Assessing Severity of Psychological Distress Among Refugees With the Refugee Health Screener, 13-Item Version

Abstract

The recent inflow of refugees to Sweden has put pressure on health care as well as revealing a need for methods regarding assessment of refugees' mental health status. The present study investigated the use of the Refugee Health Screener (RHS; Hollifield et al., 2013) to distinguish among severity levels of symptoms of psychological distress in refugees. Refugees residing in asylum accommodations (n = 510) were screened with RHS-13, together with screeners for depression, anxiety, and posttraumatic stress disorder (PTSD). Risk for mild, moderate, or severe levels of depression, anxiety, or/and PTSD was used as screening proxy. Receiver operating characteristic analysis rendered cutoff scores of 11, 18, and 25, for mild, moderate, and severe symptoms, respectively. Evaluated against each symptom scale separately, cutoffs performed well. Cutoff 11, previously identified by Hollifield et al. (2016), was also confirmed. However, utilization of additional cutoffs could improve refugee mental health by guiding clinical decision making.

Psychological distress among refugees in Germany: a cross-sectional analysis of individual and contextual risk factors and potential consequences for integration using a nationally representative survey

“…They also lend support to meta-analyses indicating that at least one in three refugees is likely impacted by symptoms of depression, anxiety and/or PTSD. 9 10 37 Our estimates of the prevalence of the different levels of psychological distress defined by Bjärtå and colleagues 31 suggest that the following treatment capacities have to be provided by the German healthcare system: Every tenth refugee is likely in urgent need of care, slightly more than one in ten further refugees is likely to require standard care following further evaluation, and one in five additional refugees have lower levels of distress requiring further assessment that might best be remedied through lower threshold psychosocial interventions. 37 38 For the sake of those in need, it is also imperative to reduce legal limitations to full access to the healthcare system for all asylum seekers, as is the case, for instance, in Austria and Switzerland.…”

“… 29 31 A later study validated further cut-off points for moderate symptoms levels indicative of a likely need for treatment and severe levels indicative of an urgent need for care (18 and 25 points, respectively). 31 …”

Suicidal Ideation and Severity of Distress among Refugees Residing in Asylum Accommodations in Sweden

“…This study was performed as a part of the project AMIR (Assessment of Mental Health and Early Intervention for Refugees). Results from the full project have been reported previously [21,22]. An outline of the methods section is presented herein, and more detail is in previous reports.…”

“…Participants completed the RHS-13 [20] and the Patient Health Questionnaire-9 (PHQ-9) [24] for the current study. The Generalized Anxiety Disorder-7 (GAD-7) [25], the Primary Care PTSD-4 (PC-PTSD-4) [26], and the World Health Organization Quality of Life – Brief (WHOQOL-BREF) [27] were completed at the same time for the larger study reported elsewhere [21,22]. The questionnaires were administered in seven different languages (Arabic, Dari, Farsi, Tigrinya, Somali, English, and Swedish).…”

“…The Refugee Health Screener (RHS) [19,20] was developed as a brief screener for identifying symptoms of depression, anxiety and PTSD among refugees. The RHS-13-item version [20] has recently been shown to be efficient in identifying severity of depression, anxiety and PTSD symptoms, using cutoff values to indicate mild, moderate and severe distress [21]. However, since the RHS does not include any items about suicidal ideation, investigating the ability of the RHS-13 to detect individuals with suicidal ideation is warranted.…”