Recognizing the integral role of parental emotional and behavioral health in shaping a supportive family environment crucial for a child’s emotional well-being, a practical tool for evaluating mental health in both preschool children and their mothers are necessary. In this methodological study conducted across eight provinces in Turkey, we aimed to develop and assess the psychometric properties of a single-item mental health measure for physically healthy children aged 2–5 years and their mothers.

The study included 411 child-mother pairs recruited from tertiary care hospitals, with subjects selected from well-child departments. Various psychometric assessments were employed, including the Strengths and Difficulties Questionnaire (SDQ) for children, Depression, Anxiety, and Stress Scale (DASS-21), Patient Health Questionnaire-4 (PHQ-4) for mothers, and single-item measures for both child and maternal mental health [mother-reported mental health of child (MRCMH) and self-reported mental health of mother (SRMH)]. Data were collected at two time points: baseline evaluation for validity testing and test-retest evaluation at the 3rd week.

The MRCMH indicated excellent validity, with sensitivity and specificity for detecting borderline and abnormal mental health difficulties in children at 90%, 100%, and 83%, respectively. The SRMH revealed sensitivity and specificity of 62% and 78% for identifying maternal depression, 57% and 76% for anxiety, 63% and 76% for stress, and 54% and 87% for psychological distress, respectively. Construct validity analyses revealed significant correlations between MRCMH and SDQ scores, as well as between SRMH and DASS-21 and PHQ-4 scores. Test-retest reliability, assessed through intraclass correlation coefficients, indicated varying agreement levels, with the highest agreement observed for SDQ total difficulties and the lowest for SRMH. Further exploration of the measures’ sensitivity and specificity revealed noteworthy accuracy in detecting child mental difficulties and maternal psychological distress. Correlational analyses between baseline and 3-week scores highlighted the stability of MRCMH and SRMH over time.

This research contributes valuable insights into the psychometric properties of single-item measures for child and maternal mental health, offering a potential tool for clinicians and researchers. The outcomes can inform public health strategies and interventions aimed at promoting positive mental health outcomes in preschool children and their mothers.

Mental health is characterized as the condition of optimal well-being where an individual recognizes and harnesses their own capabilities, effectively manages routine life stresses, maintains productive work, and contributes positively to their community [1]. Mental health in infants and young children centers on how they start to understand and manage their emotions while building connections with others. It involves their developing ability to regulate and express emotions, respond to situations appropriately, form secure relationships, and explore their surroundings within the framework of family, community, and cultural expectations [2]. Mental health, now increasingly recognized as essential for global progress, is a priority within the Sustainable Development Goals for all age groups [1, 3, 4]. Globally, about one in seven adolescents aged 10–19 live with mental health conditions such as conduct disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, eating disorders, depression, and anxiety. Additionally, between 6% and 18% of children aged 0–5 experience mental health difficulties, though comprehensive data for this younger age group is scarce [4, 5]. In 2017, data from England revealed that 5.5% of children aged 2–4 years had a mental health condition. Among these, 2.5% were diagnosed with behavioral disorders, 1.0% with emotional disorders, 0.5% with hyperactivity, and 2.8% with less common conditions. The latter group included 1.4% with autism spectrum disorder, 1.3% with sleep disorders, and 0.8% with feeding disorders [6]. Similarly, between 2016 and 2019, approximately one in six U.S. children aged 2–8 years—about 17.4%—were reported to have a diagnosed mental, behavioral, or developmental disorder [7]. Data from 2021 to 2022 indicated that 4.6% of U.S. children aged 3–5 years had behavioral disorders, 2.2% experienced anxiety, and 0.1% were diagnosed with depression [8]. A meta-analysis further reported prevalence rates of 8.5% for anxiety and 1.1% for depression among children aged 1–7 years [9]. The prevalence of common mental health conditions—such as anxiety, depression, and somatic symptoms—is notably higher among mothers of young children compared to the general population. For instance, rates were recorded at 30.4% in Germany, 31% in Scotland, 56.2% in rural Brazil, and 43.8% in urban Brazil. Similarly, studies found rates of 20% in Kenya, 28.8% in Tanzania, and 36.6% in southern Ethiopia among mothers of young children [10,11,12,13,14,15].

