Community-based cross-cultural adaptation of mental health measures in emergency settings: validating the IES-R and HSCL-37A in Eastern Democratic Republic of Congo.
ABSTRACT This study aims at providing qualitative and quantitative evidence on the relevance of two broadly used mental health self-report measures--Impact of Event Scale Revised (IES-R) and Hopkins Symptom Checklist 37 for Adolescents (HSCL-37A)--for use in Eastern Democratic of Congo, as no psychological assessment instruments were available for this region. We therefore describe an apt procedure to adapt and translate standard screening instruments in close collaboration with the local community, feasible under challenging conditions in emergency settings.
Focus groups and interviews with community key figures in psychosocial care were employed to ensure local validity of the adaptation and translation process. Consequently, the questionnaires' internal consistency (Cronbach's alpha) and construct validity (principal component analysis, testing of theoretical assumptions) were assessed based on a clustered school-based community survey among 1,046 adolescents (13-21 years) involving 13 secondary schools in the Ituri district in Eastern Democratic Republic of Congo.
Key-informant qualitative data confirmed face and construct validity of all IES-R and all HSCL-37A anxiety items. Additional culture-specific symptoms of adolescent mental ill-health were added to enhance local relevance of the HSCL-37A depression and externalizing subscales. Quantitative analysis of the survey data revealed adequate internal consistency and construct validity of both adapted measures, yet weaker results for the externalizing scale. Furthermore, it confirmed the internalizing/externalizing factor structure of the HSCL-37A and the theoretically deviating intrusion/arousal versus active avoidance factor structure for the IES-R.
Community-based adaptation can extend the validity and local relevance of mental health screening in emergency and low-income settings. The availability of adequate Swahili and Congolese French adaptations of the IES-R and HSCL-37A could stimulate the assessment of psychosocial needs in war-exposed Eastern Congolese adolescents.
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ABSTRACT: Unaccompanied asylum-seeking children (UASC) are known to be subjected to several potentially traumatic life events, risking more mental health problems than other populations of same age. In this study, we aimed to explore the prevalence of psychiatric morbidity at an early stage after arrival to the host country. We performed structured clinical interviews (CIDI) with 160 male UASC from different countries (Afghanistan, Somalia, Iran), after four months in Norway. Most of the participants had experienced life threatening events (82%), physical abuse (78%), or loss of a close relative (78%) in their former life. Altogether 41.9% of the participants fulfilled diagnostic criteria for a current psychiatric disorder. The most prevalent diagnosis was PTSD (30, 6%), followed by MDD (9, 4%), Agoraphobia (4, 4%) and GAD (3, 8%). Implications of this vulnerability call for more mental health resources in the early stages of the asylum process. Increased awareness of psychiatric morbidity in UASC may improve the prognosis, give more appropriate care, and ease the integration process on all levels of society.Clinical Practice and Epidemiology in Mental Health 06/2014; 10:53-8. DOI:10.2174/1745017901410010053
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ABSTRACT: Background The conflict-ridden context of eastern Congo has set the scene for grueling human rights violations, with sexual violence as one of the ‘weapons of war’. Currently, sexual violence continues, with a considerable increase in civilian perpetrators. However, little is known regarding the particular impact of different experiences of sexual violence on adolescents’ mental health. This study therefore investigates the impact of sexual violence on eastern Congolese adolescents’ mental health and its differing associations with daily stressors, stigma, and the labeling of sexual violence (as ‘rape’ or ‘non-consensual sexual experience’). Methods A cross-sectional, population-based survey design was implemented in 22 secondary schools, randomly selected from a stratified sample, in Bunia, eastern Congo, a region extensively affected by war. A total of 1,305 school-going adolescent girls aged 11 to 23 participated. Self-report measures of mental health symptoms, war-related traumatic events, experiences of sexual violence, daily stressors, and stigmatization were administered. Differences in sociodemographic characteristics, traumatic experiences and daily and social stressors between types of sexual violence (rape, non-consensual sexual violence, no sexual violence) were explored through statistical analysis. ANCOVA analyses investigated associations between those risk factors and adolescents’ mental health. Results More than one third of eastern Congolese adolescent girls reported experiences of sexual violence. Elevated levels of daily stressors, experiences of stigmatization, and stressful war-related events were found amongst girl victims of sexual violence, with the highest levels for girls who labeled the sexual violence as rape. Daily stressors, stigmatization, and war-related events showed a large impact on the girls’ mental health. Last, girls who labeled the sexual violence as non-consensual sexual experiences reported more post-traumatic hyper-arousal and intrusion symptoms compared to those labeling the sexual violence as rape. Conclusions These findings point to the important association between how war-affected adolescent girls label sexual violence (rape or non-consensual sexual experiences) and their mental health. This study also documents the large impact of sexual violence on other stressors (daily stressors, stigmatization, and stressful war events) and the impact of these stressors on girl victims’ mental health. It discusses important implications for addressing sexual violence and its consequences in war-affected contexts.BMC Women's Health 09/2014; 14(1):106. DOI:10.1186/1472-6874-14-106 · 1.66 Impact Factor
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ABSTRACT: Background Previous studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents. To date, no comprehensive studies on the role of childhood adversities have been conducted with war-exposed adolescents living in post-war, low-resource settings in Sub-Saharan Africa.MethodsA cross-sectional study of 551 school-going adolescents aged 13-21 years old was undertaken four years post-war in northern Uganda. Participants completed self-administered questionnaires assessing demographics, stressful war experiences, childhood adversities, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms.ResultsOur analyses revealed a main effect of gender on all mental health outcomes except avoidance symptoms, with girls reporting higher scores than boys. Stressful war experiences were associated with all mental health symptoms, after adjusting for potential confounders. Childhood adversity was independently associated with depression symptoms but not PTSD, anxiety, and PTSD cluster symptoms. However, in situations of high childhood adversity, our analyses showed that stressful war experiences were less associated with vulnerability to avoidance symptoms than in situations of low childhood adversity.Conclusions Both stressful war experiences and childhood adversities are risk factors for mental health symptoms among war-affected adolescents. Adolescents with histories of high childhood adversities may be less likely to develop avoidance symptoms in situations of high stressful war experiences. Further exploration of the differential roles of childhood adversities and stressful war experiences is needed.BMC Psychiatry 09/2014; 14(1):260. DOI:10.1186/s12888-014-0260-5 · 2.24 Impact Factor