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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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Verhagen IL, Noom MJ, Lindauer RJL, Daams JG, Hein IM. Mental health screening and assessment tools for forcibly displaced children: a systematic review. Eur J Psychotraumatol 2022; 13:2126468. [PMID: 36212114 PMCID: PMC9542271 DOI: 10.1080/20008066.2022.2126468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. Objective: The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Method: Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. Results: The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Conclusion: Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.
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Affiliation(s)
- Ilse L Verhagen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marc J Noom
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
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Gadeberg AK, Montgomery E, Frederiksen HW, Norredam M. Assessing trauma and mental health in refugee children and youth: a systematic review of validated screening and measurement tools. Eur J Public Health 2018; 27:439-446. [PMID: 28472394 DOI: 10.1093/eurpub/ckx034] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background : It is estimated that children below 18 years constitute 50% of the refugee population worldwide, which is the highest figure in a decade. Due to conflicts like the Syrian crises, children are continuously exposed to traumatic events. Trauma exposure can cause mental health problems that may in turn increase the risk of morbidity and mortality. Tools such as questionnaires and interview guides are being used extensively, despite the fact that only a few have been tested and their validity confirmed in refugee children and youth. : Our aim was to provide a systematic review of the validated screening and measurement tools available for assessment of trauma and mental health among refugee children and youth. : We systematically searched the databases PubMed, PsycINFO and PILOTS. The search yielded 913 articles and 97 were retained for further investigation. In accordance with the PRISMA guidelines two authors performed the eligibility assessment. The full text of 23 articles was assessed and 9 met the eligibility criteria. Results : Only nine studies had validated trauma and mental health tools in refugee children and youth populations. A serious lack of validated tools for refugee children below the age of 6 was identified. : There is a lack of validated trauma and mental health tools, especially for refugees below the age of 6. Detection and treatment of mental health issues among refugee children and youth should be a priority both within the scientific community and in practice in order to reduce morbidity and mortality.
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Affiliation(s)
- A K Gadeberg
- Department of Infectious Diseases, Section of Immigrant Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - E Montgomery
- Dignity, Danish Institute Against Torture, Copenhagen, Denmark
| | - H W Frederiksen
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - M Norredam
- Department of Infectious Diseases, Section of Immigrant Medicine, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Psychiatric screening and interventions for minor refugees in Europe: an overview of approaches and tools. Eur J Pediatr 2018; 177:163-169. [PMID: 29124447 DOI: 10.1007/s00431-017-3027-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Currently hundreds of thousands of minor refugees entered Europe. This group has been exposed to traumatic events pre-, during, and post-migration and is at increased risk of developing psychiatric disorders. In this article, we describe the results of our literature search on screening and interventions for post-traumatic stress disorder (PTSD) in minor refugees, in order to make recommendations for clinical practice. Results show that studies on diagnostic accuracy of assessment instruments and efficacy of mental healthcare interventions in this population are lacking. Traumatic experiences pre-flight, during the flight and at resettlement, superimposed by parental PTSD, and other contextual factors, might lead to more than 25% of minor refugees developing PTSD. CONCLUSION To enhance the number of minor refugees recognized with PTSD, we recommend the use of a brief screening instrument. A public health approach, focusing on environmental supportive factors is the first step in treatment for this group, followed by short-term psychological group interventions focusing on psycho-education and stress reduction. Minor refugees with no improvement in PTSD symptoms by these interventions need referral to specialized mental health care services. Mental health providers should be culturally competent. What is Known: • Post-traumatic stress disorder, anxiety, sleeping problems, and depression are the most common psychiatric disorders in minor refugees. • Evidence based methods on screening and interventions in minor refugees with psychiatric disorders are lacking. What is New: • In the absence of validated screening tools a best practice reliable, quick and child-friendly tool is presented. • A layered system for mental health care and psychosocial support in minor refugees is explained.
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Close C, Kouvonen A, Bosqui T, Patel K, O’Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health 2016; 12:47. [PMID: 27558472 PMCID: PMC4997738 DOI: 10.1186/s12992-016-0187-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population. METHODS Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed. RESULTS One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8-12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1-2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country. CONCLUSION First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.
