儿童青少年心理问题受到国际科学研究与社会的普遍关注。心理问题常常根据症状进行划分，如重度抑郁发作、恶劣心境、创伤后应激障碍等多种。心理问题共患现象普遍，存在某种心理问题的个体中，有一半的个体同时还有第二种、第三种甚至更多的心理问题。据估计，心理问题共患比率高达50%，远高于偶然发生概率(Newman, Moffitt, Caspi, & Silva, 1998)。这提示，心理问题可能在基于症状的特异性类别外，还存在一定普遍性。 本研究采用当前儿童青少年心理问题筛选和评估的两项常用工具，儿童青少年心理问题筛查访谈工具（MINI-KID），以及长处与困难问卷（SDQ），结合父母报告儿童青少年、儿童青少年自我报告的数据，拟从多评估者、多评估工具的情境中，采用验证性因素分析，基于当前研究提出的心理问题的两因素、三因素、以及增加一个一般性公共因子等先验模型，探讨儿童青少年心理问题的结构，并在不同地区予以验证。MINI-KID是从精神障碍诊断手册第四版（DSM-IV）和国际精神障碍分类手册（ICD-10）发展出的一个心理问题筛查的简短定式访谈工具。中文版MINI-KID由北医六院王玉凤团队修订。SDQ是Goodman发展出的一份简短的25项情绪和行为评估问卷，用于评估儿童青少年的行为和情绪问题的《长处和困难问卷》，中文版SDQ由http://www.sdqinfo.org网站上获得。 本研究的被试为来自北京和成都的1241名6-12岁的儿童青少年和其父亲或母亲，其中606名被试来自北京，635名被试来自成都。1241名父母接受访谈，完成父母报告儿童青少年的MINI-KID、1241名父母填写了SDQ问卷，评定儿童青少年的心理适应。6-12岁儿童青少年接受访谈，完成了儿童青少年自我报告的MINI-KID。MINI-KID访谈员建立了和MINI-KID修订者北医六院王玉凤医生的一致性信度100%。父母报告儿童青少年的SDQ的内部一致性系数（Cronbach’s alpha）除同伴关系量表（α= 0.36）和品行问题量表（α= 0.39）外，情绪困难、注意困难、亲社会行为分量表的内部一致性系数较好（α = 0.61-0.78），与Goodman在英国进行的先前研究相似（Goodman, 2001）。使用验证性因素分析的方法，本研究检验对比了两因素模型、三因素模型、以及增加一个一般性公共因子的模型。 研究结果表明： （1）基于MINI-KID，分别在父母报告儿童青少年、儿童青少年自我报告中对儿童青少年心理问题的两因素、三因素、以及增加一个一般性公共因子等先验模型进行检验，儿童青少年心理问题的三因素增加一个一般性公共因子模型拟合结果相对最优，卡方值、CFI、TLI、RMSEA、SRMR等各项参数显示拟合均较好。儿童青少年心理问题可以划分为情绪-焦虑问题、恐惧、外化问题三个维度，且所有12个症状均负载在一个公共因子上（如图1图c所示）。其中，情绪-焦虑问题包括重度抑郁发作、恶劣心境、创伤后应激障碍三个症状，恐惧包括惊恐障碍、广场恐怖、离别性焦虑障碍、社交恐怖（社交焦虑障碍）、特定恐怖症五个症状，外化问题包括注意缺陷多动障碍、品行障碍、对立违抗障碍这三个症状。该模型结果经成都、北京两地验证，具有稳定性。 （2）基于MINI-KID，结合基于父母报告儿童青少年和儿童青少年自我报告，验证性因素分析结果同样显示儿童青少年心理问题的三因素增加一个一般性公共因子模型拟合结果相对最优（如图2图c），卡方值、CFI、TLI、RMSEA、SRMR等各项参数显示拟合均较好。可见，多报告者共同评估情境中，儿童青少年心理问题的内在结构与单一报告者评估结果具有一致性。该模型结果经成都、北京两地验证，具有稳定性。 （3）进一步结合MINI-KID和SDQ两种工具以及父母和儿童青少年报告，验证性因素分析结果表明，儿童青少年心理问题的三因素增加一个一般性公共因子模型拟合结果相对最优（如图3图c），卡方值、CFI、TLI、RMSEA、SRMR等各项参数显示拟合均较好。 因此，儿童青少年心理问题的三因素增加一个一般性公共因子模型在不同报告者、不同报告方法共同评估下均具有适用性。其中情绪-焦虑问题包括重度抑郁发作、恶劣心境、创伤后应激障碍、广泛焦虑障碍四个症状，以及父母报告儿童青少年SDQ中“我经常头痛、肚子痛或身体不舒服”、“我经常担忧，心事重重”、“我经常不快乐、心情沉重或流泪”和“我在新的环境中会感到紧张，我很容易失去自信”四道题；恐惧包括惊恐障碍、广场恐怖、离别性焦虑障碍、社交恐怖（社交焦虑障碍）、特定恐怖症五个症状，以及父母报告儿童青少年SDQ中的“我心中有许多恐惧，我很容易受惊吓”，外化问题包括注意缺陷多动障碍、品行障碍、对立违抗障碍这三个症状，以及父母报告儿童青少年的SDQ中的品行问题五道题、多动注意困难五道题，同时，所有题目负载在增加一个一般性公共因子模型上。该模型结果经成都、北京两地验证，具有稳定性。 综上，儿童青少年心理问题可划分为情绪-焦虑问题、恐惧、外化问题三个维度，且所有症状存在一个一般性的公共因子。本研究系统检验、比较了当前研究提出的心理问题两因素、三因素、及增加一个一般性公共因子等结构假设，并采用了多报告者、多工具评价的数据，在不同地区中对模型稳定性进一步检验。研究结果为理解心理问题的共患现象提供了实证研究证据(Newman, Moffitt, Caspi, & Silva, 1998)，并为研究和临床实践中分析儿童青少年心理问题提供了实证依据。儿童青少年心理问题中存在一个公共因子，这提示儿童青少年心理问题不仅表现出一定特异性，而且具有一定内在联系。因此，儿童青少年心理健康的日常教育、问题预防不能仅仅停留于诊断出某类问题予以关注，还要同时关注儿童青少年整体的心理健康状况和相关影响因素。

The mental health problems of children and adolescents have received widespread attention from international science communities and society. Mental health problems are often classified into different symptoms, such as major depression, post-traumatic stress disorder and so on. Among individuals with certain mental health problems, half of them have second, third, or even more problems. The comorbidity rate of mental health problems is as high as 50% (Newman, Moffitt, Caspi, & Silva, 1998). A certain common factor may exist in addition to various specific categories based on symptoms. This study used two commonly used instruments for the screening and evaluation of current mental health problems for children and adolescents, the MINI-KID screening interview for children and adolescents, and the Strengths and Difficulty Questionnaire (SDQ). MINI-KID is a short-term and structural interview for mental health problem screening derived from DSM-IV and ICD-10. The Chinese version of MINI-KID was developed by Dr. Wang Yufeng and her colleagues at the sixth hospital of Beijing Medical University. The Strengths and Difficulty Questionnaire (SDQ) is a 25-item