Reliability And Validity Of Chinese Version Of Caregiver Strain Questionnaire And Its Norm For Parents Of Kunming Primary School Students

Objectives:To assess the reliability and validity of Chinese version of Caregiver Strain Questionnaire(CGSQ),and to establish the norm of Chinese version CGSQ for the caregivers of primary school children in Kunming.Hopefully,our study could provide a supplemental material for the domestic parenting stress questionnaire,and helps relevant workers to assess the parenting stress level of caregivers.Methods:Participants were divided into the disease group and the normal group.The disease group was recruited from the psychiatric outpatient clinic of the First Affiliated Hospital of Kunming Medical University,including 107 parents whose children were diagnosed with attention-deficit/hyperactivity disorder(ADHD)and 159 parents whose children were diagnosed with autism spectrum disorder(ASD)according to the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5).631 parents of normal children(normal group)were recruited from a middle-level primary school in Kunming.We used internal consistency to verify the reliability of the scale,and exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)to verify the construct validity of the scale.Based the CGSQ raw score and the corresponding percentile rank(P)at intervals of 5 of,we established a percentile rank norm table for the normal group.Besides,according to the standard model(P?5%,5%<P?17%,17%<P?83%,83%<P?95%,P>95%),we defined the caregiver's parenting stress level as extremely low,low.medium,high,and extremely high.Results:1.Reliability analysis showed that the Cronbach's a coefficient of the disease group was 0.952,and 0.958,0.953,0.845 of the three subscales(OCGS,ISCGS,ESCGS).The Cronbach's a coefficient of the normal group was 0.901,and 0.826,0.807,0.733 of the three subscales(OCGS,ISCGS,ESCGS).2.Analysis of variance showed that the Chinese version CGSQ total score and the subscales were different among ASD,ADHD and normal group.ASD reported higher total scores and subscales scores(OCGS,ESCGS)than ADHD and the normal group,ADHD reported higher subscales scores(ISCGS)than ASD and the normal group,which suggested that the total scale and subscales of Chinese version CGSQ had a good discriminant validity.3.Exploratory factor analysis showed that the Chinese version CGSQ had the same factor structure with the original scale in the disease group,and each item had a high load value on the common factor which ranged from 0.732 to 0.867;The five-factor structure of the normal group was inconsistent with the original scale,and the factor loadings ranged from 0.397 to 0.795.4.Confirmatory factor analysis showed that the three-factor model had better Fitting index than those of the two-factor model for the disease group(Three-factor:RMSEA=0.062,GFI=0.885,NFI=0.926,RFI=0.916,IFI=0.961,TLI=0.956,CFI=0.961 vs Two-factor:RMSEA=0.107,GFI=0.761,NFI=0.851,RFI=0.833,IFI=0.884,TLI=0.869,CFI=0.883);the three-factor model had a slightly better Fitting index than those of the two-factor model for the normal group.However,the Fitting index of the disease group were more favorable than those of the normal group.5.We established the percentile rank norm of Chinese version CGSQ.The percentile rank 99 correspond to the total score of 56,and the percentile rank 95 correspond to the total score of 44.6.We graded the parenting stress scores with percentile rank(P)of the Chinese version CGSQ.The total score of the scale equal to 21 meant that the stress was extremely low(P?5%),the total score of the scale equal to 22 meant that the stress was low(5%<P?17%),the total score of the scale between 22 to 34 meant that the stress was moderate(17%<P?83%),the total score of the scale between 34 and 44 meant that the stress was high(83%<P?95%),and the total score of the scale greater than 44 meant that the stress was extremely high(P>95%).Conclusions:The Chinese version of CGSQ demonstrated good reliability and validity in the caregivers who had children with psychiatric problems(ASD&ADHD),and provided evidence that the Chinese version of CGSQ could serve as a parenting stress measurement tool for this group of population.However,the reliability was acceptable but the construct validity was not ideal for the normal population,and further studies were needed to evaluate the construct validity and the norm of Chinese version CGSQ.