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Affiliation(s)
- Ciara Close
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Anne Kouvonen
- UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
- Department of Social Research, University of Helsinki, Helsinki, Finland
- SWPS University of Social Sciences and Humanities, Faculty in Wroclaw, Wroclaw, Poland
| | - Tania Bosqui
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
- College of Liberal Arts and Social Sciences, University of Guam, Mangilao, Guam
| | - Kishan Patel
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Dermot O’Reilly
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
| | - Michael Donnelly
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
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Self-regulatory fatigue, quality of life, health behaviors, and coping in patients with hematologic malignancies. Ann Behav Med 2015; 48:411-23. [PMID: 24802991 DOI: 10.1007/s12160-014-9621-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Self-regulatory fatigue may play an important role in a complex medical illness. PURPOSE Examine associations between self-regulatory fatigue, quality of life, and health behaviors in patients pre- (N = 213) and 1-year post-hematopoietic stem cell transplantation (HSCT; N = 140). Associations between self-regulatory fatigue and coping strategies pre-HSCT were also examined. METHOD Pre- and 1-year post-HSCT data collection. Hierarchical linear regression modeling. RESULTS Higher self-regulatory fatigue pre-HSCT associated with lower overall, physical, social, emotional, and functional quality of life pre- (p's < .001) and 1-year post-HSCT (p's < .01); lower physical activity pre-HSCT (p < .02) and post-HSCT (p < .03) and less healthy nutritional intake post-HSCT (p < .01); changes (i.e., decrease) in quality of life and healthy nutrition over the follow-up year; and use of avoidance coping strategies pre-HSCT (p's < .001). CONCLUSION This is the first study to show self-regulatory fatigue pre-HSCT relating to decreased quality of life and health behaviors, and predicting changes in these variables 1-year post-HSCT.
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Michalopoulos LTM, Murray LK, Kane JC, Skavenski van Wyk S, Chomba E, Cohen J, Imasiku M, Semrau K, Unick J, Bolton PA. Testing the validity and reliability of the shame questionnaire among sexually abused girls in Zambia. PLoS One 2015; 10:e0123820. [PMID: 25879658 PMCID: PMC4399983 DOI: 10.1371/journal.pone.0123820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/07/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of the current study is to test the validity and reliability of the Shame Questionnaire among traumatized girls in Lusaka, Zambia. Methods The Shame Questionnaire was validated through both classical test and item response theory methods. Internal reliability, criterion validity and construct validity were examined among a sample of 325 female children living in Zambia. Sub-analyses were conducted to examine differences in construct validity among girls who reported sexual abuse and girls who did not. Results All girls in the sample were sexually abused, but only 61.5% endorsed or reported that sexual abuse had occurred. Internal consistency was very good among the sample with alpha = .87. Criterion validity was demonstrated through a significant difference of mean Shame Questionnaire scores between girls who experienced 0–1 trauma events and more than one traumatic event, with higher mean Shame Questionnaire scores among girls who had more than one traumatic event (p = .004 for 0–1 compared to 2 and 3 events and p = .016 for 0–1 compared to 4+ events). Girls who reported a history of witnessing or experiencing physical abuse had a significantly higher mean Shame Questionnaire score than girls who did not report a history of witnessing or experiencing physical abuse (p<.0001). There was no significant difference in mean Shame Questionnaire score between girls who reported a sexual abuse history and girls who did not. Exploratory factor analysis indicated a two-factor model of the Shame Questionnaire, with an experience of shame dimension and an active outcomes of shame dimension. Item response theory analysis indicated adequate overall item fit. Results also indicate potential differences in construct validity between girls who did and did not endorse sexual abuse. Conclusions This study suggests the general utility of the Shame Questionnaire among Zambian girls and demonstrates the need for more psychometric studies in low and middle income countries.
