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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH

Authors: Debbie C. Hocking, Serafino G. Mancuso, Suresh Sundram

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

There is no screening tool for major depressive disorder (MDD) or post-traumatic stress disorder (PTSD) in asylum-seekers or refugees (ASR) that can be readily administered by non-mental health workers. Hence, we aimed to develop a brief, sensitive and rapidly administrable tool for non-mental health workers to screen for MDD and PTSD in ASR.

Methods

The screening tool was developed from an extant dataset (n = 121) of multiply screened ASR and tested prospectively (N = 192) against the M.I.N.I. (Mini International Neuropsychiatric Interview) structured psychiatric interview. Rasch, Differential Item Functioning and ROC analyses evaluated the psychometric properties and tool utility.

Results

A 9-item tool with a median administration time of six minutes was generated, comprising two ‘immediate screen-in’ items, and a 7-item scale. The prevalence of PTSD &/or MDD using the M.I.N.I. was 32%, whilst 99% of other diagnosed mental disorders were comorbid with one or both of these. Using a cut-score of ≥2, the tool provided a sensitivity of 0.93, specificity of 0.75 and predictive accuracy of 80.7%.

Conclusions

A brief sensitive screening tool with robust psychometric properties that was easy to administer at the agency of first presentation was developed to facilitate mental health referrals for asylum-seekers and new refugees.
Appendix
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Literature
1.
UNHCR: Global Trends: the world at war. In.; 2014.
2.
Heeren M, Mueller J, Ehlert U, Schnyder U, Copiery N, Maier T. Mental health of asylum seekers: a cross-sectional study of psychiatric disorders. BMC Psychiatry. 2012;12:114-21.
3.
Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J, Holland A, St. Clair J, SooHoo J. The refugee health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202–9.CrossRefPubMed
4.
Shannon PJ, Im H, Becher E, Simmelink J, Wieling E, O’Fallon A. Screening for War Trauma, Torture, and Mental Health Symptoms Among Newly Arrived Refugees: A National Survey of U.S. Refugee Health Coordinators. Journal of Immigrant & Refugee Studies. 2012;10(4):380–94.CrossRef
5.
Shannon PJ, Vinson GA, Wieling E, Cook T, Letts J. Torture, war trauma, and mental health symptoms of newly arrived Karen refugees. Journal of Loss and Trauma. 2015;20(6):1–14.CrossRef
6.
Hvass AMF, Wejse C. Systematic health screening of refugees after resettlement in recipient countries: a scoping review. Ann Hum Biol. 2017;44:1–9.CrossRef
7.
Barnes DM. Mental health screening in a refugee population: a program report. J Immigr Health. 2001;3(3):141–9.CrossRefPubMed
8.
McMahon J, MacFarlane A, Avalos G, Cantillon P, Murphy AW. A survey of asylum seekers’ general practice service utilisation and morbidity patterns. Ir Med J. 2007;100(5):461–4.PubMed
9.
Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA. 2005;294(5):602–12.CrossRefPubMed
10.
Steel Z, Chey T, Silove DM, Marnane C, Bryant RA, van Ommeren MH. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.CrossRefPubMed
11.
Gerritsen AA, Bramsen I, Devillé W, van Willigen LH, Hovens JE, van der Ploeg HM. Physical and mental health of afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2006;41(1):18–26.CrossRefPubMed
12.
Toar M, O'Brien KK, Fahey T. Comparison of self-reported health & healthcare utilization between asylum seekers and refugees: An observational study. BMC Public Health. 2009;9:214–24.CrossRefPubMedPubMedCentral
13.
Heeren M, Wittmann L, Ehlert U, Schnyder U, Maier T, Müller J. Psychopathology and resident status–comparing asylum seekers, refugees, illegal migrants, labor migrants, and residents. Compr Psychiatry. 2014;55(4):818–25.CrossRefPubMed
14.
Hocking DC, Kennedy GA, Sundram S. Social factors ameliorate psychiatric disorders in community-based asylum seekers independent of visa status. Psychiatry Res. 2015;230(2):628–36.CrossRefPubMed
15.
World Health Organization. Mental health action plan 2013–2020. In: Geneva: world health organisation; 2013.
16.
Laban CJ, Gernaat H, Komproe IH, De Jong JTVM. Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2007;42(10):837–44.CrossRefPubMedPubMedCentral
17.
Stolk Y, Kaplan I, Szwarc J. Clinical use of the Kessler psychological distress scales with culturally diverse groups. Int J Methods Psychiatr Res. 2014;23(2):161–83.CrossRefPubMed
18.
Dowling A, Enticott J, Russell G. Measuring self-rated health status among resettled adult refugee populations to inform practice and policy – a scoping review. BMC Health Serv Res. 2017;17(1):817.CrossRefPubMedPubMedCentral
19.
Beusenberg M, Orley JH, Organization WH: A User's guide to the self reporting questionnaire (SRQ-20). 1994.
20.
