Towards cultural validation of the revised children's anxiety and depression scale in Karnataka, India: Think aloud interviews among 13-17 year olds.

Improving youth mental health is a national priority in India, especially given the very high rates of youth suicide. Yet prevalence data in India is often incomplete and more culturally validated mental health measures are needed to inform prevention and intervention work. The Revised Children's Anxiety and Depression Scale (RCADS-47) is a widely-used measure of mental health globally, including in India, but is yet to be culturally validated there. As the first step in establishing cultural validity, this study aimed to establish the cultural and semantic equivalence of the English-version of the RCADS-47 in a sample of Indian adolescents. This study examined Indian adolescents' (n = 12) understanding of the measure items and response meaning via Think Aloud interviews. Responses to each item were coded according to predefined categories representing comprehension. Items coded as problematic for three or more participants were considered for rephrasing. Of the 47 items, 14 were identified as problematic, with the Obsessive-Compulsive Disorder subscale presenting the most problems. Several RCADS-47 items were identified as potentially problematic for Indian adolescents. Potential causes of these difficulties and suggested rephrasing are discussed along with the next stage of validating the measure in India.