LAUSR

Abstract Background The research tools for the assessment of adolescent mental health are mostly developed for high-income settings, and are used elsewhere without linguistic or cultural modification. Youth involvement in the development of research aimed at young people is recommended by WHO, but few studies have involved young people in the design of mental health tools. In this study we aimed to develop a self-completion questionnaire to assess adolescent mental health based on perceptions of Chinese adolescents. Methods We did a literature search to initially identify 11 scales suitable for assessing adolescent mental health and influencing factors and help-seeking behaviour. Students from rural and urban areas, and from public and private schools in Zhejiang, Anhui, Henan, and Jiangsu provinces, China, were invited to work with researchers to develop a questionnaire. Inclusion criteria were students aged 13–20 years who were willing to be involved in the study. Students initially independently completed the draft questionnaire, and provided detailed feedback in one-to-one interviews with researchers and in focus group sessions. Researchers recorded student inputs. Analysis involved inductive summarisation and factor extraction. Ethical approval was obtained from the Medical Ethics Committee of Zhejiang University. We obtained verbal consent from the volunteers and from the parents of those younger than 18 years. Findings From Feb 9, 2019, to May 16, 2019, 46 student volunteers (30 male and 16 female; mean age 16 years, SD 13–20) were recruited into our study. We finalised a self-completion questionnaire with 99 items including three psychological scales. With youth involvement, we found that standard Chinese translations of widely-used scales were not understandable. Students felt that some items would not be answered honestly, and so they were changed or removed. The students were very eager to include sensitive topics, such as suicide and self-harm, and some suggested more attention should be paid to this. At their request, questions about academic pressure were expanded, with questions on social media added, including specific questions on posting modified pictures and sharing of personal problems online. Interpretation Adolescent participation in questionnaire design improves the structure and content of tools assessing mental health, making such research tools more acceptable and understandable. Funding Global Health Centre of Zhejiang University.