21.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):600–13.CrossRef
22.
Liebschutz J, Saitz R, Brower V, Keane T, Lloyd-Travaglini C, Averbuch T, Samet J. PTSD in Urban Primary Care: high prevalence and low physician recognition. J Gen Intern Med. 2007;22(6):719–26.CrossRefPubMedPubMedCentral
23.
Ehlers A, Gene-Cos N, Perrin S. Low recognition of post-traumatic stress disorder in primary care. London Journal of Primary Care. 2009;2(1):36-42.
24.
Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Mental health treatment received by primary care patients with posttraumatic stress disorder. The Journal of Clinical Psychiatry. 2003;64(10):1230–6.CrossRefPubMedPubMedCentral
25.
Hocking DC, Sundram S. Screening tool for asylum-seeker mental health (STAMH): a pilot study. Eur Psychiatry. 2016;33:S231.
26.
Mollica RF, LS MD, Massagli MP, Silove DM. Measuring Trauma, Measuring Torture: Instructions and guidance on the utilization of the Harvard Program in Refugee Trauma’s versions of the Hopkins Symptom Checklist-25 (HSCL-25) & the Harvard Trauma Questionnaire (HTQ). Cambridge, MA: Harvard Program in Refugee Trauma; 2004.
27.
Momartin S, Steel Z, Coello M, Aroche JR, Silove D, Brooks R. A comparison of the mental health of refugees with temporary versus permanent protection visas. In: Med J Aust, vol. 185; 2006. p. 357–61.
28.
Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS. Nonspecific psychological distress and other dimensions of psychopathology: measures for use in the general population. Arch Gen Psychiatry. 1980;37(11):1229–36.CrossRefPubMed
29.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.PubMed
30.
Sheehan D, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan M, Dunbar G. The validity of the MINI international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12(5):232–41.CrossRef
31.
Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, Janavs J, Dunbar GC. The MINI international neuropsychiatric interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–31.CrossRef
32.
33.
Jankovic J, Bremner S, Bogic M, Lecic-Tosevski D, Ajdukovic D, Franciskovic T, Galeazzi GM, Kucukalic A, Morina N, Popovski M, et al. Trauma and suicidality in war affected communities. Eur Psychiatry. 2013;28(8):514–20.CrossRefPubMed
34.
Priebe S, Bogic M, Ajdukovic D, Franciskovic T, Galeazzi GM, Kucukalic A, Schutzwohl M. Mental disorders following war in the Balkans: a study in 5 countries. JAMA Psychiatry. 2010;67(5):518–28.
35.
Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.CrossRefPubMed
36.
Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.CrossRefPubMed
37.
Lhewa D, Banu S, Rosenfeld B, Keller A. Validation of a Tibetan translation of the Hopkins symptom checklist–25 and the Harvard trauma questionnaire. Assessment. 2007;14(3):223–30.CrossRefPubMed
38.
Khuon F, Lavelle J. Indochinese versions of the Hopkins symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.CrossRefPubMed
39.
Tinghög P, Carstensen J. Cross-cultural equivalence of HSCL-25 and WHO (ten) wellbeing index: findings from a population-based survey of immigrants and non-immigrants in Sweden. Community Ment Health J. 2010;46(1):65–76.CrossRefPubMed
40.
Levav I, Kohn R, Billig M. The protective factor of religiosity under terrorism. Psychiatry: Interpersonal and Biological Processes. 2008;71(1):46–58.CrossRef
41.
Shrout PE, Dohrenwend BP, Levav I. A discriminant rule for screening cases of diverse diagnostic types: preliminary results. J Consult Clin Psychol. 1986;54(3):314–9.CrossRefPubMed
42.
Gilboa S, Levav I, Gilboa L, Ruiz F. The epidemiology of demoralization in a kibbutz. Acta Psychiatr Scand. 1990;82(1):60–4.CrossRefPubMed
43.
Ritsner M, Rabinowitz J, Slyuzberg M. The Talbieh brief distress inventory: a brief instrument to measure psychological distress among immigrants. Compr Psychiatry. 1995;36(6):448–53.CrossRefPubMed
44.
Ritsner M, Ponizovsky A, Chemelevsky M, Zetser F, Durst R, Ginath Y. Effects of immigration on the mentally III—does it produce psychological distress? Compr Psychiatry. 1996;37(1):17–22.CrossRefPubMed
45.
Dohrenwend BP, Levav I, Shrout PE. Screening scales from the psychiatric epidemiology research interview (PERI). In: Weissman A, Myers JK, Ross CE, editors. Community Surveys of Psychiatric Disorders. New Jersey: Rutgers University Press; 1986.
46.
Lerner Y, Kertes J, Zilber N. Immigrants from the former soviet union, 5 years post-immigration to Israel: adaptation and risk factors for psychological distress. Psychol Med. 2005;35(12):1805.CrossRefPubMed
47.
Silove DM, Steel Z, McGorry P, Mohan P. Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants. Acta Psychiatr Scand. 1998;97(3):175–81.CrossRefPubMed
48.
Silove DM, Sinnerbrink I, Field A, Manicavasagar VL, Steel Z. Anxiety, depression and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Br J Psychiatry. 1997;170:351–7.CrossRefPubMed
49.
