Mental disorder is a condition characterized by clinically significant disturbances in the process of cognition, emotion regulation, or behavior. Mental disorders usually affect feelings and produce changes in behavior, the symptoms of which vary according to the severity.1,2 The set of symptoms occur concurrently and are clinically significant involving disturbance of the cognitive process, emotional regulation, and behavior. Symptoms of mental disorders are varied but often appear as mood or behavioral problems. Behavioral changes that occur are frequently disregarded due to the stigma of mental health. In Indonesia, there are still people who believe that mental disorders are caused by things that are irrational or supernatural. Hence, most mental disorders are not detected, and their management is not executed correctly.3
In 2017, the overall incidence of mental disorders was predicted at 1:10 (792 million) of the global population. 4 The WHO reports an increase in mental disorders by as much as 13%.5 A recent mental health survey was done by WHO, and mental disorder prevalence in the Mediterranean region attained approximately 11-40.1% from 2001–2020. This study was conducted in the general population and populations affected by trauma (war, violence, displacement of population, damage to infrastructure, and unemployment). Out of 52 studies, depression was the biggest contributor to the prevalence rate, namely 20.5% of 179,637 samples. 6 Moreover, a study was done in 2017 at Banaras Hindu University in India. Southeast Asia has a mental health prevalence of 122:1000. Out of all of the countries in South-East Asia, Afghanistan became the largest contributor to the prevalence of mental disorders, namely 534 out of 1000 people. 7 It is apparent that mental disorder has greatly influenced the global burden of diseases. The survey of Disability-adjusted life years (DALYs) from 1990–2019 for mental disorders raised its number from 80.8 million to 125.3 million. Lost productivity due to all mental disorders also costs the global economy roughly $2.5 trillion per year by 2010. 8
Data from the Indonesia Ministry of Health also reflect the same picture. In 2018, an increasing number of people with mental disorders was shown, from 7.695 to 9.405; this explained its prevalence rate, which reached up to 20% in the general population.9 They also stated that mental disorders have the highest rate of Years of healthy life lost due to disability (YLD), that is 13.4%. Depression and anxiety are ranked first and second, affecting the total disease burden in Indonesia, which hasn’t changed from year to year. Those increasing numbers also affected the Disability-adjusted life years (DALYs), which is 4.5%.3
An escalation of mental disorder cases has not been resolved properly because of the lack of distribution of mental health professionals to the rural area of Indonesia, the shortage of psychiatrists, and a low number of early detections of mental disorders. Early detection of mental disorders using specific measuring tools is one method of reducing mental disorders that can lead to a life with disability and lost productivity.9 There are abundant measuring tools in the form of questionnaires, interviews, checklists, and assessments to detect mental disorders, but those measuring tools are often time-consuming and require trained mental health professionals to be administered. Therefore, one of the four Self-reporting Questionnaires (SRQ) can be used.
There are four types of SRQs that have different functions and consist of different items.10 The SRQ-10 is a measuring tool that has 10 short questions about neurotic symptoms.11 The SRQ-20 is a measuring tool that contains 20 questions about neurotic symptoms.10 SRQ-24 has 4 additional questions, 1 question regarding drug use, and 3 questions regarding psychotic symptoms.12 SRQ-29 is an extended version of SRQ-24 which has 5 additional questions regarding post-traumatic stress disorder.13
The SRQ-20 is a low-cost screening tool that contains easy-to-understand twenty neurotic symptoms questions to elicit information about a patient's mental state. Its self-rating scale nature allows it to eliminate observer bias in terms of symptoms and problems that may arise in people with mental disorders. The SRQ-20 was established by the WHO to early detect mental disorders in primary health care, especially in developing countries.10 It consists of yes/no (binary) questions, with codes of “1” indicating the occurrence of a symptom and “0” if the symptom is not present.10 Therefore, the SRQ-20 is particularly suitable for early detection of mental disorders.
Studies conducted by WHO, the Indonesian Ministry of Health, etc. It is stated that SRQ-20 can help medical personnel detect early occurrences of mental disorders so that they can be handled properly. The SRQ-20 has advantages over other measuring instruments because it can help detect mental disorders that are tricky to detect in crowded situations, such as in health centers or in emergency rooms at hospitals, and helps medical personnel to diagnose mental disorders.10,14,15 Therefore, the SRQ-20 will be used as a measuring tool in this study.
There also have been several comparative and validation studies that stated SRQ-20 is cost-effective and preferable to be used than other measuring tools.15–18 These studies stated the validity and reliability of SRQ-20 rely upon the method and settings of the studies themselves and the population of the settings.14, 18–20 There have been numerous attempts in Indonesia to translate and utilize the SRQ-20 as a screening tool. The first study that can be identified was conducted in Semarang, East Java, and attempted to translate the SRQ-20 into Bahasa Indonesia. The SRQ-20 is used by the Indonesia Ministry of Health to investigate potential risk factors for mental and emotional disorders.21
A recent study was done in Bandung City with students as the participants also used the SRQ-20 as a measuring tool. The most recent study was done among Padjadjaran University students and it has a significant result of the factor analysis and reliability of 0.84. That result has its own limitations because of the population of students aged 19–23 years old which could affect the generalization result of SRQ-20.21 Thus, the purpose of this study is to fill a gap by assessing the validity of the internal structure, factorial validity, and factor structure of the Self-Reporting Questionnaire (SRQ)-20 that has been translated into Bahasa Indonesia.