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Hoeboer CM, Karaban I, Karchoud JF, Olff M, van Zuiden M. Validation of the PCL-5 in Dutch trauma-exposed adults. BMC Psychol 2024; 12:456. [PMID: 39198929 PMCID: PMC11351185 DOI: 10.1186/s40359-024-01951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The PTSD Checklist for DSM-5 (PCL-5) is an internationally widely used self-report questionnaire that can be used to screen for probable diagnosis of posttraumatic stress disorder (PTSD). Information on the psychometric properties of the Dutch PCL-5 is currently lacking. OBJECTIVE We aimed to validate the Dutch PCL-5 in a sample of Dutch adults with prior (suspected) serious injury and establish the optimal cut-off for probable PTSD diagnosis herein. METHODS Data for the current study were collected as part of a long-term follow-up measurement of the TraumaTIPS cohort, where adults admitted to an emergency department following (suspected) serious injury completed a follow-up measurement 12-15 years post-trauma. Of N = 333 eligible participants, n = 192 (57.7%) consented and completed the PCL-5 alongside self-report instruments measuring depression (QIDS), PTSD (IES-R), and quality of life (WHO-QOL and EQ-6D). In total, n = 185 participants also completed a clinician administered interview for PTSD (CAPS-5). Most participants were men (66%) and on average 54 years old (SD = 12.41). We evaluated the diagnostic utility of the PCL-5 using Youden index and tested reliability and convergent validity. RESULTS The PCL-5 demonstrated excellent diagnostic accuracy with a cut-off point of 16 resulting in an optimal Youden index (0.90) for screening purposes with a high sensitivity (1.00) and specificity (0.90). A cut-off of 22 yielded a slightly lower Youden index (0.84) but better positive predictive value (0.50 instead of 0.33) than the cut-off of 16. A cut-off of 29 resulted in the most accurate prevalence estimates. The PCL-5 showed a high internal consistency (Cronbach's α = 0.94), excellent inter-item and item-total correlations and good convergent validity (r > .5 for CAPS-5, IES-R and QIDS). CONCLUSIONS The PCL-5 is a reliable and valid measurement for PTSD symptoms and probable diagnosis and shows excellent screening abilities in Dutch adults with prior (suspected) serious injury, with a lower optimal cut-off compared to previously found in clinical populations. We recommend a cut-off of 22 for screening purposes and a cut-off of 29 for prevalence estimates in Dutch trauma-exposed adults.
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Affiliation(s)
- Chris M Hoeboer
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands.
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands.
| | - Irina Karaban
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
| | - Jeanet F Karchoud
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 5, Amsterdam, 1005 AZ, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Even D, Cohen GH, Wang R, Galea S. The cumulative contribution of direct and indirect traumas to the production of PTSD. PLoS One 2024; 19:e0307593. [PMID: 39141638 PMCID: PMC11324107 DOI: 10.1371/journal.pone.0307593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE Posttraumatic Stress Disorder (PTSD) affects millions of people worldwide. While the relationship between direct exposure to traumatic events and PTSD is well-established, the influence of indirect trauma exposure on PTSD remains unclear. It is similarly unclear what role cumulative exposure to direct and indirect traumas play in the risk of PTSD. METHODS The study uses data from the Houston Trauma and Recovery Study, conducted on 2020-2021, and involved a random sampling of 1,167 individuals residing in Houston during Hurricane Harvey in 2017. Participants were asked about their experiences related to both Hurricane Harvey and the subsequent COVID-19 pandemic. Exposures were categorized as direct or indirect traumas, in line with the criteria delineated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Cumulative exposures were also calculated. RESULTS Among participants, 12.6% were experiencing current PTSD. There were significant associations between both direct [OR = 3.18, 95% CI 1.85, 5.46] and indirect [OR = 1.91, 95% CI 1.05, 3.46] traumas related to Harvey, as well as direct [OR = 2.13, 95% CI 1.20, 3.77] and indirect [OR = 1.69, 95% CI 0.93, 3.09] traumas due to COVID and the risk of PTSD in fully adjusted models. Further, significant associations were found between the cumulative exposure to traumas from both Hurricane Harvey and COVID-19 and the risk of PTSD, considering both direct [OR = 2.53, 95% CI 1.36, 4.70] and indirect exposures [OR = 2.79, 95% CI 1.47, 5.28]. CONCLUSIONS Our study offers support for connections between exposure to both direct and indirect traumas stemming from large-scale disasters and PTSD. Moreover, we show that cumulative exposures to multiple large-scale events increase the risk of PTSD. This highlights the importance of the consideration of a range of exposures as risks for PTSD, particularly in a time of compounding disasters and broad population exposures to these events.
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Affiliation(s)
- Dan Even
- Moshe Prywes Center for Medical Education, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Gregory H. Cohen
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Ruochen Wang
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
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Hagström A, Hasson H, Hollander AC, Vahtra C, Delilovic S, Augustsson H. "Sometimes it can be like an icebreaker": A mixed method evaluation of the implementation of the Refugee Health Screener-13 (RHS-13). J Migr Health 2024; 10:100243. [PMID: 39220097 PMCID: PMC11365362 DOI: 10.1016/j.jmh.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65-92%) and five centres with low-level (0-36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.
