Background Assessing child psychopathology is critical for early intervention and effective treatment; however, it is challenging and often requires information from multiple sources, including parents and the child. Moreover, prior research shows that there can be large discrepancies between child and parent reports, which pose important challenges for accurate assessment and intervention/treatment decisions. Several factors have been reported to influence these discrepancies, including cultural and social differences, emphasizing the need to better characterize assessment approaches and their disagreement. Data on child/adolescent mental health and their assessments are particularly lacking in Lebanon and the region. This study examines the level of agreement between parent and child mental health assessments in the first national Psychopathology in Children and Adolescents in Lebanon Study (PALS).

Methods PALS recruited 1,283 children and adolescents (mean age: 11.42±2.80; 50.12% female) through multi-stage stratified proportionate sampling (2018). The Strengths and Feelings Questionnaire (SDQ), Mood and Feelings Questionnaire (MFQ), and the Screen for Child Anxiety and Emotional Related Disorders (SCARED), were completed by both children/adolescents and their parents, with variations according to age groups. Cohen kappa was used to assess the level of agreement between parent and child reports. Logistic regression models examined whether agreement is related to socioeconomic and family composition and history factors.

Results The agreement in child- and parent-reports for depression, anxiety, and emotional/behavioral difficulties measures was kappa= 0.23[0.12–0.36], 0.24[0.17–0.31], and 0.14[0.02–0.26], respectively. Important disagreement was noted for anxiety and emotional/behavioral difficulties screening: child-based prevalence of anxiety disorders was 11.85% whereas parent-based prevalence was 6.24%; prevalence of parent-based emotional/behavioral difficulties was 8.05% and child-based prevalence was 3.58%. Higher family income, higher maternal and paternal educational attainment, and lower number of siblings were significantly associated with lower disagreement between child- and parent- assessments. Lower academic performance, presence of child physical illness, higher parental psychopathology scores, family history of psychiatric disorders, and whether the child ever sought mental health services were all related to higher disagreement.

Conclusion Results show low agreement in mental health assessments between Lebanese parents- and children, with disorder-specific particularities. Disagreement was exacerbated in the presence of lower family and parental socioeconomic indicators and familial presence of mental health disorders, and tracked with academic difficulties. Results highlight the importance of integrating multiple sources and joint assessments of multiple disorders and of improving approaches of child mental health assessments, particularly in the context of highly needed population-based research efforts.