Many mental health challenges in adulthood often originate from experiences in early childhood, particularly within the formative years from birth to around 5–8 years old. This highlights the importance of supporting mental health from a young age as a vital component of pediatric care [16]. Pediatricians are advised to take a comprehensive history during well-child visits, including family and social backgrounds, and to screen for postpartum depression in mothers of infants up to six months, alongside regular developmental assessments at each visit [17]. The American Academy of Pediatrics (AAP) further recommends behavioral, social, and emotional screenings for children under five as part of routine well-child care, as well as inquiries into the emotional and mental well-being of caregivers [18]. Mental health is closely interconnected with children’s physical health, risk behaviors, daily functioning, and social relationships [7]. Integrating mental health monitoring into well-child visits could thus improve health outcomes for young children by enabling the design and implementation of targeted mental health interventions.

The well-being of a child’s emotional and behavioral health relies on the presence of a supportive family environment, underscoring the importance of maintaining parental emotional and behavioral health to foster such a conducive family setting [16]. Early-life adversity including parental, particularly maternal, mental health problems is linked to childhood mental health difficulties and poorer cognitive outcomes [19]. Therefore, the mental health of child and mother are inseparable. An efficient, reliable, and valid evaluation of mental health should be performed together in young children and their mothers.

Existing literature indicates that single-item measures of self-rated mental health correlate well with multi-item mental health assessments in adults [20, 21]. Previous analyses suggest that single-item ratings for aspects like depression, mood, and mental resilience can effectively capture outcomes comparable to those from traditional multi-item assessments in young adults [22]. Mental health screening for children in settings such as well-child visits and schools, is typically conducted using validated multi-item instruments, including the Pediatric Symptom Checklist (PSC-17, PSC-35), the 5-item Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire, the Ages and Stages Questionnaire-II, the DISC Predictive Scales, and the Mental Health Check-up in the Emergency Department Adolescent/Parent Questionnaire [23]. However, single-item measures that ask children/parents/caregivers to provide an overall rating of children’ mental health are less commonly used, and their psychometric properties have been less thoroughly studied. Implementing single-item assessments with effectiveness comparable to multi-item questionnaires could be a cost-effective, time-saving approach for evaluating mental health in clinical settings [24]. Therefore, the aim of this study was to develop and validate a single-item measure for assessing the mental health of physically healthy children aged 2–5 years and their mothers. We hypothesized that this single-item measure would accurately reflect the mental well-being of both children and mothers and could serve as a practical, time-efficient screening tool in routine pediatric care. By providing a simple and rapid method for mental health assessment, this tool is intended to facilitate early identification of mental health concerns during standard pediatric visits. The study’s outcomes can inform public health strategies, policies, and interventions geared towards fostering positive mental health outcomes in preschool children and their mothers.

This methodological study carried out in tertiary care hospitals in eight different provinces located in four different geographical regions of Turkey and investigated single-item measure of mental health. Healthy preschool child-mother pairs from well-child departments were the subjects. The mothers’ written consents were obtained to participate. This study was approved by Mersin University Clinical Research Ethics Committee (2023-04-12/240).

The data were collected with the face-to-face interview method by the researchers using a structured survey querying demographic data, using mother-reported mental health of child (MRCMH) and self-reported mental health of mother (SRMH) items, and using scales of Strength and Difficulties Questionnaire (SDQ), Depression, Anxiety and Stress Scale − 21 Items (DASS-21), and Four-Item Patient Health Questionnaire for Anxiety and Depression (PHQ-4).

Data were collected at two time points: baseline evaluation for validity testing and test-retest evaluation at the 3rd week. For test-retest reliability, the time between assessments was 3 weeks in the study of psychometric properties of Turkish version of DASS-21 and it was 1 to 3 weeks in the studies of the psychometric properties of the PHQ4 in clinical and nonclinical populations [25, 26]. We chose a 3-week interval to ensure consistency with these previous studies.

Sample size was calculated using G*Power (version 3.1.9.4. Franz Faul, Universitat Kiel, Germany).

