BackgroundThere is a scarcity of adapted measures to study resilience and mental health of people in humanitarian settings in Africa. The aim of this study was to identify the factor structure and other psychometric properties of the Sense of Coherence (SoC-13) scale in Eritrean refugees living in Ethiopia.MethodsIn a cross-sectional survey, 562 adults were selected randomly from Eritrean refugees living in Mai Aini camp, Ethiopia. The SoC-13, the Center for Epidemiologic Studies Depression scale (CES-D), the Pre and Post-Migration Living Difficulties checklist, the Primary Care Post-Traumatic Stress Disorder screener (PC-PTSD), the Oslo Social Support Scale (OSS-3), the Coping Style scale and the Fast Alcohol Screening Test (FAST) were administered concurrently. Confirmatory Factor Analysis (CFA) was used to investigate the factor structure of the SoC-13 using IBM SPSS Amos, version 21.ResultA one factor model of the SoC with twelve items had the best fit to the current data (CFA = 0.982, RMSEA = 0.035 [90%CI = 0.018, 0.050]), with good internal consistency (Cronbach’s Alpha = 0.75). When all 13 items of the Tigrigna version were considered, there was an inverse association of SoC-13 with PC-PTSD(r = − 0.433, p < 0.001), CES-D (r = − 0.597, p < 0.001), Pre and post-migration living difficulties checklist (r = − 0.265, p < .001and r = − 0.249, p < 0.001 respectively), and FAST (r = − 0.105, p < 0.001), providing support for the divergent validity of the scale. The SoC-13 was associated positively with the Oslo Social Support scale (OSS-3)(r = 0.363 p < 0.001) and task-oriented coping (r = 0.089, p < 0.001), demonstrating convergent validity. The four items, specifically item-1, item-2, item-3 and item-12 have shown relatively weaker item loadings (β<0.40); but item-2 demonstrated non-significant loading (β = 0.06, p>0.05) in a one factor model of SoC-13.ConclusionsAlthough the 13-items of the Tigrigna version of the SoC scale loaded significantly onto their respective factors in the three factor model, only 12 items loaded significantly onto the one factor model, which demonstrated superior fit to the current data. Keeping in mind that future research should examine the conceptualizations of the four items demonstrating poor convergent validity in this Eritrean sample, the reduced Tigrigna version of SoC-12 is a reasonable measure of sense of coherence in this community.Electronic supplementary materialThe online version of this article (10.1186/s13031-019-0185-1) contains supplementary material, which is available to authorized users.

BackgroundDepression is among the top mental health problems with a major contribution to the global burden of disease. This study aimed at identifying the latent factor structure and construct validity of the Center for Epidemiologic Studies Depression (CES-D) Scale.Participants and settingA cross-sectional survey of 562 adults aged 18 years and above who were randomly selected from the Eritrean refugee community living in the Mai-Aini refugee camp, Ethiopia.MeasuresThe CES-D Scale, Primary Care PTSD (PC-PTSD) screener, premigration and postmigration living difficulties checklist, Oslo Social Support Scale (OSS-3), Sense of Coherence Scale (SoC-13), Coping Style Scale and fast alcohol screening test (FAST) were administered concurrently. Confirmatory factor analysis was employed to test prespecified factor structures of CES-D.ResultFirst-order two factors with second-order common factor structure of CES-D (correlated error terms) yielded the best fit to the data (Comparative Fit Index =0.975; root mean square error of approximation=0.040 [90% CI 0.032 to 0.047]). The 16 items defining depressive affect were internally consistent (Cronbach’s α=0.932) and internal consistency of the 4 items defining positive affect was relatively weak (Cronbach’s α=0.703). These two latent factors have a weaker standardised covariance estimate of 33% (24% for women and 40% for men), demonstrating evidence of discriminant validity. CES-D is significantly associated with measures of adversities, specifically, premigration living difficulties (r=0.545, p<0.001) and postmigration living difficulties (r=0.47, p<0.001), PC-PTSD (r=0.538, p<0.001), FAST (r=0.197, p<0.001) and emotion-oriented coping (r=0.096, p˂0.05) providing evidence of its convergent validity. It also demonstrated inverse association with measures of resilience factors, specifically, SoC-13 (r=−0.597, p<0.001) and OSS-3 (r=−0.319, p<0.001). The two correlated factors model of CES-D demonstrated configural, metric, scalar, error variance and structural covariance invariances (p>0.05) for both men and women.ConclusionsUnlike previous findings among Eritreans living in USA, second-order two factors structure of CES-D best fitted the data for Eritrean refugees living in Ethiopia; this implies that it is important to address culture for the assessment and intervention of depression.

ObjectiveThis study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and psychological symptoms in a refugee population in sub-Saharan Africa.MethodsA cross-sectional survey design was employed to collect data. The study was carried out in Mai Aini refugee camp in Ethiopia. A total of 562 adult Eritrean refugees aged 18–74 years were selected randomly to screen for depression and post-traumatic stress disorder (PTSD) symptoms and to examine associated factors. Data were collected using the premigration and postmigration living difficulties checklist, Center for Epidemiologic Studies Depression (CES-D) scale, Primary Care PTSD Screener, coping style scale, Sense of Coherence scale and Oslo Social Support scale. Path modelling was used to test the mediation and moderation effects of prespecified factors.ResultsPremigration living difficulties were associated directly with symptoms of PTSD (β=0.09, p<0.05), and associated indirectly with PTSD symptoms in paths through duration of stay in the camp, sense of coherence, postmigration living difficulties, task-oriented coping style and depressive symptoms (β=0.26, p<0.01). Premigration and postmigration living difficulties were associated directly with depressive symptoms with standardised estimate of β=0.35(p<0.001) and β=0.23(p<0.05), respectively. Postmigration living difficulties were associated indirectly with PTSD through paths of sense of coherence, task-oriented coping style and depressive symptoms (β=0.13; p<0.01). Social support moderated the effect of postmigration living difficulties on depressive symptoms (p<0.05). Emotion-oriented coping style moderated the effect of premigration threat for abuse on PTSD (β=−0.18, p<0.001) and depressive (β=−0.12, p<0.01) symptoms, as well as moderating threat to life on PTSD symptoms (β=−0.13, p<0.001).ConclusionsSense of coherence and task-oriented coping style showed a partial mediating effect on the association between exposure to trauma and symptoms of PTSD. An emotion-oriented coping style and social support moderated the effect of premigration and postmigration living difficulties, respectively. Fostering social support, task-oriented and emotion-oriented coping styles may be beneficial for these refugees.