Factor structure and measurement invariance of the 35-item self-report version of the Pediatric Symptom Checklist (PSC-35) in children and adolescents in five Global South Countries

The Pediatric Symptom Checklist (PSC-35; Jellinek et al., 1999) is a widely used screening tool designed to identify emotional and behavioral problems in children and adolescents. Due to its brevity, open-access availability, and translation into more than 20 languages, it may be particularly suitable for use in low-resource and international settings. As global mental health research continues to expand, ensuring that instruments like the PSC measure psychological constructs equally across different countries and groups becomes increasingly important. This is especially true for open-access tools like the PSC, whose widespread availability necessitates careful testing of their psychometric properties across diverse populations. Measurement invariance refers to whether a psychological instrument assesses the same underlying construct in the same way across groups—such as countries, genders, or age categories. Without evidence of measurement invariance, group comparisons (e.g., mean differences) may be misleading, reflecting variations in how different groups interpret and respond to items rather than true differences in the construct itself (Gao et al., 2022). Thus, measurement invariance of the PSC is a prerequisite for validly interpreting differences in emotional and behavioral problems between groups. While measurement invariance has been extensively examined for instruments like the Strengths and Difficulties Questionnaire (SDQ) and the Child Behavior Checklist (CBCL) (e.g., Stevanovic et al., 2015; Schlechter et al., 2024), fewer studies have investigated invariance in the PSC, despite its growing international use. Findings from SDQ analyses indicate limited comparability across countries and cultures, particularly in its self-report version, likely due in part to its inclusion of reverse-worded items (Duinhof et al., 2019; Kankaanpäa et al., 2023). This lack of invariance suggests that children and adolescents from different nations may interpret and respond to items differently, compromising the validity of cross-country comparisons. In line with this, the SDQ in its current form may require adaptation to ensure its suitability for cross-cultural research (Stevanovic et al., 2015). These findings underscore the need to validate other screening tools, such as the PSC, for international use. While the PSC shares similarities with the SDQ and CBCL in terms of the assessed constructs, there are also differences, e.g., no reverse-worded items, that may have implications for the factor structure and invariance. Previous analyses of the PSC’s factor structure and measurement invariance have primarily focused on the parent-report or self-report version of the 17-item short form (PSC-17). Studies in Global North countries support a three-factor model (emotional problems, behavioral problems, attention problems) across different ethnic groups (Stoppelbein et al., 2012), genders (Bergmann et al., 2018; Piqueras et al., 2021), and points in time (Piqueras et al., 2021). However, the only available study examining the factor structure and measurement invariance of the PSC-17 in a Global South country, in a sample of orphaned and vulnerable children in Zambia, found the best fit for a bifactor model (a general factor plus three subscale factors), which was invariant across age and gender (Lin et al., 2022). To our knowledge, there are currently no studies examining the factor structure and measurement invariance of the PSC-35 across multiple countries in the Global South. The present study investigates the factor structure and measurement invariance of the PSC-35 in five Global South countries differing in socio-cultural, economic and religious aspects: Ghana, Tanzania, Uganda, Haiti, and Pakistan. It further examines invariance within countries across gender and age groups. In addition, exploratory analyses will examine the factor structure and measurement invariance of the PSC-17 by considering the respective items of the PSC-35. The findings will contribute to the evidence base on the PSC’s validity as a tool for child mental health assessment. The primary focus is on testing measurement invariance across countries. Only if sufficient invariance is established across countries will we proceed to test invariance across gender and age. This hierarchical approach ensures that subgroup comparisons (e.g., gender, age) are only interpreted in contexts where the factor structure is comparable (Vandenberg & Lance, 2000). 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