To assess the validity of the SRMH and MRCMH tests compared to the existing valid tests, baseline sample size was estimated using the “Correlation: Bivariate normal model” with a one-tailed test. The test parameters were set as follows: Correlation ρ H1 = 0.15, ρ H0 = 0, α error probability = 0.05, and Power (1-β error probability) = 0.90. The total sample size was calculated to be 377. Considering the possibility of 10% invalid questionnaires, it is planned to recruit 415 participants.

To perform the test-retest reliability and calculate the ICC, the sample size was estimated using ANOVA: Repeated measures, within factors. The parameters were set as follows: Effect size f = 0.25, α error probability = 0.05, Power (1-β error probability) = 0.95, Number of groups = 1, and Number of measurements = 2. The total sample size was calculated to be 54. Considering the possibility of 10% missing data, it is planned to recruit 60 participants.

In the first phase, 415 participants completed the survey. 4 surveys were excluded due to missing data, leaving 411 participants in the study. Of those included, 60 were invited for the second survey, and 56 responded.

We used items asking mothers to report their own and their children’s mental status. Despite varying cultural viewpoints, mothers demonstrate a strong comprehension of the symptoms associated with child mental health issues [27]. Adult mental health is defined as a state of well-being that enables individuals to cope with life’s stresses, realize their abilities, learn and work effectively, and contribute to their community [28]. The study contained a self-rated single item asking for mental health on a five point scale which was previously used in several community health surveys [20]. The Self-Reported Mother Mental Health (SRMH) was designed as a single-question questionnaire, asking, “How would you rate your overall sense of well-being and mental health? At the present time, would you say your mental health is.?” Responses were recorded on a five-point Likert scale: excellent, very good, good, fair, and poor. The same five-point Likert scale classification was used for the MRCMH item, which asked, “How would you describe your child’s mental health? At the present time, would you say your child’s mental health is.?”

Participants were recruited between April 2023 and June 2023. Children who applied for well-child check-up accompanied by their mothers constituted the study sample.

Children aged 24–59 months and mothers aged 18–39 years, without a history of mental disorders, were eligible for inclusion. Exclusion criteria included an inability to complete the questionnaires (e.g., refugee mothers who do not speak Turkish) and any history of mental illness or addiction. Given that mothers with known mental health issues, either themselves or in their children, are often more susceptible to chronic stress and psychopathology [29, 30], we focused on the ‘well-child’ population to minimize potential response biases and obtain more objective answers regarding acute events using the single-item questionnaires.

Assessment of child mental health involved utilizing the SDQ as reported by parents. The SDQ is a concise behavioral screening tool comprising 25 items distributed across five scales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Each scale consists of five items. The total difficulties score, ranging from 0 to 40, is derived by summing scores from emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems scales. A higher total difficulties score indicates a greater likelihood of mental challenges. The prosocial scale is evaluated independently, with a higher score signifying improved social behavior. SDQ scores are categorized into three bands: normal (a total difficulties score of 0–12 for 24–48 month olds and 0–13 for 48–59 month olds, and a prosocial score of 7–10 for 24–48 month olds and 6–10 for 48–59 month olds), borderline (a total difficulties score of 13–15 for 24–48 month olds and 14–16 for 48–59 month olds, and a prosocial score of 6 for 24–48 month olds and 5 for 48–59 month olds) and abnormal (a total difficulties score of 16–40 for 24–48 month olds and 17–40 for 48–59 month olds, and a prosocial score of 0–5 for 24–48 month olds and 0–5 for 48–59 month olds) [31,32,33,34].

In the present study, “SDQ-Turkish for the parents of 2–4 year olds” and SDQ-Turkish for the parents of 4–17 year olds” were used in children 24–47 months and children aged 48–59 months, respectively. We used having borderline or abnormal total difficulties and prosocial behaviours scores, not having normal scores, to determine child mental difficulties [32,33,34]. In our study, Chronbach alpha values for emotional symptoms, conduct problems, hyper activity/inattention, peer relationship problems, prosocial behavior, internalizing, externalizing, and total difficulties were found to be 0.63, 0.60, 0.60, 0.30, 0.71, 0.63, 0.71, and 0.77, respectively; the Cronbach’s alpha value was above 0.60 for all subscales except Peer Relationship Problems.

