Department of Psychology and Social work, Mid Sweden University, 831 25, Östersund, Sweden.
Department of Behavioral Sciences and Learning, Linköping University, 581 83, Linköping, Sweden.
BMC Psychiatry. 2023 Jan 3;23(1):7. doi: 10.1186/s12888-022-04481-2.
Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure.
Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers.
The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%).
This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation.
许多难民由于在迁移前、迁移中和迁移后经历的压力和创伤性事件而患有心理健康问题。然而，难民面临着各种各样的障碍，限制了他们获得心理健康护理的机会。基于互联网的工具，有多种语言版本，可以成为增加难民获得心理健康服务机会的一种方式。本研究旨在开发和测试一种筛查工具，以筛查难民中常见的精神障碍（即抑郁、焦虑、创伤后应激障碍和失眠）的临床相关症状。我们设计、翻译和改编了一种适合在瑞典居住的最大难民群体使用的基于互联网的分层筛查程序。该工具旨在准确识别精神困扰症状（第 1 层）、区分特定精神障碍症状（第 2 层）和评估症状严重程度（第 3 层）。我们测试了使用分层筛查程序的整体效率。
757 名居住在瑞典的难民，会说阿拉伯语、达里语、波斯语、英语或瑞典语，使用三层筛查程序和每一层的筛查工具完成在线问卷调查。在这项研究中，第 3 层量表被用作临床相关症状的参考标准，以评估在准确性和减少前几层的项目负担方面的筛查效率。
结果表明，分层程序可以在保持高准确性的同时减少项目负担，最多有 86%的症状得到正确评估，且中等及以上症状的假阴性率（最多 9%）和严重症状的假阴性率（最多 1.3%）非常低。
本研究生成了一种准确的筛查工具，可有效识别难民中常见精神障碍的临床相关症状。使用改编的在线分层程序筛查难民的多种心理健康问题，有可能促进筛查并增加难民获得心理健康服务的机会。我们讨论了筛查工具的实用性和进一步评估的必要性。