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Affiliation(s)
- Lynn T. M. Michalopoulos
- Social Intervention Group, Global Health Research Center of Central Asia, School of Social Work, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Laura K. Murray
- Center for Refugee and Disaster Response, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jeremy C. Kane
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stephanie Skavenski van Wyk
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elwyn Chomba
- Ministry of Community Development, Mother Child Health (MCDMCH), Lusaka, Zambia
| | - Judith Cohen
- Center for Traumatic Stress in Children & Adolescents, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mwiya Imasiku
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Katherine Semrau
- Center for Global Health & Development, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Jay Unick
- School of Social Work, University of Maryland, Baltimore, Maryland, United States of America
| | - Paul A. Bolton
- Center for Refugee and Disaster Response, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Deeba F, Rapee RM, Prvan T. Psychometric properties of the Children's Revised Impact of Events Scale (CRIES) with Bangladeshi children and adolescents. PeerJ 2014; 2:e536. [PMID: 25237597 PMCID: PMC4157240 DOI: 10.7717/peerj.536] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/03/2014] [Indexed: 11/20/2022] Open
Abstract
Identification of possible cases suffering post-traumatic stress disorder (PTSD) is important, especially in developing countries where traumatic events are typically prevalent. The Children's Revised Impact of Events Scale is a reliable and valid measure that has two brief versions (13 items and 8 items) to assess reactions to traumatic events among young people. The current study evaluated the psychometric properties of both versions of the CRIES in a sample of 1,342 children and adolescents aged 9-17 years (M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh. A sub-group of 120 children from four schools was re-tested on the measures within 3.5 weeks. Confirmatory factor analysis supported factor structures similar to those found in other studies for both versions of the CRIES. Multiple group confirmatory factor analysis showed gender and age-group differences within the sample, supporting established age and gender differences in prevalence of PTSD symptoms. Analyses also indicated moderate to excellent internal consistency and test-retest reliability and clear discriminant and convergent validity. These data support use of both the CRIES-13 and CRIES-8 to provide quick and psychometrically sound assessment of symptoms of PTSD among children and adolescents from Bangla-speaking communities.
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Affiliation(s)
- Farah Deeba
- Centre for Emotional Health, Department of Psychology, Faculty of Human Sciences, Macquarie University, NSW, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, Department of Psychology, Faculty of Human Sciences, Macquarie University, NSW, Australia
| | - Tania Prvan
- Department of Statistics, Faculty of Science, Macquarie University, NSW, Australia
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Verlinden E, van Meijel EPM, Opmeer BC, Beer R, de Roos C, Bicanic IAE, Lamers-Winkelman F, Olff M, Boer F, Lindauer RJL. Characteristics of the Children's Revised Impact of Event Scale in a clinically referred Dutch sample. J Trauma Stress 2014; 27:338-44. [PMID: 24797017 DOI: 10.1002/jts.21910] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early identification of posttraumatic stress disorder (PTSD) in children is important to offer them appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES) is a brief self-report measure designed to screen children for PTSD. Research regarding the diagnostic validity of the CRIES is still insufficient, has been restricted to specific populations, and sample sizes have often been small. This study evaluated the reliability and validity of the 8-item (CRIES-8) and 13-item (CRIES-13) versions of the CRIES in a large clinically referred sample. The measure was completed by 395 Dutch children (7-18 years) who had experienced a wide variety of traumatic events. PTSD was assessed using the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent version. A cutoff score of 17 on the CRIES-8 and 30 on the CRIES-13 emerged as the best balance between sensitivity and specificity, and correctly classified 78%-81% of all children. The CRIES-13 outperformed the CRIES-8, in that the overall efficiency of the CRIES-13 was slightly superior (.81 and .78, respectively). The CRIES appears to be a reliable and valid measure, which gives clinicians a brief and user-friendly instrument to identify children who may have PTSD and offer them appropriate and timely treatment.
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Affiliation(s)
- Eva Verlinden
- Academic Medical Center, Department of Child and Adolescent Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations. Int J Behav Med 2014; 20:13-21. [PMID: 21928059 DOI: 10.1007/s12529-011-9194-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an intensive cancer therapy entailing numerous physical, emotional, cognitive, and practical challenges. Patients' ability to adjust and cope with such challenges may depend on their ability to exert control over cognitive, emotional, and behavioral processes, that is, ability to self-regulate. Self-regulatory capacity is a limited resource that can be depleted or fatigued (i.e., "self-regulatory fatigue"), particularly in the context of stressful life events such as cancer diagnosis and treatment. PURPOSE This is one of the first studies to examine self-regulatory fatigue in a cancer population. The current study aimed to (1) extract items for a specific scale of self-regulatory capacity and (2) examine the impact of such capacity on adaptation in patients with hematologic malignancies preparing for HSCT. METHODS Factor analysis of four existing scales gauging psychological adjustment and well-being in 314 patients preparing for HSCT (63% male and 89% Caucasian) identified 23 items (α = 0.85) related to self-regulatory control or fatigue. This measure was then examined using existing clinical data obtained from 178 patients (57% male and 91% Caucasian) undergoing treatment for hematologic malignancies in relationship to quality of life, coping, and self-reported adherence to physicians' recommendations. RESULTS Controlling for pain severity, physical fatigue, and depression, self-regulatory fatigue scores were incrementally associated with decreased quality of life, use of avoidance coping strategies, and decreased adherence to physicians' recommendations. CONCLUSION These results emphasize the potential role of self-regulatory capacity in coping with and adjusting to hematologic cancers and future research is warranted.