Maternal mental health was assessed using the DASS-21 and PHQ-4. The DASS-21, a collection of three self-report scales, is specifically crafted to assess the emotional states of depression, anxiety, and stress [35]. DASS-21 translated to Turkish and validity studies was performed [36]. Each of the scales within DASS-21 comprises 7 items. The calculation of scores for depression, anxiety, and stress involves summing the scores assigned to the relevant items on each respective scale [25, 36, 37]. The cut-off for conventional severity labels were defined as recommended in the literature: normal (a total depression score of 0–4, a total anxiety score of 0–3, a total stress score of 0–7), mild (a total depression score of 5–6, a total anxiety score of 4–5, a total stress score of 8–9), moderate (a total depression score of 7–10, a total anxiety score of 6–7, a total stress score of 10–12), severe (a total depression score of 11–13, a total anxiety score of 8–9, a total stress score of 13–16), and exteremely severe (a total depression score of ≥ 14, a total anxiety score of ≥ 10, a total stress score of ≥ 17) [25]. Validity for of depression, anxiety, and stress subscales were estimated as 0.87, 0.81, 0.79 in our study.

The PHQ-4 stands as a validated ultra-brief instrument adapt at identifying both anxiety and depressive disorders. Comprising four questions, respondents answer on a four-point Likert-type scale. Its primary aim is to precisely gauge the fundamental symptoms of depression and anxiety. The total PHQ-4 score serves as a comprehensive measure, encompassing depression and anxiety subscale scores, providing insights into overall symptom burden, functional impairment, and disability [38]. PHQ-4 has good support for its validity in Turkish adults and in this study, scores are rated as recommended in the literature: normal (a total score of 0–2), mild (a total score of 3–5), moderate (a total score of 6–8), and severe (a total score of 9–12) [39]. Cronbach’s alpha value was calculated as 0.85 in our study.

The statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM SPSS Corp.; Armonk, NY, USA) and STATA version 13 for Windows (Stata Statistical Software: Release 13). Normality was assessed through the application of the Shapiro-Wilk test and examination of histograms. For continuous variables mean ± standard deviation and median (IQR 25th-75th percentiles) values, for categorical variables numbers (n) and percentages (%) were given as descriptive statistics. Relationships between continuous variables were examined with Spearman correlation coefficient. Validity, sensitivity, specificity, positive predictive value, negative predictive value, and Youden index analysis were used to assess the performance of MRCMH and SRMH. Test-retest reliability was evaluated through the computation of the intraclass correlation coefficient (ICC). Absolute reliability pertains to the extent of consistency observed in repeated measurements of the same instrument on a given individual. A classification for the 95% confident interval of the ICC estimate as follows: < 0.50 poor, 0.50–0.75 moderate, 0.75–0.90 good, and > 0.90 excellent reliability [40]. Statistical significance level was set as p < 0.05.

The study included participants from Central Anatolia, Southeastern Anatolia, Mediterranean, and Marmara regions of Turkey. The characteristics of the 411 children are presented in Table 1. Children had a median age of 41.6 months and 199 (48.4%) were male. At baseline, median SDQ prosocial subscale was 8 and total difficulties score was 11. At baseline, 78.1% of children had good, very good or excellent MRCMH score while 18.5% had fair and 3.4% had poor MRCMH score. At 3-week, 85.7% of children had good, very good or excellent MRCMH score while 8.9% had fair and 5.4% had poor MRCMH score.

The characteristics of the 411 mothers are presented in Table 2. Mothers had a median age of 33.1 (31.9–34.5) years and 165 (40.1%) were employed. Eleven mothers were illiterate (2.7%), nine (2.2%) were literate without diploma, and 8% of mothers were primary school, 12.9% were secondary school, 25.1% were high school and 49.1% were college graduate. At baseline, 108 mothers (26.3%) had mild or moderate and 50 (12.2%) had severe or extremely severe DASS-21 depression scala score. At baseline, 99 mothers (24.1%) had mild or moderate and 69 (16.8%) had severe or extremely severe DASS-21 anxiety scala score. At baseline, 107 mothers (26%) had mild or moderate and 37 (9%) had severe or extremely severe DASS-21 stress scala score. At baseline, 168 mothers (40.95) had none psychological distress, while 211 (51.3%) had mild or moderate and 32 (7.8%) had severe psychological distress according to the PHQ-4 scores. At baseline, 62.8% of mothers had good, very good or excellent SRMH score while 27.5% had fair and 9.7% had poor SRMH score. At 3-week, 73.3% of mothers had good, very good or excellent SRMH score while 23.2% had fair and 3.6% had poor SRMH score.

