Validation of the Arabic Version of the Refugee Health Screener-13 Among Perinatal Syrian Refugees in Lebanon

Abstract

Background: Refugee mothers are at a significantly increased risk of suffering from perinatal depression. However, available tools to screen for it often use a western paradigm of mental health, may not be culturally appropriate, and may not account for the background stress experienced by refugees. The objective of this study is to test and validate RHS-13, which was developed by consultation with refugees from different backgrounds, among a group of Syrian refugee mothers living in Beka’s valley in Lebanon. Methodology: The tool was tested on a sample of 103 women. Internal consistency of the items for each subscale was assessed using Cronbach’s alpha. An interitem correlation was performed to examine the most correlated items on the scale. Pearson correlation coefficient was calculated between each subscale and its diagnostic proxy. To find the best fit cut-point between sensitivity and specificity, ROC curves were used. Results: RHS-13 is a reliable and valid tool to detect depression and anxiety among perinatal Syrian mothers (Internal consistency 0.803) (correlation with PHQ: 0.63), (correlation with GAD-7: 0.73). The best fit cut-points were 12, 15, and 25 indicating the severity of symptoms from mild to severe, respectively. Conclusion: RHS-13 is a valid tool among perinatal refugees in Lebanon and can be used by primary care physicians, mental health providers, social workers working with refugees from the Middle East to screen mothers for depression and anxiety.

Exploring stressors impacting the mental health of refugee mothers in Lebanon during COVID-19 pandemic: A qualitative study

“…The larger mixed methods study included validation of a mental health tool among postpartum mothers and qualitative interviews exploring stressors faced by mothers in Lebanon, cultural traditions around childbirth, sources of social support, and attributions of postpartum depression among Syrian mothers (Alnaji, 2021). In this article, we aim to answer the following research question: What are the perceived stressors impacting the mental wellbeing of postpartum Syrian women who lived in Bekaa Valley region during the first year of the COVID-19 pandemic?…”

“…We begin by describing the methodology of this study. As this article is part of a larger mixed-methods study, we will only address the aspect of perceived stressors; details of other aspects of the framework are documented elsewhere (Alnaji, 2021). We will then describe the findings organized by four themes: (1) challenges of living in Lebanon, (2) financial situation and the economic crisis, (3) health and access to health care, and (4) the pandemic and social isolation.…”

Validation of the Arabic version of the refugee health screener-13 among postpartum Syrian refugees in Lebanon

“…The RHS-13 instrument was not explicitly developed for postpartum depression (Hollifield et al, 2013). However, in our initial investigations, we discovered that Syrian mothers had difficulty comprehending existing instruments designed for postpartum depression, including the Edinburgh Postpartum Depression Scale (Alnaji, 2021). This concern was shared by Fellmeth in her study of postpartum depression among refugees on the Thai Myanmar border (Fellmeth et al, 2018).…”