Exploring and addressing the unmet healthcare needs of Indian adolescents

The article by Dogra et al made for an interesting read. ¹ However, the use of only the self-report Strengths and Difficulties Questionnaire (SDQ) and lack of validation of the SDQ in Indian adolescents - which the authors acknowledge - pose serious methodological concerns. The authors also mention the absence of SDQ reference standards for children of Indian ethnic backgrounds. In contrast, the study by Goodman et al makes an attempt to use the Development and Well-Being Assessment (DAWBA) scale (although strictly not a gold standard) subsequent to the SDQ in an attempt to validate the latter in a sample of British Indian children. ² The mean SDQ score for Indian children from this study could have been used as a reference point by Dogra et al.

In trying to explore the reason why adolescents of Indian ethnic backgrounds have better mental health than their White peers, the authors have not explored ‘cultural integration’, which has been hypothesised as a significant factor in previous studies. ³ This is measured by the number of friends of other ethnic backgrounds, including the majority community. It is understood that migrants to high-income countries tend to be intelligent, resilient and resourceful, and could also possibly have a better level of cultural integration. Although comparison had been drawn between Indian and White adolescents who identify themselves with a single culture and those who do not perceive the same, a parallel comparison between Indian adolescents (an intragroup comparison) who perceive and do not perceive themselves as belonging to a single culture may have shed more light.

Furthermore, comparative studies of adolescents from the same ethnic community in their home setting and as immigrants elsewhere will help us to understand the role of migration and mental health in immigrant adolescents. Understanding and exploring the reasons behind an apparent mental health advantage of one ethnic community over another holds a lot of promise in addressing the unmet mental health needs of adolescents throughout the world. Well-replicated studies addressing the methodological issues highlighted here would go a long away towards achieving the above objectives.