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Horesh D, Solomon Z, Keinan G, Ein-Dor T. The clinical picture of late-onset PTSD: a 20-year longitudinal study of Israeli war veterans. Psychiatry Res 2013; 208:265-73. [PMID: 23294854 DOI: 10.1016/j.psychres.2012.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 11/27/2022]
Abstract
Delayed-onset posttraumatic stress disorder (PTSD) has been under medico-legal debate for years. Previous studies examining the prevalence and clinical characteristics of delayed-onset PTSD have yielded inconclusive findings. This study prospectively examines the prevalence and clinical picture of late-onset PTSD among Israeli war veterans. It also evaluates whether or not late-onset PTSD erupts after a completely non-symptomatic period. 675 Israeli veterans from the 1982 Lebanon War, with and without antecedent combat stress reaction (CSR), have been assessed 1, 2 and 20 years post-war. They were divided into 4 groups, according to the duration of delay in PTSD onset. Participants completed self-report questionnaires tapping psychopathology, combat exposure and socio-demographics. 16.5% of the veterans suffered from late-onset PTSD. A longer delay in PTSD onset was associated with less severe psychopathology. Also, CSR was associated with a shorter delay in PTSD onset. Finally, the vast majority of veterans already suffered from PTSD symptoms prior to late PTSD onset. Our results offer further validation for the existence of delayed-onset PTSD. Delayed-onset PTSD appears to be a unique sub-type of PTSD, with an attenuated clinical picture. In addition, delayed-onset PTSD may be the result of an incubation process, wherein symptoms already exist prior to PTSD onset.
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Affiliation(s)
- Danny Horesh
- Department of Psychiatry, New York University, New York, NY 10016, USA.
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A Meta-Analysis of Coefficient Alpha for the Impact of Event Scales: A Reliability Generalization Study. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2011. [DOI: 10.1177/008124631104100102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a score reliability meta-analysis across studies using the Impact of Event Scales. Five hundred and ninety-four studies using the measure were located through electronic database searches and then separated to identify studies that had calculated and reported reliability coefficients from their own data. The 66 articles that remained were then coded to identify potential study characteristics that might influence the variation in reliability estimates. Results indicate adequate internal consistency estimates for all subscales across both scale versions. Furthermore, coefficient alpha was positively correlated with studies involving war and abuse victims for the IES Avoidance subscale. The alpha coefficient was also positively correlated with the percentage of female participants for the Intrusion subscale and negatively correlated to journal type for the composite reliability estimate. Results from this study provide useful information, in terms of scale performance, for researchers interested in using the scale for future academic pursuits and for school psychologists. In particular, implications for school psychologists are considered.
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ZHANG NING, ZHANG YUQING, WU KANKAN, ZHU ZHUOHONG, DYREGROV ATLE. Factor structure of the Children’s Revised Impact of Event Scale among children and adolescents who survived the 2008 Sichuan earthquake in China. Scand J Psychol 2011; 52:236-41. [DOI: 10.1111/j.1467-9450.2010.00867.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Davidson GR, Murray KE, Schweitzer RD. Review of Refugee Mental Health Assessment: Best Practices and Recommendations. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2010. [DOI: 10.1375/prp.4.1.72] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This article focuses on mental health assessment of refugees in clinical, educational and administrative-legal settings in order to synthesise research and practice designed to enhance and promote further development of culturally appropriate clinical assessment services during the refugee resettlement process. It specifically surveys research published over the last 25 years into the development, reliability measurement and validity testing of assessment instruments, which have been used with children, adolescents and adults from refugee backgrounds, prior to or following their arrival in a resettlement country, to determine whether the instruments meet established crosscultural standards of conceptual, functional, linguistic, technical and normative equivalence. The findings suggest that, although attempts have been made to develop internally reliable, appropriately normed tests for use with refugees from diverse cultural and linguistic backgrounds, matters of conceptual and linguistic equivalence and test–retest reliability are often overlooked. Implications of these oversights for underreporting refugees' mental health needs are considered. Efforts should also be directed towards development of culturally comparable, valid and reliable measures of refugee children's mental health and of refugee children's and adults' psychoeducational, neuropsychological and applied memory capabilities.
