although this developmental stage is marked by a range of potential stressors , help seeking rates in traditional mental health services tend to be low . parents , teachers , school or college counsellors and other supportive adults need to be empowered to recognise and respond to emotional and behavioral difficulties among youth . brief , low - cost screening instruments , like the strengths and difficulties questionnaire , may help build a national database of youth mental health needs , beyond diagnosable psychiatric conditions.(9 ) however , there are some concerns about inaccurate estimates , particularly concerning cross - cultural variations in rating and in caseness indicators of the sdq.(10 ) while some studies have used the original cut - off scores , others(111213 ) have reported discrepancies in rates while using alternate cut - off points derived from their sample percentile distributions . the present study was planned in the initial phase of a two - year adolescent mental health and suicide prevention teacher training programme in an educational institution in bangalore , india . it assessed the rates of vulnerable adolescents at risk for a range of emotional and behavioral difficulties in order to plan targeted training objectives and processes . additionally , it examined the utility of a brief screening tool and compared the rates of adolescent problems using varied cut - off points . informed assent and consent for participation was sought from all 1336 students enrolled in a pre - university college , and their parents . the sample included 1087 male and female students enrolled in the first and second year of a pre - university college in bangalore ( 81.4% participation rate ) . the sample was almost equally divided between the first and second year of pre - university college , with a slightly higher proportion of students from the commerce stream ( 53.6% vs 46.4% ) . about 3/4 lived in nuclear families and the majority ( 63.2% ) lived in an urban area . perceptions of difficulties in the family domain ; e.g. physical punishment , parental marital discord , death of a parent , excessive alcohol / drug use by a family member , financial difficulties in the family ; were assessed in a yes / no format . strengths and difficulties questionnaire ( sdq)(14 ) this 25 item behavioral screening questionnaire has a three point rating ( not true , somewhat true , certainly true ) . four problem scales ; emotional symptoms , conduct problems , hyperactivity / inattention , peer relationship problems add to generate a total difficulties score ( 0 - 40 ) . the original british cut - off points were derived by classifying approximately 10% of the normative sample with the most extreme scores in the  abnormal  banding , the next 10% in the  borderline  banding and the remaining 80% in the  normal  banding categories . some studies in europe , asia and africa have used scores above the 90 percentile of their samples to define the abnormal group.(11121516 ) in the present study , it was planned to contrast rates calculated from using both the original cut - offs and the percentile scores derived from the study sample . the sdq has good psychometric properties in varied cultures and languages and demonstrated use in indian studies.(7171819 ) institutional ethical clearance was obtained and classroom administration was done after obtaining written parental consent and student assent . individuals were considered to be in the abnormal range if the sdq total difficulties score was above the 90th percentile for this data . individuals scoring over the 92.5 percentile , on each of the sdq subscales , were placed in the abnormal range for that domain.(12 ) number ( % ) of individuals falling in the abnormal range using the uk cutoff(20 ) and the cut offs derived in this study are presented . analyses using t - tests and one - way anovas identified independent variables to be considered in the multiple regression analyses ( at p < 0.1 ) , to identify predictors of total difficulties , from among twelve variables ; gender , education and stream , type of family , residence of family , paternal and maternal education levels , presence of physical punishment by parent / s , parental marital discord , parental death , excessive alcohol / drug use by a family member , family financial difficulties . informed assent and consent for participation was sought from all 1336 students enrolled in a pre - university college , and their parents . the sample included 1087 male and female students enrolled in the first and second year of a pre - university college in bangalore ( 81.4% participation rate ) . the sample was almost equally divided between the first and second year of pre - university college , with a slightly higher proportion of students from the commerce stream ( 53.6% vs 46.4% ) . about 3/4 lived in nuclear families and the majority ( 63.2% ) lived in an urban area . perceptions of difficulties in the family domain ; e.g. physical punishment , parental marital discord , death of a parent , excessive alcohol / drug use by a family member , financial difficulties in the family ; were assessed in a yes / no format . strengths and difficulties questionnaire ( sdq)(14 ) this 25 item behavioral screening questionnaire has a three point rating ( not true , somewhat true , certainly true ) . four problem scales ; emotional symptoms , conduct problems , hyperactivity / inattention , peer relationship problems add to generate a total difficulties score ( 0 - 40 ) . the original british cut - off points were derived by classifying approximately 10% of the normative sample with the most extreme scores in the  abnormal  banding , the next 10% in the  borderline  banding and the remaining 80% in the  normal  banding categories . some studies in europe , asia and africa have used scores above the 90 percentile of their samples to define the abnormal group.(11121516 ) in the present study , it was planned to contrast rates calculated from using both the original cut - offs and the percentile scores derived from the study sample . the sdq has good psychometric properties in varied cultures and languages and demonstrated use in indian studies.(7171819 ) perceptions of difficulties in the family domain ; e.g. physical punishment , parental marital discord , death of a parent , excessive alcohol / drug use by a family member , financial difficulties in the family ; were assessed in a yes / no format . strengths and difficulties questionnaire ( sdq)(14 ) this 25 item behavioral screening questionnaire has a three point rating ( not true , somewhat true , certainly true ) . four problem scales ; emotional symptoms , conduct problems , hyperactivity / inattention , peer relationship problems add to generate a total difficulties score ( 0 - 40 ) . the original british cut - off points were derived by classifying approximately 10% of the normative sample with the most extreme scores in the  abnormal  banding , the next 10% in the  borderline  banding and the remaining 80% in the  normal  banding categories . some studies in europe , asia and africa have used scores above the 90 percentile of their samples to define the abnormal group.