emotional and behavioral assessment questionnaire developed by Goodman. The Chinese version of the SDQ was acquired from http://www.sdqinfo.org maintained by Goodman’s team. This study used data from 1241 children from Beijing and Chengdu and their fathers or mothers, of whom 606 were from Beijing and 635 from Chengdu. Total 1241 parents were interviewed with MINI-KID, and completed SDQ questionnaires to assess children's psychological adaptation. Children were interviewed their self-reported MINI-KID. Using a confirmatory factor analysis approach, we compared the two-factor model, the three-factor model, and three factor with a general factor model. Results indicated: (1) Based on the MINI-KID screening tool for children's psychological problems, the three factor with a general factor model of children's psychological problems had the best model fit index based on parent-reported and self-reported of children and adolescents. That is, children and adolescents' psychological problems could be classified into three dimensions: emotional and anxiety problems, fear, and externalization problems (as shown in Figure 1c). At the same time, all 12 symptoms were loaded on a common factor. (2) Based on the MINI-KID, combined with self-reports of children and adolescents and children and adolescents based on parental reports, the confirmatory factor analysis results also showed that the three factor with a general factor model of children's psychological problems had the best model fit index. That is, children and adolescents' psychological problems could be classified into three dimensions: emotional and anxiety problems, fear, and externalization problems (as shown in Figure 2c). At the same time, all 12 symptoms were loaded on a common factor. (3) Further combining the MINI-KID and SDQ tools and the parent and child adolescent reports, confirmatory factor analysis results show that the three factor with a general factor model of children's psychological problems had the best model fit index. That is, children and adolescents' psychological problems could be classified into three dimensions: emotional and anxiety problems, fear, and externalization problems (as shown in Figure 3c). And at the same time, all items were loaded on a common factor. The results above showed that children and adolescents' psychological problems could be classified into three dimensions: emotional and anxiety problems, fear, and externalization problems (as shown in Figure 3c). And at the same time, all items were loaded on a common factor. In summary, the psychological problems of children and adolescents could be classified into three dimensions: emotional-anxiety, fear, and externalization. There is a common factor for all symptoms. This research system tested and compared structural hypotheses such as the two factors and three factors of the psychological problems proposed in the current study, and added a general factor. It also used data from multiple reporters and multiple tools to evaluate the stability of models in different regions. The research results provided empirical evidence for understanding the comorbidity of psychological problems (Newman, Moffitt, Caspi, & Silva, 1998), and provided empirical evidence for the analysis of children and adolescents' psychological problems in research and clinical practice. There was a general factor in the psychological problems of children and adolescents. This suggested that the psychological problems of children and adolescents not only showed certain specificities, but also had certain internal relations.