Validation of the Refugee Health Screener-15 for the assessment of perinatal depression among Karen and Burmese women on the Thai-Myanmar border

Abstract

Perinatal depression is common, and left untreated can have significant and long-lasting consequences for women, their children and their families. Migrant women are at particular risk of perinatal depression as a result of a multitude of stressors experienced before, during and after migration. Identification of perinatal depression among migrant women—particularly those living in low- and middle-income regions—remains challenging, partly due to the lack of locally-validated and culturally appropriate screens tools. This study formally validates Burmese and Sgaw Karen versions of the Refugee Health Screener-15 (RHS-15) as a screening tool for perinatal depression among migrant women living on the Thai-Myanmar border. The Structured Clinical Interview for the Diagnosis of DSM-IV Disorders (SCID) was used as the gold-standard comparator. Complete results were obtained for 235 Burmese-speaking and 275 Sgaw Karen-speaking women. Despite displaying reasonable psychometric properties, a number of shortcomings associated with the RHS-15 limited its utility in this setting. The Likert-type response categories of the RHS-15 proved problematic in this low-literacy population. Combined with the relative superiority and greater ease of administration of the SCID, the RHS-15 is not recommended as the tool of choice for detecting perinatal depression in this setting.

Perinatal depression in migrant and refugee women on the Thai–Myanmar border: does social support matter?

“…The SCID provides a clinical diagnosis of depression and is thus distinct from screening instruments which are limited to identifying symptoms indicative of depression. The decision to use the SCID was based on prior research on the psychometric validity and acceptability of various screening tools in this setting [ 29 , 30 ]. The Likert-type response scales used by screening tools were unfamiliar and challenging to participants.…”

Quality of mental health questionnaires in conflict-affected adult populations in low and middle income countries: A systematic review

“…Ultimately, 30 studies were included in the review. ( Blair et al, 2017 ; Getnet and Alem, 2019 ; Ventevogel et al, 2007 ; Bolton, 2001 ; Michalopoulos et al, 2015 ; Tay et al, 2017 ; Tay et al, 2017 ; Dokkedah et al, 2015 ; Morina et al, 2013 ; Morina et al, 2010 ; Miller et al, 2009 ; Vallieres et al, 2018 ; Liddell et al, 2013 ; McDonald et al, 2019 ; Heeke et al, 2017 ; Ibrahim et al, 2018 ; Jayawickreme et al, 2012 ; Powell and Rosner, 2005 ; Vinson and Chang, 2012 ; Silove et al, 2017 ; Tay et al, 2018 ; Fellmeth et al, 2018 ; Tay et al, 2015 ; Tay et al, 2016 ; Tay et al, 2015 ; Veronese and Pepe, 2013 ; Ing et al, 2017 ; Farhood et al, 2015 ; Elsass et al, 2009 ; Tremblay et al, 2009 ) Of these studies, 18 had been published in the last 5 years (2015 onwards). ( Blair et al, 2017 ; Getnet and Alem, 2019 ; Vallieres et al, 2018 ; McDonald et al, 2019 ; Ibrahim et al, 2018 ; Silove et al, 2017 ; Tay et al, 2018 ; Fellmeth et al, 2018 ; Tay et al, 2015 ; Tay et al, 2019 ; Tay et al, 2016 ; Tay et al, 2015 ; Ing et al, 2017 ; Farhood et al, 2015 ; Michalopoulos et al, 2015 ; Tay et al, 2017 ; Tay et al, 2017 ; Dokkedah et al, 2015 )

Fig.

…”

“…Studies included study populations from a broad range of settings. These included: 7 African countries (Democratic Republic of Congo ( Michalopoulos et al, 2015 ), Ethiopia ( Getnet and Alem, 2019 ), Guinea ( Vinson and Chang, 2012 ), Kenya ( McDonald et al, 2019 ), Rwanda ( Bolton, 2001 ), Sierra Leone ( Vinson and Chang, 2012 ), and Uganda (2 studies) ( Blair et al, 2017 ; Dokkedah et al, 2015 )); 5 Asian countries (Afghanistan (2 studies) ( Ventevogel et al, 2007 ; Miller et al, 2009 ), India ( Elsass et al, 2009 ), Sri Lanka (2 studies) ( Tay et al, 2017 ; Jayawickreme et al, 2012 ), the Thai-Myanmar border (3 studies) ( Ing et al, 2017 ; Michalopoulos et al, 2015 ; Fellmeth et al, 2018 ) and Timor-Leste (2 studies) ( Liddell et al, 2013 ; Tay et al, 2017 )); 1 Oceanic country (Papua New Guinea (6 studies) ( Tay et al, 2016 ; Tay et al, 2015 ; Tay et al, 2017 ; Tay et al, 2018 ; Tay et al, 2015 ; Tay et al, 2019 )); 2 European countries (Bosnia-Herzegovina ( Powell and Rosner, 2005 ) and Ex-Yugoslavia (2 studies) ( Morina et al, 2013 ; Morina et al, 2010 )); 3 Middle Eastern countries (Iraq (2 studies) ( Michalopoulos et al, 2015 ; Ibrahim et al, 2018 ), Israeli-Palestinian conflict zone ( Veronese and Pepe, 2013 ), and Lebanon (2 studies) ( Farhood et al, 2015 ; Vallieres et al, 2018 )); and 1 South American country (Peru ( Tremblay et al, 2009 )). Two studies included refugee participants in both high income countries (Germany, Italy and United Kingdom) and a LAMIC (Ex-Yugoslavia) ( Morina et al, 2013 ; Morina et al, 2010 ) which provided disaggregated LAMIC data and so only the LAMIC-related data were included in the review.…”

An Overview of the Health Profile of Syrian Refugees Arriving in Kentucky from 2012-2017

“…Behavioral risk factors included self-reported history of tobacco use and/ or exposure and the results of the mental health evaluation. Mental health evaluation was done using the Refugee Health Screener-15 (RHS-15), a tool developed by Pathways to Wellness to sensitively detect the range of emotional distress common across refugee groups [7]. The data was grouped into adult and pediatric (age <18) refugees for analysis.…”