Distress and Resilience in Resettled Refugees of War: Implications for Screening.

There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener-15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11-16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi's continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (ß = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).

Effective Screening for Emotional Distress in Refugees: The Refugee Health Screener.

Screening for emotional distress is important, but not widely available. This study assesses the utility of the Refugee Health Screener 15 (RHS-15) in a public health setting. Refugee Health Screener 15 and diagnostic proxy (DP) instruments assessing anxiety, depression, and posttraumatic stress disorder were administered to refugees from 3 countries at their public health examination. Properties of the RHS-15 and its components were evaluated utilizing appropriate methods. Scale Cronbach α was 0.95, and a factor analysis identified 1 factor accounting for 66% of scale variance. Refugee Health Screener 15 scores and cases discriminated between refugee groups similar to DPs. Refugee Health Screener 15 case sensitivity and specificity to DPs were acceptable (≥0.87/0.77). A shorter, 13-item component had acceptable metric properties. The RHS-15 appears to be a valid screener for emotional distress of refugees. The 13-item scale may be more efficient and as efficacious for case identification. The critical public health need and recommendations for implementation are discussed.

The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees.

OBJECTIVE: Screening for emotional distress in newly arrived refugees is not a standard practice due to multiple barriers, one being the absence of a valid screening instrument for multiple refugee populations. The Refugee Health Screener-15 (RHS-15) was empirically developed to be a valid, efficient and effective screener for common mental disorders in refugees. METHOD: Development followed published methods. Two hundred fifty-one refugees from three countries were screened at their public health visit with a pilot instrument, and 190 were administered diagnostic proxy instruments (DPs). Data analyses using multiple methods selected the best items for classification on DPs. Follow-up clinical service data were obtained. RESULTS: Post hoc analyses of the developed RHS-15 showed good sensitivity(range .81 to .95) and specificity (range .86 to .89) to DP's in two of three ethnic groups. Seventy-four percent of positive cases accepted treatment services. Of those, 79% engaged in treatment, and 92% continued treatment more than 3 months. CONCLUSIONS: The RHS-15 is a screener for common mental disorders in newly-arrived refugees in public health. The RHS-15appears to be effective, but further prospective research in a broad range of refugee groups is required to establish generalizability. Strengths, limitations, methods to apply the RHS-15 for optimal performance, and future directions for research and implementation are discussed.