The associations between MRCMH scores with SDQ scores and between SRMH scores with DASS-21 and PHQ-4 scores at baseline and at 3-week are summarized in Table-3. All correlations between baseline MRCMH and SDQ scores were statistically significant at p < 0.05. Baseline SDQ prosocial score was very weakly negatively correlated with baseline MRCMH and baseline SDQ total difficulties score was weakly correlated with baseline MRCMH. There was no correlation between 3-week MRCMH and 3-week SDQ scores (p > 0.05). All correlations between baseline SRMH and DASS-21 scores were statistically significant at p < 0.001. Baseline SRMH score was moderately correlated with baseline DASS-21 scores. Also, baseline SRMH score moderately correlated with baseline PHQ-4 score (p < 0.001). There were significant weak correlations between 3-week SRMH and 3-week DASS-21 scores (p < 0.05). There was a significant moderate correlation between 3-week SRMH and 3-week PHQ-4 scores (p < 0.001).

The intraclass reliability of scala scores are presented in Table 4. The intraclass correlation coefficient (ICC) scores demonstrated poor to good agreement for MRCMH (ICC scores range; 0.33–0.77) and poor to moderate agreement for SRMH (ICC scores range; 0.17–0.72). The ICC value was the highest for the SDQ total difficulties score and the lowest for the SRMH.

The validity and the sensitivity and specificity of MRCMH for child borderline and abnormal mental difficulties (based on the SDQ-total difficulties score) were 90%, 100%, and 83%, respectively. The validity and the sensitivity and specificity of MRCMH for child borderline and abnormal prosocial behavior (based on the SDQ-prosocial score) were 54%, 57%, and 52%, respectively. The sensitivity and specificity of SRMH for mother depression were 62% and 78%, for mother anxiety were 57% and 76%, for mother stress were 63% and 76%, respectively. The sensitivity and specificity of SRMH for mother psychological distress were 54% and 87%, respectively (Table 5).

The associations between baseline scores with 3-week scores are summarized in Table 6. Baseline MRCMH moderately correlated with baseline SRMH and 3-week MRCMH scores (p < 0.001). 3-week MRCMH moderately correlated with 3-week SRMH (p < 0.001). Baseline SRMH and 3-week SRMH were weakly correlated (p < 0.05).

Awareness about the mental health of young children is growing and the use of single-item screening tools is rising [5, 20]. By considering these two facts together, we developed and validated the MRCMH and SRMH which contain only one item each that provide a feasible screening for the presence of mental health difficulties in preschool children and for the presence of depression, anxiety, stress, and psychological distress in their mothers.

The UNICEF Office of Research highlights a significant impact of mental health issues, noting that half of these problems manifest by age 14, and three-quarters by age 24. Additionally, 10% of children aged 5 to 16 years are identified as having clinically diagnosable mental problems. However, a concerning trend is observed, as 70% of children and adolescents facing mental health challenges have not received timely and suitable interventions during their formative years [4]. To the best of our knowledge, no global data is available for under-five children on this issue. Mental screening with a validated instrument may lead to the identification of children with mental health problems who are in need of early intervention services. The existing literature suggests that screening can have a positive effect on discussing mental health issues and universal mental health screening in pediatric primary care is recommended [41]. The point to be considered is that conducting a periodic mental screening should not increase work load and respondent burden. For the very reason, we designed single item screening tools, MRCMH and SRMH, for implementation in well-child settings.

