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.
- SourceAvailable from: Cindy Mels
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- "Post-traumatic stress symptoms were assessed with the Impact of Event Scale Revised (Weiss & Marmar, 1997). This 22-item questionnaire has been adapted and validated for use in eastern Congolese adolescents (Cronbach's alphas 0.92 and 0.93 in the project's total sample; for details on the items and validation procedure, see Mels et al., 2010b). Respondents were asked to rate the amount of difficulties they had experienced in the past month (on a scale from 0 to 4). "
ABSTRACT: This study explores coping strategies used by war-affected eastern Congolese adolescents across age and sex, and the association between post-traumatic stress symptoms and engagement and disengagement coping. Cross-sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13-21 years (M = 15.83, standard deviation = 1.81) participated in self-report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post-traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war-affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.Stress and Health 02/2015; 31(1). DOI:10.1002/smi.2540 · 1.81 Impact Factor
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- "En cuanto a la discusión acerca del efecto diferencial de la exposición a la violencia y su impacto percibido en la sintomatología producida, los datos del estudio apoyan la teoría de evaluación cognitiva (Lazarus y Folkman, 1984), demostrando la contribución significativa del impacto percibido sobre todo en cuanto a síntomas de depresión y ansiedad. Se considera que estos síntomas pueden ser otra manifestación más de la perturbación psicológica o el trauma generado por la exposición a eventos de violencia, considerados como impactantes por los sujetos (Mels et al., 2010b; Miller y Rasmussen, 2010). No obstante, la ausencia de un efecto de la exposición real sobre los síntomas evaluados no implica que sea una variable irrelevante, sobre todo considerando la importante correlación encontrada entre la exposición acumulada y el impacto total percibido. "
ABSTRACT: : La violencia comunitaria forma parte de la vida cotidiana de cada vez más niños y jóvenes, particularmente en las grandes ciudades. La exposición a este tipo de violencia ha sido asociada con el desarrollo de varios problemas conductuales y emocionales, tales como conductas agresivas y delincuentes, ansiedad y depresión. Este estudio pretende explorar la exposición de adolescentes uruguayos en situación de vulnerabilidad socioeconómica a la violencia comunitaria y su impacto percibido, e investigar su relación con problemas internalizantes y externalizantes reportados por ellos. Se consiguió una muestra de 101 adolescentes de 13 a 18 años en la ciudad de Montevideo, pertenecientes a tres centros socioeducativos seleccionados deliberadamente y por conglomerado. Se administró el Hopkins Symptom Checklist para adolescentes, la Escala de Violencia Comunitaria y un cuestionario sociodemográfico. Se encontró que el 84,2% de la muestra había sido expuesto a la violencia comunitaria. El impacto percibido de la violencia apareció como predictor de problemas internalizantes, junto a la variable edad. Los resultados sugieren que diferentes mecanismos explican los distintos tipos de problemas psicológicos investigados. Se discuten las implicaciones para la intervención y la prevención.
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- "Changes in reported symptom levels were chosen instead of cut-off diagnostic points to assess outcome variables. This was due to the lack of a 'gold standard' to determine caseness in the DR Congo (Mels et al., 2010) and the authors' concern with the validity of applying specific cut-off points with a non-Western population where psychological distress may present with different symptoms but may be missed by existing measures. (For comparison 26/159 participants had a score of 17 or greater on the CRIES-8, a cut-off point previously found to correlate well with a diagnosis of PTSD (Children & War Foundation, 2009). "
ABSTRACT: Rural communities in the Haut-Uele Province of northern Democratic Republic of Congo live in constant danger of attack and/or abduction by units of the Lord's Resistance Army operating in the region. This pilot study sought to develop and evaluate a community-participative psychosocial intervention involving life skills and relaxation training and Mobile Cinema screenings with this war-affected population living under current threat. 159 war-affected children and young people (aged 7–18) from the villages of Kiliwa and Li-May in north-eastern DR Congo took part in this study. In total, 22% of participants had been abduction previously while 73% had a family member abducted. Symptoms of post-traumatic stress reactions, internalising problems, conduct problems and pro-social behaviour were assessed by blinded interviewers at pre- and post-intervention and at 3-month follow-up. Participants were randomised (with an accompanying caregiver) to 8 sessions of a group-based, community-participative, psychosocial intervention (n = 79) carried out by supervised local, lay facilitators or a wait-list control group (n = 80). Average seminar attendance rates were high: 88% for participants and 84% for caregivers. Drop-out was low: 97% of participants were assessed at post-intervention and 88% at 3 month follow-up. At post-test, participants reported significantly fewer symptoms of post-traumatic stress reactions compared to controls (Cohen's d = 0.40). At 3 month follow up, large improvements in internalising symptoms and moderate improvements in pro-social scores were reported, with caregivers noting a moderate to large decline in conduct problems among the young people. Trial Registration clinicalTrials.gov, Identifier: NCT01542398.Child abuse & neglect 07/2014; 38(7). DOI:10.1016/j.chiabu.2014.02.004 · 2.34 Impact Factor