Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.
The original versions of the Harvard Trauma Questionnaire and Hopkins Symptoms Checklist-25 were written and subsequently validated in the Cambodian, Laotian, and Vietnamese languages. For use in a Dutch treatment center, with refugee patients mostly speaking other languages, additional translations were made. The objective of this study was examination of the psychometric properties of some of these new translations, i.e., the Arabic, Farsi, Serbo-Croatian, Russian, and English bilingual adaptations. It is concluded that the psychometric properties of both tests are adequate across those different cultures and are, in general, applicable to measure symptoms of depression, anxiety, and posttraumatic stress disorder.
In this study a newly developed Self-rating Inventory for Posttraumatic Stress Disorder (PTSD) is presented. The instrument consists of 47 items, reflecting DSM-III-R criteria, associated features and items corresponding to the disorder of extreme stress not otherwise specified. All items are phrased in a trauma-independent way and are measured on an intensity scale. The instrument was validated on 76 subjects with war-related trauma and 59 psychiatric outpatients, one third of whom were traumatized. Test-retest for the scale was 0.90. The coefficient alpha appeared to be 0.96 for the 47-items scale and 0.92 for the 22 DSM-III-R subscale. The scale correlated significantly with the Clinician Administered PTSD Scale, the Mississippi Scale for Combat-related PTSD, the MMPI PTSD subscale and the Impact of Event Scale. The overall efficiency of the Self-rating Inventory for PTSD was comparable to the overall efficiency of the Mississippi Scale and superior to the MMPI PTSD subscale. Factor analysis on the 22 DSM-III-R items showed 4 factors, representing numbing, intrusion, avoidance and sleeping problems. It is concluded that the Self-rating Inventory for PTSD is a powerful instrument for diagnosing PTSD in survey research. The instrument appears to be capable of differentiating not only between PTSD and non-PTSD subjects but also between traumatized non-PTSD subjects and non-traumatized psychiatric patients.
Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.
The Clinician Administered PTSD Scale was employed with 76 traumatized Dutch subjects from different treatment centers and one social rehabilitation center. Subjects were traumatized either in childhood, in adolescence, or in early adulthood. The CAPS showed an overall agreement with clinical diagnosis of 79%, with a kappa coefficient of .58. Interrater agreement on the CAPS subscales of intensity (intrusion, avoidance, and hyperarousal) varied from .93 to .98. The internal consistency for all core symptoms of DSM‐III‐R at the CAPS intensity level for current PTSD was .89, and for lifetime PTSD .86. Concurrent validity was established by correlating the CAPS with the Mississippi Scale, the MMPI, and the Impact of Event Scale. All correlations were significant beyond .001. Finally, the CAPS items, both core symptoms and associative features, are discussed in detail at item level.
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