In previous studies, several single-item measures were conducted among pediatric population. Karvounides et al. validated a brief measure of current stress, the Stress Numerical Rating Scale– 11 (SNRS-11) and determined that using well-validated measures for comparison, SNRS-11 showed a significant validity in adolescents. SNRS-11 was reported to the first single-item stress measure for a pediatric sample [42]. The single-item measure for adolescent happiness was conducted among schoolchildren in three countries from distinct European regions and the findings indicated that a single-item happiness measure is a valid tool for population based adolescent studies [43]. A recently introduced single-item tool has proven to be an effective, dependable, and valid approach for screening problematic sexual behavior in preteen children [44]. The single-item tool we developed, MRCMH, is the first mother-reported single item mental health measure for preschool age with a high sensitivity, specificity, and reliability for mental health difficulties in preschool children.

Parents typically initiate discussions about their child’s mental health with pediatricians and family physicians as the initial point of contact. Nevertheless, physicians may experience a lack of confidence in their expertise or capabilities and express apprehensions about limited time and resources when it comes to identifying mental health issues in young children [45]. MRCMH may facilitate physicians’ work by providing a favorable screening compared to lengthier or complex mental health questionnaires. Charach et al. conducted a review indicating that prevalence rates of mental health problems in preschool children, as identified through parent-report measures, vary widely from 5.2 to 35.0%. This considerable range reflects the diversity in methodologies, encompassing the use of various standardized screening measures, different subscales within these measures, and varied thresholds applied to the same scale [46]. Using MRCMH can minimize aforsaid heterogeneities. Our findings indicate that MRCMH is associated with multi-item measure of child’s mental health.

The correlations we found between the SDQ and MRCMH scores were weak. This is understandable, as SDQ are composed of several subscales that assess different constructs, which are not represented by a single item [32]. Moderate correlations were observed at baseline with the DASS-21, supporting this explanation, as it appears that the single-item questions on depression, anxiety, and stress were better addressed in the maternal assessment. Additionally, the reduction in the strength of the association at 3 weeks can be explained by the smaller sample size in the second measurement (56 vs. 411), which increases the likelihood of a Type II error and reduces the statistical power to detect a significant correlation [47, 48]. Furthermore, correlation analysis with a small sample size results in a wider confidence interval for the correlation coefficient. As a result, the significant finding observed in the initial measurement may not have been detected in the retest analysis [47, 48].

Bagur et al. emphasized that professionals assessing the young child and family should consider the depression and anxiety levels of caregivers because caregivers’ depression and anxiety exert an impact on children’s mental health [49]. In line with this conclusion, we used DASS-21 to screen maternal depression and anxiety. There is a link between stress and mental illness as stress deranges the psychological well-being of a person and leads to anxiety and depression [50]. We evaluated maternal stress and psychological distress with DASS-21 stress subscale and PHQ-4. Our results indicated a consistent association between the selected measures and the single-item measure of maternal mental health. SRMH showed a high specificity and a significant reliability for depression, anxiety, and stress in mothers of under-five children.

Children, often offspring of parents, particularly mothers, who have mood and anxiety disorders, face an elevated risk of developing mental disorders. These may encompass both externalized and internalized behavioral disorders, as well as challenges such as poor academic performance or depression during childhood and adolescence [51]. Our findings support this conclusion by showing significant positive correlations between SRMH and MRCMH. Therefore, screening mothers of young children for depression, anxiety and stress and delivering early promotion, prevention and treatment interventions for maternal mental health may enhance both maternal and under-five health.

It is reported that recognition of mental problems does not occur until someone in the parents’ social network explicitly validate their concerns about their child’s mental status [52]. Furthermore, parents confronting the reality of their children having mental health disorders often find themselves grappling with the decision of whether to disclose or conceal their child’s condition [53]. Given these facts, a mental health screening of children by health professionals may encourage mothers to disclose and may promote parental recognition of child’s mental problems. We offer that efficiency and effectivity of integrating mental health screening using MRCMH into the well-child checkups should be taken into consideration by health policy-makers.

In pediatric patient populations, single-item measures may aid in assessment of the effects of disease symptoms on patients’ lives and may reduce respondent burden. A pair of single-item tools, namely the FPS-R-like anxiety scale and the 10-cm VAS adapted specifically for anxiety, exhibited both reliability and validity in measuring anxiety within a pediatric cancer population [54]. Conway et al. presented initial findings on the validity, reliability, and responsiveness of a single-item measure for assessing quality of life in children with drug-resistant epilepsy [55]. In future studies, MRCMH may be adapted to pediatric diseases.

