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

Abstract

BackgroundThere 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.MethodsThe 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.ResultsA 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%.ConclusionsA 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.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1660-8) contains supplementary material, which is available to authorized users.

Prolonged Grief Disorder Among Refugees in Psychological Treatment—Association With Self-Efficacy and Emotion Regulation

“…In the Swiss context, socio-cultural and structural barriers to accessing mental health care by refugees and asylum-seekers may include language difficulties, problems related to medical or authority gatekeepers, lack of resources, lack of awareness about health, fear of stigma, and mismatch between the local health system and perceived needs of refugees and asylum seekers (78). Over and above addressing these barriers to psychological assessment and treatment in general, our findings underline the importance of independent grief assessment, which is often not included in screening instruments for refugees (79,80). Despite the confounding effect of experiencing both traumatic events and interpersonal loss, refugees and conflict-affected populations seem to present distinctive symptom profiles of PGD and/or PTSD (18,21,26).…”

The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis

“…None of these instruments were developed specifically for refugee populations but have been widely used in different cultural contexts. Nine studies mentioned the reliability or validity of the used instruments [ 23 , 35 , 36 , 39 , 41 , 44 – 46 , 51 ]. Thirteen studies conducted the assessment in the refugee’s native language [ 25 , 31 , 32 , 37 , 39 , 42 , 43 , 45 – 47 , 51 – 53 ].…”

“…All were observational, except one RCT from which we included baseline prevalence data [24]. Studies were undertaken in 15 countries: Australia (652 refugees) [33][34][35][36][37], Austria (150) [38], China (65) [32], Germany (1,104) [39][40][41][42][43][44], Italy (297) [39], Lebanon (646) [45,46], Nepal (574) [25], Norway (64) [23], South Korea (200) [47], Sweden (86) [48], Switzerland (164) [49,50], Turkey (238) [51], Uganda (77) [24], UK (420) [39,52], and the US (406) [31,53]. Participants were from four geographic regions: the Middle East (43%), Europe (29%), Asia (20%), and Africa (5%), with two studies reporting refugee samples coming from 18 different countries (3%) [26,41] (97% of total sample due to unreported countries of origin).…”

“…Six studies of psychotic illness were identified (n = 1,695) [23,31,36,39,43,45]. Participants had a weighted mean age of 37.6 years and 51% were female.…”

“…Thirteen studies were assigned a low risk of bias and determined to be of high quality [23,24,35,37,38,40,[45][46][47][48][49][50]53]. Nine studies demonstrated moderate risk of bias PLOS MEDICINE [25,33,34,36,39,41,44,51,52]. A moderate rating was assigned to studies that had issues with the representativeness of their sample or used nonrandom sampling techniques.…”