Validation of the Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in Iranian Adolescents Aged 11 - 17 Years

Abstract

Background: Early assessment and intervention in adolescent mental health are essential for improving developmental outcomes. Objectives: This study examined the content validity, face validity, internal consistency, test–retest reliability, and structural validity of the Persian version of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure in students aged 11 - 17 years in Ilam, Iran. Methods: A cross-sectional study was conducted in 2024 among 350 high school students selected using multistage cluster random sampling. The validation process included forward–backward translation, expert review to establish content validity, and pilot testing to assess face validity. Exploratory factor analysis (EFA) was first conducted in a randomly selected subsample (n = 175), followed by first- and second-order confirmatory factor analyses (CFA) in the remaining subsample (n = 175). Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest stability (intraclass correlation coefficients [ICCs]). Missing data were handled using complete-case analysis after confirming a missing completely at random (MCAR) pattern with Little's test, and sensitivity analyses were performed to assess robustness. Results: The participants’ mean age was 14.23 years (SD = 0.75), and 72.6% were female; most students (91.4%) lived in urban areas. The content validity indices were satisfactory, with item-level content validity index (CVI) values ranging from 0.83 to 1.00 and a scale-level CVI of 0.92, whereas the face validity assessment yielded an overall face validity index (FVI) of 0.91. Cronbach’s alpha coefficients ranged from 0.76 to 0.94, and ICCs ranged from 0.80 to 0.93, indicating strong internal consistency and test–retest reliability. EFA supported the expected 12-factor structure of the measure. In CFA, a second-order model with a higher-order general psychopathology factor showed a better fit than the first-order model. After removing two items with low factor loadings (Q7 and Q19), the final second-order model achieved a good fit, with standardized factor loadings for the retained items ranging from 0.63 to 0.85. These findings support the structural validity of the Persian instrument based on EFA and CFA; convergent, discriminant, and concurrent validity were not assessed in this study. Conclusions: The Persian DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure demonstrates acceptable content validity, face validity, structural validity, and reliability for screening mental health symptoms in Iranian adolescents. However, because convergent, discriminant, and concurrent validity were not assessed, broader claims regarding diagnostic accuracy cannot yet be made. With this caveat, the instrument may be useful in school-based screening and research settings, pending further validation against external diagnostic criteria.