The Culturally and Contextually Sensitive Assessment of Mental Health using a Structured Diagnostic Interview (MINI Kid) for Syrian Refugee Children and Adolescents in Lebanon: Challenges and Solutions

Abstract

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective paper aimed to review challenges and share lessons learned from the process of administration and supervision of a structured clinical interview, the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and the Clinical Global Impression (CGI) severity scale, with N=119 Syrian refugee children (aged 8-17) resident in informal tented settlements in Lebanon. Qualitative data was derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: 1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); 2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); 3) cultural norms and meaning (impact of different meanings on answers); 4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and 5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improve accessibility, and consideration for inter-connected formulations is essential to help inform prevalence rates, treatment plans, and public health strategies.

Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH)

“…access to services). The subsample selected for clinical interview completed the MINI KID 6.0 [30]; additional information was gathered where appropriate and a Clinical Global Impression severity (CGI-s) score was assigned [31], with psychiatric diagnoses agreed by consensus during supervision with an experienced clinical psychologist [8,9]. Domains of measurement are described in Table 2 and Supplementary Section 7.…”

“…At follow-up, the same caregiver was available in n = 926 cases (92.5%); otherwise a different caregiver took part (n = 65, 6.5%) or the child took part without a caregiver (n = 9, 0.9%). Of the subsample who completed a clinical interview, n = 63 (47.0%) children were female and mean age was 12.15 years (SD = 2.15, range [8][9][10][11][12][13][14][15][16][17][18][19]; n = 130 (97.0%) mothers or other female caregivers and n = 20 (14.9%) fathers attended the appointment (in n = 16 cases, both parents attended). The mean age of the primary caregiver was 38.07 (SD = 7.54, range .…”

“…The mean age of the primary caregiver was 38.07 (SD = 7.54, range . Further details about this subsample have been reported elsewhere [8,9].…”

“…There were challenges associated with assessing mental disorders in this population given high levels of current adversity. These challenges, and the approaches taken to improve the cultural and contextual sensitivity of the assessment process, are discussed at length in Kyrillos et al [9]. Importantly, the performance of the anxiety measure proved not optimal [8] and was excluded for individual level prediction for the resilience analyses discussed below.…”

“…More broadly, there are challenges associated with differentiating mental disorders from distress and behavioural responses that are understandable or potentially adaptive in the context of a refugee camp. These issues are explored in detail in Kyrillos et al [9].…”