An ICC value above 0.5 generally indicates consistent reliability and acceptable agreement between testing points [40]. Therefore, ICC values between 0.5 and 0.6 for MRCMH and SRMH are considered acceptable, particularly in situations where broad population reach is important, such as large-scale screening or time-sensitive assessments. In cases where the goal is to obtain a general estimate of reliability rather than precise measurement, an ICC in this range still provides valuable insights, especially in practical or resource-limited settings. For greater confidence and precision in measurement reliability, an ICC above 0.7 would be ideal, as seen in the SDQ-total difficulties and DASS-depression subscales.

It’s important to acknowledge the limitations of this study. The generalizability of the findings may be constrained by the sample demographics and the specific context in which the assessments were conducted. Although mother–child pairs were recruited from eight health centers across different regions of Turkey, the study ultimately reflects a hospital-based sample. Furthermore, the applicability of a measurement tool developed in one country to other countries and cultural contexts is a critical concern. Therefore, both the extension of findings from a hospital-based sample to the general population and cross-cultural generalizations of SRMH and MRCMH measures need further evaluation. Additionally, mothers’ perceptions of their own and their children’s mental health may change over time. Longitudinal studies are needed to explore potential changes in SRMH and MRCMH scores over time and across different settings. Another limitation is the reliance on self-report measures, which may introduce response biases. Moreover, the cross-sectional design of the study precludes the establishment of causal relationships. As this was a validation study, adjustments for multiple comparisons were not applied, and complex interactions or multiple effects were not explored.

The favorable psychometric properties observed for the single-item MRCMH suggest that it can serve as an efficient and practical screening tool for assessing mental health difficulties among preschool-aged children during well-child visits. Similarly, the SRMH offers a straightforward method for capturing maternal mental health status. Implementing such brief, validated tools could enhance early identification and management of mental health concerns in routine pediatric and maternal care, particularly in busy clinical settings where time constraints limit the use of lengthy assessment instruments.

Based on the findings, a caregiver- and preschool teacher–rated version of the single-item MRCMH could be developed to broaden its applicability across different care settings. Future efforts should aim to validate the agreement between MRCMH scores and external ratings provided by caregivers and teachers. Additionally, adaptation of the SRMH and MRCMH measures for children with chronic illnesses and those receiving social care services could address the needs of more vulnerable populations. Making these tools accessible to healthcare providers and social workers could facilitate broader mental health surveillance and support services.

Future Perspectives should focus on validating the SRMH and MRCMH measures across diverse cultural settings to establish their cross-cultural applicability. Longitudinal studies are needed to assess the stability and sensitivity of these single-item measures over time. Furthermore, exploring the utility of these tools in different clinical contexts, such as chronic disease management or social care, could extend their impact. Development of digital platforms integrating single-item mental health screening into electronic health records could further streamline mental health monitoring in pediatric and maternal healthcare practices.

In summary, the outcomes of this psychometric evaluation underscore the favorable measurement characteristics of the single-item MRCMH for gauging mental health difficulties in preschool children. The robust validity and satisfactory reliability observed in this assessment substantiate the potential utility of the MRCMH as an effective tool in this domain. Similarly, the single-item SRMH exhibits promise in measuring depression, anxiety, and distress among mothers of under-five children, with findings indicating a moderate level of validity and reliability. Furthermore, the effectiveness of the MRCMH and SRMH in clinical settings needs to be explored through comprehensive epidemiologic surveys, considering practicality and accuracy, without unduly increasing the respondent burden and workload.

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Study conception and design: ÖT, MEN, BG, AB, EKÜ, NK, ZYÖ, HA; Acquisition of data: ÖT, MEN, BG, AB, EKÜ, NK, ZYÖ, HA; Data transfer from google form to SPSS database and coding; SSY; Analysis and interpretation of data: ÖT, SSY; Drafting of manuscript: ÖT; Critical revision: SSY; All authors approved the final version of manuscript and agree to be accountable for authenticity and integrity of the work.

Correspondence to Sıddika Songül Yalçın.

Mersin University Ethics Committe approved the study (MEU 2023/240) in accordance with the Declaration of Helsinki. Informed consent is obtained from all parents.

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The authors declare no competing interests.

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