Mental disorders, disability and treatment gap in a protracted
                        refugee setting

Llosa, Augusto E.; Ghantous, Zeina; Souza, Rodrigo Barbosa de; Forgione, Fabio; Bastin, Pierre; Jones, Alison Snow; Antierens, Annick; Slavuckij, Andrei; Grais, Rebecca F.

doi:10.1192/bjp.bp.112.120535

Cited by 44 publications

(68 citation statements)

References 31 publications

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“…The sample of 748 of participants from 283 households was 50.9% female with a mean age of 39 years (Standard Deviation, SD = 15.8) [14]. Overall, 246 of 748 adults (32.9%) screened positive by the household informant method, with 11 by vignette alone, 195 by WASSS-H alone, and 40 by both.…”

Section: Resultsmentioning

confidence: 99%

“…55 of 80 (68.8%) selected to undergo phase 2 accepted and completed reappraisal procedures. The overall, adjusted prevalence of current mental disorders was 19.4% (12.6–26.2) [14]. …”

Section: Resultsmentioning

confidence: 99%

“…Exclusion of some modules of the MINI (e.g. substance abuse and personality disorders [14]. ) could have affected instrument performance estimates, for instance driving down the positive predictive value if they were picked up on screening but not on confirmation due to omission of the corresponding modules.…”

Section: Discussionmentioning

confidence: 99%

“…Information on the methods of our survey has been published previously [14]. Briefly, the survey adopted a two-phase (screen-confirm) strategy,[22, 23] in which the screening phase (phase 1) utilized four screening tools and two methods, namely, household informant and individual interviews.…”

Section: Methodsmentioning

confidence: 99%

“…Previously we reported on a 2010 population-based survey conducted in the Burj el-Barajneh refugee camp in Lebanon to assess the prevalence of mental disorders amongst camp residents, as well as to inform organizations providing mental health support in the camp and its surroundings. We estimated that one fifth of adults in the camp had at least one current mental disorder, and we found that these disorders were disabling and nearly ubiquitously untreated [14]. …”

Section: Introductionmentioning

confidence: 99%

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A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

Llosa¹,

Ommeren

Kolappa

et al. 2017

BMC Psychiatry

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BackgroundTime and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.MethodsLay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.ResultsThe 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.ConclusionsOur results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1154-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…55 of 80 (68.8%) selected to undergo phase 2 accepted and completed reappraisal procedures. The overall, adjusted prevalence of current mental disorders was 19.4% (12.6–26.2) [14]. …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

Llosa¹,

Ommeren

Kolappa

et al. 2017

BMC Psychiatry

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At risk or not at risk? A meta‐analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

et al. 2015

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An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR1 and CHR2). The reference index was psychosis onset over time in both CHR1 and CHR2 subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR1: N51,359; CHR2: N51,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR1 subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide.

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Severe Mental Disorders and Neuropsychiatric Conditions in Refugee Children and Adolescents

Liu

Chowdhary

2020

Child, Adolescent and Family Refugee Mental Health

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Mental disorders, disability and treatment gap in a protracted refugee setting

Cited by 44 publications

References 31 publications

A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

At risk or not at risk? A meta‐analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

Severe Mental Disorders and Neuropsychiatric Conditions in Refugee Children and Adolescents

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