Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care.

Abstract

Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multi-ethnic, newly-arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women’s health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally-responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages. An interdisciplinary community partnership was established with a local behavioral health services agency to facilitate the referral of women scoring positive on the RHS-15. Staff and provider training sessions, as well as the incorporation of bi-cultural, multi-lingual Cultural Health Navigators, greatly facilitated linguistically-appropriate care coordination for refugee women in a culturally sensitive manner. Twenty-six (23.2%) of the 112 women who completed the RHS-15 scored positive; of which 14 (53.8%) were Iraqi, one (3.8%) was Burmese, and three (11.5%) were Somali. Among these 26 women, eight (30.8%) are actively receiving mental health services, and five (19.2%) have appointments scheduled. However 13 (50%) are not enrolled in mental health care due to either declining services (46.2%), or a lack of insurance (53.8%). Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths and reduce the stigma of mental health.

Efficient identification of mental health problems in refugees in Germany: the Refugee Health Screener

“…The results are promising: The RHS successfully predicted clinically relevant symptoms of PTSD, depression, anxiety, or somatization, thereby detecting the most common mental health problems in refugees (Steel et al, 2009). Consistent with research conducted on refugee samples in the US (Hollifield et al, 2016, 2013; Johnson-Agbakwu et al, 2014; Polcher & Calloway, 2016), the RHS showed an excellent feasibility, validity, and reliability in the examined sample. It was not only applicable as an interview, but also showed good psychometric properties when carried out as a self-rating instrument, thus making it accessible for a larger variety of settings.…”

“…Notwithstanding the heterogeneity of the sample, the psychometric properties of the RHS were excellent, with a high predictability in the detection of mental health problems. The positive screening rates of previous RHS studies showed figures ranging from 23 to 46% (Hollifield et al, 2013, 2016; Johnson-Agbakwu et al, 2014; Polcher & Calloway, 2016). The higher screening rate of 52% in the RHS-15 self-rating version and 35% for clinically relevant depression, anxiety, and somatization symptoms in this study are comparable to prevalence rates of studies with similar refugee populations such as Führer et al (2016; 55% depression, 40% anxiety disorder, 18% PTSD).…”

“…The RHS-15 screens for multiple mental problems, shows good psychometric properties, and is feasible in public health settings (Hollifield et al, 2016, 2013; Johnson-Agbakwu, Allen, Nizigiyimana, Ramirez, & Hollifield, 2014; Polcher & Calloway, 2016). It assesses symptoms of the most common mental problems in refugees: PTSD, depression, and anxiety symptoms.…”

Factors affecting implementation of perinatal mental health screening in women of refugee background

“…The perceived role of bicultural workers in educating and supporting women of refugee background is supported by the literature [21, 25] and by the CCCF, which asserts that individuals’ awareness and knowledge alone are insufficient to result in culturally competent environments and organisations must also adapt services to be accessible to culturally and linguistically diverse patients [32]. That all HPs asserted a role at one or more stages of screening, referral and management confirms the need for an inter-disciplinary approach in this setting.…”

“…Previous studies of maternity care models with women of refugee background have not explored mental health screening [21, 22], system challenges or factors critical to success in rolling out a comprehensive screening and referral programme [24, 25]. …”