Wind Tim R, van der Aa Niels, Knipscheer Jeroen, de la Rie Simone
Department of Research, Arq Psychotrauma Expert Group, Diemen, the Netherlands.
Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
Eur J Psychotraumatol. 2017 Jun 9;8(sup2):1321357. doi: 10.1080/20008198.2017.1321357. eCollection 2017.
: Questionnaires are widely used to assess the mental health status of refugees, whereas their construct validity largely remains unexplored. : This study examined the construct validity of two widely-used instruments for the assessment of PTSD symptoms (Harvard Trauma Questionnaire [HTQ]; 16 items) and symptoms of anxiety and depression (Hopkins Symptom Check list-25 [HSCL-25]; 25 items) among Dutch and refugee patients with different linguistic backgrounds. : We applied exploratory factor analyses and measurement invariance analyses to test construct validity.Participants ( =1 256) were divided into five linguistic groups defined by language family, including four non-western linguistic groups (Indo-Iranian [ = 262], Niger-Congo [ = 134], Semitic [ = 288], and South Slavic languages [ = 199]) and one western linguistic group (Germanic languages; Dutch [ = 373]). : Exploratory factor analysis yielded a 3-factor structure of the HTQ and a 2-factor structure of the HSCL-25. Measurement invariance 20 analyses on the HTQ showed strong measurement invariance across the groups of refugee patients. However, Dutch patients reported milder symptom severity on most items of the HTQ. Measurement invariance analyses on the HSCL-25 (not conducted in Dutch patients) indicated partial strong measurement invariance across refugee patients. : We conclude that mental health constructs measured by the HTQ and the HSCL25 25 are to a large extent interpreted in a similar way by refugee patients. This indicates that these instruments can be applied in non-western refugee patient populations, and that local idioms of distress and inherent response patterns may not play a major role when applying the HTQ and the HSCL-25 in these populations. Yet, whereas meaningful comparisons of observed PTSD and depression scores between groups of refugee patients with different non30 western linguistic background are feasible, comparisons between patients with a western and non-western linguistic background, as well as comparisons of anxiety scores, are likely to be biased. Future studies need to establish whether the commonly used cut-off scores of both questionnaires apply for refugee patients with non-western linguistic backgrounds.
问卷调查被广泛用于评估难民的心理健康状况，但其结构效度在很大程度上仍未得到探索。本研究考察了两种广泛使用的工具在荷兰和具有不同语言背景的难民患者中评估创伤后应激障碍症状（哈佛创伤问卷[HTQ]；16项）以及焦虑和抑郁症状（霍普金斯症状清单-25[HSCL-25]；25项）的结构效度。我们应用探索性因素分析和测量不变性分析来检验结构效度。参与者（n = 1256）根据语系分为五个语言组，包括四个非西方语言组（印欧语系[n = 262]、尼日尔-刚果语系[n = 134]、闪米特语系[n = 288]和南斯拉夫语系[n = 199]）和一个西方语言组（日耳曼语系；荷兰语[n = 373]）。探索性因素分析得出HTQ的三因素结构和HSCL-25的二因素结构。对HTQ的测量不变性分析显示，难民患者组之间具有很强的测量不变性。然而，荷兰患者在HTQ的大多数项目上报告的症状严重程度较轻。对HSCL-25的测量不变性分析（未在荷兰患者中进行）表明，难民患者之间部分具有很强的测量不变性。我们得出结论，HTQ和HSCL-25所测量的心理健康结构在很大程度上为难民患者以相似的方式所理解。这表明这些工具可应用于非西方难民患者群体，并且在这些人群中应用HTQ和HSCL-25时，当地的痛苦表述和内在反应模式可能不会起主要作用。然而，虽然在具有不同非西方语言背景的难民患者组之间对观察到的创伤后应激障碍和抑郁评分进行有意义的比较是可行的，但在具有西方和非西方语言背景的患者之间进行比较以及焦虑评分的比较可能会有偏差。未来的研究需要确定这两种问卷常用的临界值分数是否适用于具有非西方语言背景的难民患者。