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Affiliation(s)
- Ana Hagström
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Henna Hasson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Carl Vahtra
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Sara Delilovic
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Hanna Augustsson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Filippou K, Knappe F, Hatzigeorgiadis A, Morres ID, Tzormpatzakis E, Havas E, Pühse U, Theodorakis Y, Gerber M. Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp. J Phys Act Health 2024; 21:657-667. [PMID: 38621670 DOI: 10.1123/jpah.2023-0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers. METHODS Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being. RESULTS High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect. CONCLUSIONS The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.
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Affiliation(s)
- Konstantinia Filippou
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Ioannis D Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | | | - Elsa Havas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Yannis Theodorakis
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Frounfelker RL, Mishra T, Holmes KB, Gautam B, Betancourt TS. Mental health among older Bhutanese with a refugee life experience: A mixed-methods latent class analysis study. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:304-315. [PMID: 37155291 PMCID: PMC10330824 DOI: 10.1037/ort0000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
There are disparities in the mental health of refugee populations compared to individuals who have not experienced forced migration. It is important to identify individuals with a refugee life experience who are most in need of mental health care and prioritize their engagement in services. The objectives of this convergent mixed-methods study are to quantitatively identify the association between exposure to pre- and postresettlement traumas and stressors and mental health among older adults with a refugee life experience, qualitatively identify typologies of narratives of forced migration, and integrate findings to provide a more comprehensive understanding of the relationship between trauma and symptoms of posttraumatic stress disorder (PTSD). Study participants were Bhutanese with a refugee life experience living in a metropolitan area in New England (United States). We used quantitative surveys to identify exposures to traumas and symptoms of PTSD. We used latent class analysis to identify subgroups of trauma exposure and association with symptoms of PTSD. A subset of individuals participated in qualitative interviews. Narrative thematic analysis was used to explore typologies of life history narratives. Quantitatively, we identified four classes of patterns of trauma exposure throughout the refugee life trajectory. These classes were associated with current symptoms of PTSD. Qualitatively, we identified four narrative types that indicate participants interpreted and made sense of their life trajectories in a variety of ways. Integration of findings indicate that caution is needed in identifying individuals in need of mental health services and the best approach for interventions that promote psychosocial well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Tej Mishra
- Washington, D.C. Department of Public Health
| | - Kieran B. Holmes
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Bhuwan Gautam
- Department of Public Health Sciences, Penn State College of Medicine
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Magwood O, Bellai-Dussault K, Fox G, McCutcheon C, Adams O, Saad A, Kassam A. Diagnostic test accuracy of screening tools for post-traumatic stress disorder among refugees and asylum seekers: A systematic review and meta-analysis. J Migr Health 2022; 7:100144. [PMID: 36568829 PMCID: PMC9772565 DOI: 10.1016/j.jmh.2022.100144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Refugees and asylum seekers often experience traumatic events resulting in a high prevalence of post-traumatic stress disorder (PTSD). Undiagnosed PTSD can have detrimental effects on resettlement outcomes. Immigration medical exams provide an opportunity to screen for mental health conditions in refugee and asylum seeker populations and provide links to timely mental health care. Objective To assess the diagnostic accuracy of screening tools for PTSD in refugee and asylum seeker populations. Methods We systematically searched Medline, Embase, PsycINFO, CENTRAL and CINAHL up to 29 September 2022. We included cohort-selection or cross-sectional study designs that assessed PTSD screening tools in refugee or asylum seeker populations of all ages. All reference standards were eligible for inclusion, with a clinical interview considered the gold standard. We selected studies and extracted diagnostic test accuracy data in duplicate. Risk of bias and applicability concerns were addressed using QUADAS-2. We meta-analyzed findings using a bivariate random-effects model. We partnered with a patient representative and a clinical psychiatrist to inform review development and conduct. Results Our review includes 28 studies (4,373 participants) capturing 16 different screening tools. Nine of the 16 tools were developed specifically for refugee populations. Most studies assessed PTSD in adult populations, but three included studies focused on detecting PTSD in children. Nine studies looked at the Harvard Trauma Questionnaire (HTQ) with diagnostic cut-off points ranging from 1.17 to 2.5. Meta-analyses revealed a summary point sensitivity of 86.6% (95%CI 0.791; 0.917) and specificity of 78.9% (95%CI 0.639; 0.888) for these studies. After evaluation, we found it appropriate to pool other screening tools (Posttraumatic Stress Disorder Checklist, the Impact of Event Scale, and the Posttraumatic Diagnostic Scale) with the HTQ. The area under the curve for this model was 79.4%, with a pooled sensitivity of 86.2% (95%CI 0.759; 0.925) and a specificity of 72.2% (95%CI 0.616; 0.808). Conclusions Our review identified several screening tools that perform well among refugees and asylum seekers, but no single tool was identified as being superior. The Refugee Health Screener holds promise as a practical instrument for use in immigration medical examinations because it supports the identification of PTSD, depression, and anxiety across diverse populations. Future research should consider tool characteristics beyond sensitivity and specificity to facilitate implementation in immigration medical exams. Registration Open Science Framework: 10.17605/OSF.IO/PHNJV.
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Affiliation(s)
- Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Kara Bellai-Dussault
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Grace Fox
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Chris McCutcheon
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Owen Adams
- Canadian Medical Association, 1410 Blair Towers Place, Suite 500, Ottawa, ON K1J 9B9, Canada
| | - Ammar Saad
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
- Pinecrest-Queensway Community Health Centre, 1365 Richmond Rd #2, Ottawa, ON K2B 6R7, Canada
- Ottawa Newcomer Health Centre, 291 Argyle, Ottawa, ON K2P 1B8, Canada
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