Introduction to the special collection: developing valid psychological measures for populations impacted by humanitarian disasters

A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis

Introduction

There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies.

Methods

To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress.

Results

Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors.

Conclusion

Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.

Quality of mental health questionnaires in conflict-affected adult populations in low and middle income countries: A systematic review

BACKGROUND

Accurate measurement of mental health disorders in conflict-affected populations is crucial for improving mental health care for these populations. Most studies to develop mental health questionnaires for conflict-affected populations are conducted in high income countries despite the vast majority of conflict-affected populations residing in Low and Middle Income Countries (LAMICs). The aim of this systematic review is to assess the quality of questionnaires for mental disorders that have been either developed or validated in conflict- affected settings in LAMICs.

METHODS

A systematic review of 5 databases (CINAHL Plus, EMBASE, Global Health, MEDLINE and PsycINFO) was conducted to identify validation studies for questionnaires measuring mental health disorders in adult conflict-affected population in LAMICs. Well-established psychometric criteria evaluating reliability, validity and responsiveness of questionnaires were applied for quality appraisal.

RESULTS

Thirty validation studies were included in this review, which reported on data for 33 questionnaires. Twenty-four were questionnaires that had been originally developed in different settings and adapted for use with a new conflict-affected population and 9 had been newly developed for the conflict-affected population being studied. Overall, there was high variability in the quality of evidence for the questionnaires with moderate evidence for the validity and reliability of included questionnaires but no responsiveness data reported.

CONCLUSION

There has been increasing recognition of the particular importance of psychometrics in this field to facilitate the development of good quality mental health questionnaires suitable for use in LAMICs. However, this review highlighted the current limited quantity and quality of such questionnaires.

Measuring mental health in humanitarian crises: a practitioner's guide to validity

Background

There are ongoing methodological advances in measuring mental health in humanitarian crises. This Special Section describes numerous innovations. Here we take a practitioner's view in understanding the key issues related to assessment of mental health in humanitarian contexts and how the innovations contribute to the field.

Main body

In this guide for practitioners, we address the following issues: (1) clarifying the intended purpose of conducting mental health assessment in humanitarian crises: why is this information collected and for what intended purposes?; (2) determining what type of tool should be selected and the types of psychometric properties that are important for tools serving this particular purpose; (3) when a validated tool is not available, considering how qualitative and quantitative methods should be used to generate information on validity; and finally, (4) how to report on validity and its implications for interpreting information for humanitarian practitioners, governments, care providers, and other stakeholders supporting people affected by humanitarian emergencies.

Conclusion

Ultimately, mental health assessment tools are not independent of the group with which they were designed, nor are the psychometric properties of the tools or their utility universal across purposes. Therefore, organizations and stakeholders will optimize their positive impact when choosing tools wisely, appropriately adapting and validating tools, and providing guidance on how to interpret those findings to best serve populations in need.

The development of a contextually appropriate measure of psychological distress in Sierra Leone

Background

Studies of psychological distress in Sierra Leone have typically used measures which were developed for use in other contexts, and which often have not been adapted or validated for use in Sierra Leone. This has resulted in a lack of reliable information about the patterns of psychological distress within the population, which is a barrier to the development of effective and appropriate mental health services. The aim of the study was to develop a locally-appropriate measure of psychological distress for Sierra Leone.

Methods

The new measure consists of two instruments: the Sierra Leone Psychological Distress Scale (SLPDS) and a gendered measure of ability to carry out daily tasks—a Function scale—as an indication of the severity of distress. A three-phase mixed methods exploratory sequential study was conducted. Phase 1 was item generation and testing, leading to the development of a set of potential items for both instruments. Phase 2 was a small pilot study (N = 202) leading to the selection of the final set of items for both measures. Phase 3 was a validation phase where the SLPDS and the Function scale were administered with a larger sample of 904 respondents. Item analysis was used to assess the internal consistency of the scales, and Exploratory Factor Analysis to explore the properties of the SLPDS.

Results

Exploratory factor analysis using the principal axis factoring with an oblique rotation identified a three-factor structure for the 18-item SLPDS. Internal consistency for the SLPDS (Cronbach’s alpha = 0.89) and three subscales was good (Cronbach’s alpha > 0.73). The internal reliability of the male and female versions of the Function scale was also found to be acceptable (Cronbach’s alpha = 0.90 for the female scale and 0.79 for the male scale).

Conclusions

Together the SLPD and Function scales provide a locally-validated tool which will enable government bodies and local and international non-governmental organisations in Sierra Leone to assess mental health and psychosocial needs. This will support both effective service provision and the evaluation of initiatives designed to improve mental health and psychosocial wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00610-w.