Hollifield Michael, Warner Teddy D, Lian Nityamo, Krakow Barry, Jenkins Janis H, Kesler James, Stevenson Jayne, Westermeyer Joseph
Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 2400 Tucker Ave NE, Albuquerque, NM 87131, USA.
JAMA. 2002 Aug 7;288(5):611-21. doi: 10.1001/jama.288.5.611.
Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret.
To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements.
MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database.
Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status.
Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature.
Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria.
The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
难民经历了多重创伤性事件，并伴有严重的相关健康问题，但有关难民创伤和健康状况的数据往往相互矛盾且难以解读。
评估有关难民创伤与健康的文献特征，识别并评估用于测量难民创伤和健康状况的工具，并提出改进建议。
医学期刊数据库（MEDLINE）、心理学文摘数据库（PsychInfo）、健康与心理社会测量工具数据库（Health and PsychoSocial Instruments）、护理学与健康领域数据库（CINAHL）以及考克兰系统评价数据库（Cochrane Systematic Reviews，通过OVID检索，检索时间从各数据库创建之初至2001年10月），以及新墨西哥难民项目数据库。
应用关键词和组合运算符来识别评估难民创伤和/或健康状况测量的英文出版物。
为每篇文章提取的信息包括作者、出版年份、主要关注点、类型（实证研究、综述或描述性研究）以及所包含工具的类型/名称和属性。如果文章是综述或描述性研究、并非主要关于难民健康状况或创伤、或者仅关于传染病，则排除在进一步分析之外。然后根据已发表文献中描述的5项标准（目的、结构定义、设计、开发过程、信度和效度）对工具进行评估。
在识别出的394篇出版物中，183篇被纳入以进一步分析其特征；91篇（49.7%）包含定量数据，但未评估难民研究中所用工具的测量属性，78篇（42.6%）报告了测量指标之间的统计关系（假定有效），14篇（7.7%）仅涉及工具的统计属性。在这183篇出版物中，使用了125种不同的工具；其中，12种是在难民研究中开发的。这些工具中没有一种完全符合所有5项评估标准，3种符合4项标准，5种仅符合1项标准。另外8种标准工具是在非难民人群中设计和开发的，但经过改编用于难民研究；其中，2种符合所有5项标准，6种符合4项标准。
关于难民创伤或健康的大多数文章要么是描述性的，要么包括来自在难民中效度和信度有限或未经检验的工具的定量数据。难民研究中准确测量的主要限制在于工具缺乏理论基础，以及对使用和报告合理测量原则的忽视。
