michael Murphy et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Arauz-Boudreau et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] reported the usefulness of an internet-based approach using PSC-Y and PSC-17 Form. We implemented the Japanese version of the PSC-17-Y response form on school-provided tablet devices in several junior high schools within a single prefecture as part of a pilot initiative. We are also currently investigating the usefulness of online based screening combined AI chat and the Japanese version of the PSC-17-Y [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Several children who exhibited high total score of the Japanese version of the PSC-17-Y response form were subsequently referred for school counseling services. As this initiative is scaled up, it may hold increasing potential to reduce the incidence of non-attendance at school and suicide. This is an attempt to evaluate and improve mental health of children who are self-isolating at home due to the non-attendance at school, and it is expected to be used as a psychosocial screening tool for children who are not attending school to early identification and intervention.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe score of each factor and the total score of the Japanese version of the PSC-17-Y with the patient group were significantly higher than those of the normal controls. In addition, the 12/13 cutoff value of the total score showed high sensitivity and specificity. We implemented the Japanese version of the PSC-17-Y response form on school-provided tablet devices. As a result, several children who exhibited high total score of the Japanese version of the PSC-17-Y response form were subsequently referred for school counseling services. These findings supported that the Japanese version of the PSC-17-Y leads to the prevention and early intervention of psychosocial problems with schoolchildren.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Pediatric Symptom Checklist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSC-17-Y\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e17-item version of the PSC-Youth Self-Report\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea Under the Curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver Operating Characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approvals:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Kansai Medical University (No. 2020015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participants and consent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to administering the PSC-17-Y to the control group, we provided a written explanation of the experimental procedures to their parents. We confirmed their willingness to participate in the study and obtained written informed consent from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Health and Labour Sciences Research Grants in Japan (No. H30-Sukoyaka-Ippan-004). In addition, this study was partly funded by the Nakatani Foundation, Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data collection was performed by Takahiro Higuchi, Yuko Ishizaki, Hiroyuki Uenishi, and Yoshitoki Yanagimoto. Formal analysis was performed by Takahiro Higuchi and Hiroyuki Uenishi. Funding acquisition was performed by Yuko Ishizaki. Investigation was performed by Takahiro Higuchi, Yuko Ishizaki, Hiroyuki Uenishi, Yoshitoki Yanagimoto and Mayuko Ono. Project administration was Yuko Ishizaki. Supervision was performed by Haruhiko Ishiza and Kazunari Kaneko. The first draft of the manuscript was written by Takahiro Higuchi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Dr. Yasuko Nagao, Dr. Yuri Fuji, Dr. Sachiyo Tanaka Dr. Ryuhei Yoshida and Ms. Azusa Hiratsuka for their assessment of the subjects’ development.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health, Labour and Welfare, Japan. The current state of suicide abroad. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mhlw.go.jp/content/2024-1-1-06.pdf\u003c/span\u003e\u003cspan address=\"https://www.mhlw.go.jp/content/2024-1-1-06.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2024. Accessed 31 Dec 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Education, Culture, Sports, Science and Technology, Japan. 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Proceedings of the 42th congress of Association of Japanese Clinical Psychology. 2023; OA5-2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"PSC-17-Y, Screening, Schoolchildren, Psychosocial problems, Early intervention, Prevention, Early intervention","lastPublishedDoi":"10.21203/rs.3.rs-8488914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8488914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Pediatric Symptom Checklist (PSC) is a brief questionnaire aimed at detecting psychosocial problems of children and adolescents for intervention in early stage. Despite we have devised the 17-item version of the PSC-Youth Self-Report (PSC-17-Y) Japanese version, our subsequent goal is to ascertain its sufficiency through a comparative assessment of the scores between patients and schoolchildren for prevention and early intervention of psychosocial problems with schoolchildren.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe subjects were 52 patients with psychosocial problems (23 boys and 29 girls; mean age, 13.6 years) and 64 age-matched schoolchildren (24 boys and 40 girls; mean age, 13.4 years). We compared the total score and each factor score of the Japanese version of the PSC-17-Y.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Mann-Whitney U test was then applied to examine the differences between the groups, and the results showed that the patient group was significantly higher than the control group in the all factors and the total score. The cutoff value of the total score between 12 and 13 was considered clinically appropriate.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings supported that the Japanese version of the PSC-17-Y leads to prevention and early intervention of psychosocial problems with schoolchildren.\u003c/p\u003e","manuscriptTitle":"Optimal cutoff value of the Japanese shortened version of the Pediatric Symptom Checklist (PSC) Youth Self-Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 10:19:20","doi":"10.21203/rs.3.rs-8488914/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-10T06:45:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T23:30:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107504968711404264442998185515132873942","date":"2026-02-25T23:09:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T13:30:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T11:40:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125671869725947715842801826624093602844","date":"2026-01-31T13:17:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34239070079132579016618166158523624655","date":"2026-01-31T08:49:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T11:10:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-08T11:40:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-02T22:07:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T22:07:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-12-31T10:30:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f169f48-d6ad-4014-9ed3-0d1c0b4bfa90","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:02:58+00:00","versionOfRecord":{"articleIdentity":"rs-8488914","link":"https://doi.org/10.1186/s40359-026-04652-w","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-04-28 15:57:31","publishedOnDateReadable":"April 28th, 2026"},"versionCreatedAt":"2026-02-02 10:19:20","video":"","vorDoi":"10.1186/s40359-026-04652-w","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04652-w","workflowStages":[]},"version":"v1","identity":"rs-8488914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8488914","identity":"rs-8488914","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}