(11121516 ) in the present study , it was planned to contrast rates calculated from using both the original cut - offs and the percentile scores derived from the study sample . the sdq has good psychometric properties in varied cultures and languages and demonstrated use in indian studies.(7171819 ) institutional ethical clearance was obtained and classroom administration was done after obtaining written parental consent and student assent . individuals were considered to be in the abnormal range if the sdq total difficulties score was above the 90th percentile for this data . individuals scoring over the 92.5 percentile , on each of the sdq subscales , were placed in the abnormal range for that domain.(12 ) number ( % ) of individuals falling in the abnormal range using the uk cutoff(20 ) and the cut offs derived in this study are presented . analyses using t - tests and one - way anovas identified independent variables to be considered in the multiple regression analyses ( at p < 0.1 ) , to identify predictors of total difficulties , from among twelve variables ; gender , education and stream , type of family , residence of family , paternal and maternal education levels , presence of physical punishment by parent / s , parental marital discord , parental death , excessive alcohol / drug use by a family member , family financial difficulties . the cut - off scores derived from the percentile distribution of this study differed from that of the original uk cut - offs in select sdq domains [ table 1 ] . the difference in the overall difficulties score cutoff was mainly due to the differences observed in domains of emotional symptoms ( rate lowered from 22.4% to 9% ) and conduct problems ( rate lowered from 18.8% to 13% ) . the rates of hyperactivity / inattention , peer problems and prosocial behavior in the abnormal range were the same using the original cut - offs and the cut - off points derived from the study sample . percentage of abnormal scores on sdq based on sample percentile cut - offs and uk percentile cut - offs findings related to gender differences indicated significantly higher levels of emotional symptoms and total problems among females [ table 2 ] . there were no significant gender differences in the levels of self - reported conduct problems and hyperactivity / inattention . gender differences in sdq total and subscale mean scores multiple regression analysis examined if the following nine variables significantly predicted the level of total problems on sdq [ table 3 ] ; gender , education level , education stream , maternal education level , presence of physical punishment by parent / s , parental marital discord , death of a parent , excessive alcohol / drug use by a family member , financial difficulties in the family . predictors of total difficulty levels on the sdq the results indicated that five predictors explained 14.5% of the variance ( f = 20.61 , p < .001 ) in total difficulty levels : education stream ( commerce ;  = 0.09 ; t = 3.08 ; p < .01 ) ; education level ( 2 year pre - university ;  = .08 , t = 2.86 , p < .01 ) ; presence of parental marital discord (  = 0.18 , t = 5.76 , p < .001 ) , financial difficulties (  = 0.22 ; t = 7.39 , p < .001 ) and parental physical punishment (  = 0.11 ; t = 3.83 , p < .001 ) . the study provides a snapshot of vulnerability among students from a pre - university college in bangalore , with 10% of the sample at risk , with both internalizing ( emotional ) and externalizing ( conduct ) manifestations as prominent . the rates tended to be lower than those in other indian studies using the sdq.(4717 ) at least partially , this could be due to the use of the original cut - offs in this group of studies . al.(10 ) cautioned that sdq tended to overestimate prevalence in low and middle - income countries , including india . in the present study , cut - offs derived from the percentile distribution of the sample were higher than the original cut - offs for total , emotional and conduct problems , resulting in lower rates in these domains . the findings support the call for local and contextual knowledge and population specific norms when using screening tools like sdq as an indicator for further exploration and follow - up.(1421 ) the present study identified gender differences in patterns of psychopathology among adolescents . consonant with theoretical models(22 ) and other studies using the sdq,(7232425 ) emotional symptoms were predominant among girls and peer problems among boys . interestingly , in contrast to previous research , the present findings did not support the tilt towards higher conduct problems and hyperactivity among males . the reasons could include the subjective interpretations of the sdq items in these domains and may also reflect the narrowing of the gender gap pertaining to conduct disorder in adolescence.(26 ) clearly , college mental health programs must have a gender - informed perspective in early identification and intervention . within the sample , students in the commerce stream and those in the second year , closer to their final examinations , were more at risk . disturbed home environments can be a potent influence on youth mental health and both parental marital discord and corporal punishment have been linked with adolescent mental health trajectories.(222728 ) the present study identified the triad of parental marital discord , financial difficulties in the family and physical punishment by parents as predictors of total difficulty levels . overall , the findings suggest that comprehensive community - based youth mental health interventions must encompass family related vulnerabilities and find ways to engage and involve parents . the study has inherent limitations in terms of a non - representative sample and the purposive sampling method in a single educational institution . the use of a single stage screening method and the absence of the impact supplement of the sdq could result in inflated estimates of youth at risk . caseness and planning service delivery could benefit from inclusion of the sdq impact supplement , a second stage using standardised diagnostic interviews and the analysis of sensitivity and specificity . the importance of specificity would vary depending on the aim ; is the focus on identifying definite psychiatric caseness or on exploring the magnitude of potential vulnerability among adolescents to plan a range of promotive and preventive inputs along intervention . youth mental health initiatives in educational settings need to cover a spectrum of vulnerability and sensitive instruments , like the sdq , tapping difficulties in the borderline and abnormal range , could help identify varied youth mental health needs . the present study highlights the need to examine the psychometric properties of the sdq in a larger , representative community sample of adolescents in india . roc analysis could clarify the predictive validity of the sdq , while confirmatory factor analysis could assess the proposed five factor structure of the tool . the study focused on identifying potential mental health needs in an age band where there is scarce indian literature and highlighted issues related to assessment methodologies . the findings have implications for understanding gender - specific vulnerabilities , family contextual variables and planning targeted youth mental health services .