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Duarte CS, Bordin IAS, Green GR, Hoven CW. Measuring child exposure to violence and mental health reactions in epidemiological studies: challenges and current issues. CIENCIA & SAUDE COLETIVA 2009; 14:487-96. [DOI: 10.1590/s1413-81232009000200017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Indexed: 11/22/2022] Open
Abstract
This paper examines challenges and current issues involved in measuring exposure to different types of violence which are associated mental health problems in children and adolescents. Standardized measures suitable for epidemiological studies, selected based on their relevance in the current literature, are briefly described and commented. The assessment of child's exposure to violence may focus on a specific event (e.g., kidnapping), a specific context (e.g., war) or even of a certain type of exposure (e.g., intrafamilial physical violence). The assessment of child mental health after exposure to violence has traditionally focused on posttraumatic stress disorder (PTSD) - most frequently measured through non-diagnostic scales. However, other mental health reactions may be present and screening as well as diagnostic instruments which may be used to assess these reactions are also described. Two issues of emerging importance - the assessment of impairment and of traumatic grief in children - are also presented. Availability of culturally appropriate instruments is a crucial step towards proper identification of child mental health problems after exposure to violence.
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Bhushan B, Sathya Kumar J. Emotional Distress and Posttraumatic Stress in Children Surviving The 2004 Tsunami. JOURNAL OF LOSS & TRAUMA 2007. [DOI: https://doi.org/10.1080/15325020600945996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bhushan B, Sathya Kumar J. Emotional Distress and Posttraumatic Stress in Children Surviving The 2004 Tsunami. JOURNAL OF LOSS & TRAUMA 2007. [DOI: 10.1080/15325020600945996] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Giannopoulou I, Smith P, Ecker C, Strouthos M, Dikaiakou A, Yule W. Factor structure of the Children’s Revised Impact of Event Scale (CRIES) with children exposed to earthquake. PERSONALITY AND INDIVIDUAL DIFFERENCES 2006. [DOI: 10.1016/j.paid.2005.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents. METHODS We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure. RESULTS Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain. CONCLUSIONS Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.
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Abstract
The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.
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Huizinga GA, Visser A, van der Graaf WTA, Hoekstra HJ, Klip EC, Pras E, Hoekstra-Weebers JEHM. Stress response symptoms in adolescent and young adult children of parents diagnosed with cancer. Eur J Cancer 2005; 41:288-95. [PMID: 15661555 DOI: 10.1016/j.ejca.2004.10.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 08/27/2004] [Accepted: 10/08/2004] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess stress response symptoms in children of parents diagnosed with cancer 1-5 year prior to study entry. The impact of event scale was used to measure stress response symptoms in terms of intrusion and avoidance; the youth self-report assessed emotional and behavioural functioning; the state-trait anxiety inventory for children measured trait-anxiety. Participants included 220 adolescents (aged 11-18 years) and 64 young adults (aged 19-23 years) from 169 families. Twenty-one percent of the sons and 35% of the daughters reported clinically elevated stress response symptoms. Daughters, particularly those whose mothers were ill, reported significantly more intrusion and avoidance than did sons. Intrusion among daughters was positively related to age. Stress response symptoms in both sons and daughters were significantly associated with trait anxiety, but not with intensity of treatment or time since diagnosis. Daughters whose parents suffered from recurrent illness reported more symptoms than did daughters whose parents had a primary disease. Children (daughters in particular) with clinically elevated stress response symptoms reported significantly more problems of internalising and cognition than did their norm group peers. One-fifth of the sons and more than one-third of the daughters expressed clinically elevated stress response symptoms. These children also reported internalising and cognitive problems. Daughters appeared to be more at risk than sons.
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Affiliation(s)
- Gea A Huizinga
- Department of Health Psychology, Groningen University Medical Centre, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Barenbaum J, Ruchkin V, Schwab-Stone M. The psychosocial aspects of children exposed to war: practice and policy initiatives. J Child Psychol Psychiatry 2004; 45:41-62. [PMID: 14959802 DOI: 10.1046/j.0021-9630.2003.00304.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The atrocities of war have detrimental effects on the development and mental health of children that have been documented since World War II. To date, a considerable amount of knowledge about various aspects of this problem has been accumulated, including the ways in which trauma impacts child mental health and development, as well as intervention techniques, and prevention methods. Considering the large populations of civilians that experience the trauma of war, it is timely to review existing literature, summarize approaches for helping war-affected children, and suggest future directions for research and policy.