Schweitzer RD, Melville F, Steel Z, Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust N Z J Psychiatry. 2006;40(2):179–88.CrossRefPubMed
50.
Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik I. Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry. 2006;188:58–64.CrossRefPubMed
51.
Laban CJ, Gernaat H, Komproe IH, van der Tweel, I.,, De Jong JTVM: Post-migration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2005, 193(12):825–832.
52.
Ryan DA, Benson C, Dooley B. Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland. J Nerv Ment Dis. 2008;196(1):37–45.CrossRefPubMed
53.
R Core Team: R: A language and environment for statistical computing. Version 3.2.2. Vienna, Austria: R Foundation for Statistical Computing; 2015.
54.
Mair P, Hatzinger R. Extended Rasch modeling: the eRm package for the application of IRT models in R. J Stat Softw. 2007;20(9):1–20.CrossRef
55.
Rizopoulos D: ltm: An R package for latent variable modeling and item response theory analyses.
56.
Rasch G. An item analysis which takes individual differences into account. The British journal of mathematical and statistical psychology. 1966;19(1):49–57.CrossRefPubMed
57.
Bond TG, Fox CM. Applying the Rasch model: fundamental measurement in the human sciences, vol. 2. New Jersey: Lawrence Erlbaum Associates; 2007.
58.
Drasgow F, Lissak RI. Modified parallel analysis: a procedure for examining the latent dimensionality of dichotomously scored item responses. J Appl Psychol. 1983;68(3):363–73.CrossRef
59.
Ponocny I. Nonparametric goodness-of-fit tests for the rasch model. Psychometrika. 2001;66(3):437–59.
60.
Linacre JM. What do infit and outfit, mean-square and standardized mean. Rasch Measurement Transactions. 2002;16(2):878.
61.
Wright BD, Linacre JM, Gustafson J, Martin-Lof P. Reasonable mean-square fit values. Rasch measurement Transactions. 1994;8(3):370.
62.
Wright BD, Stone MH. Measurement essentials. 2nd ed. Wide Range Inc: Wilmington; 1999.
63.
Swaminathan H, Rogers HJ. Detecting differential item functioning using logistic regression procedures. J Educ Meas. 1990;27(4):361–70.CrossRef
64.
Magis D, Béland S, Tuerlinckx F, De Boeck P. A general framework and an R package for the detection of dichotomous differential item functioning. Behav Res Methods. 2010;42(3):847–62.CrossRefPubMed
65.
Nagelkerke NJ. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–2.CrossRef
66.
Gómez-Benito J, Hidalgo MD, Padilla J-L. Efficacy of effect size measures in logistic regression: an application for detecting DIF. Methodology. 2009;5(1):18–25.CrossRef
67.
Jodoin MG, Gierl MJ. Evaluating type I error and power rates using an effect size measure with the logistic regression procedure for DIF detection. Appl Meas Educ. 2001;14(4):329–49.CrossRef
68.
Kim J, Oshima TC. Effect of multiple testing adjustment in differential item functioning detection. Educ Psychol Meas. 2013;73(3):458–70.CrossRef
69.
Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper. Arthritis Care & Research. 2007;57(8):1358–62.CrossRef
70.
Briggs SR, Cheek JM. The role of factor analysis in the development and evaluation of personality scales. J Pers. 1986;54(1):106–48.CrossRef
71.
Zhou XH, Obuchowski NA, DK MC. Statistical methods in diagnostic medicine. New York: Wiley-Interscience; 2002.CrossRef
72.
Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models,evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.
73.
74.
75.
Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez J-C, Müller M. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12(1):1–8.CrossRef
76.
77.
Silove DM, Steel Z. Understanding community psychosocial needs after disasters: implications for mental health services. In: J Postgrad Med, vol. 52; 2006. p. 121–5.
78.
Silove DM, Steel Z, Watters C. Policies of deterrence and the mental health of asylum seekers. JAMA. 2000;284(5):604–11.CrossRefPubMed
79.
Kleijn W, Hovens J, Rodenburg J. Posttraumatic stress symptoms in refugees: assessments with the Harvard trauma questionnaire and the Hopkins symptom checklist–25 in different languages. Psychol Rep. 2001;88(2):527–32.CrossRefPubMed
80.
Nickerson A, Schick M, Schnyder U, Bryant RA, Morina N. Comorbidity of posttraumatic stress disorder and depression in tortured, treatment-seeking refugees. J Trauma Stress. 2017;30(4):409–15.CrossRefPubMed
81.
Karam EG. Comorbidity of posttraumatic stress disorder and depression. In: Fullerton C, Ursano RJ, editors. Posttraumatic stress disorder: Acute and long-term responses to traumas and disaster. Washington DC: American Psychiatric Press; 1997. p. 77–90.
82.
Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMed
Metadata
Title
Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH
Authors
Debbie C. Hocking
Serafino G. Mancuso
Suresh Sundram
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1660-8

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