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Affiliation(s)
- Joshua Barenbaum
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06520-7900, USA
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Lonigan CJ, Phillips BM, Richey JA. Posttraumatic stress disorder in children: diagnosis, assessment, and associated features. Child Adolesc Psychiatr Clin N Am 2003; 12:171-94. [PMID: 12725007 DOI: 10.1016/s1056-4993(02)00105-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although a growing body of research has increased knowledge of the after-effects of trauma in children, including the development of PTSD, there are significant gaps in this knowledge concerning diagnosis, assessment, and associated features. With regard to diagnosis, variations in symptomatic expression of PTSD in children have been proposed; however, there have been few examinations of the validity of these variations in terms of course and consequence of PTSD defined in these ways. Several factors increase children's risk for development of PTSD or PTSD symptoms after trauma. Such information is potentially useful for identifying children who may benefit from more thorough or ongoing assessment after trauma. With regard to assessment, an array of increasingly sophisticated and clinically useful measures is being developed; however, currently there is a dearth of high quality data concerning the diagnostic use of different assessments. An area of general weakness concerning these assessments is the limited data on discriminant validity. A sizeable body of evidence indicates that trauma can produce diverse reactions in children, including a general increase in internalizing and externalizing symptoms. Clinically useful measures allow PTSD to be differentiated from this general reaction to traumatic events, much of which may reflect a nonpathologic response. With regard to associated features, limited information suggests that PTSD can have a cascading negative effect on children's development and functioning. More research is needed, however, to delineate factors that reflect risk for PTSD after trauma, factors that reflect consequences of PTSD, and mediating variables.
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Affiliation(s)
- Christopher J Lonigan
- Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, USA.
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Smith P, Perrin S, Dyregrov A, Yule W. Principal components analysis of the impact of event scale with children in war. PERSONALITY AND INDIVIDUAL DIFFERENCES 2003. [DOI: 10.1016/s0191-8869(02)00047-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ohan JL, Myers K, Collett BR. Ten-year review of rating scales. IV: scales assessing trauma and its effects. J Am Acad Child Adolesc Psychiatry 2002; 41:1401-22. [PMID: 12447027 DOI: 10.1097/00004583-200212000-00012] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article summarizes scales assessing trauma and its effects on youths. METHOD We sampled trauma-related articles published over the past 25 years, with an emphasis on the past decade, selected scales with at least several publications, and reviewed their properties. Those with minimally adequate psychometric properties and continued literature citations or a special niche are presented. RESULTS Most of trauma-related scales are relatively new, reflecting the evolving interest in juvenile trauma. Therefore, they do not have the depth of psychometric examination nor the breadth of applications described for previously reviewed scales. However, they have been applied to various traumatic situations. These scales assess a range of trauma-related symptoms and behaviors, including posttraumatic stress disorder, symptoms related to posttraumatic stress disorder, and dissociation. Additionally, several scales assess the trauma itself. CONCLUSIONS Trauma-related scales show promise for research and clinical use in understanding youths' responses to trauma. However, their utility for treatment planning and for accountability in practice is generally not as clear. The potential user must clearly define the goals of measurement and use these scales within their limited roles. With these caveats, trauma-related scales may assist our work with traumatized youths.
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Allwood MA, Bell-Dolan D, Husain SA. Children's trauma and adjustment reactions to violent and nonviolent war experiences. J Am Acad Child Adolesc Psychiatry 2002; 41:450-7. [PMID: 11931602 DOI: 10.1097/00004583-200204000-00018] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with children's stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to children's trauma reactions and adjustment in a group of children from Bosnia. METHOD During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Children's Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers. RESULTS In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with children's adjustment and trauma reactions. CONCLUSIONS Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.
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Neria Y, Solomon Z, Ginzburg K, Dekel R. Sensation seeking, wartime performance, and long-term adjustment among Israeli war veterans. PERSONALITY AND INDIVIDUAL DIFFERENCES 2000. [DOI: 10.1016/s0191-8869(99)00243-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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