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.
- The British Journal of Psychiatry 06/2003; 182:376-8. · 6.61 Impact Factor
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ABSTRACT: Worldwide, 300?000 children are currently used as child soldiers in armed conflicts. We interviewed 301 former child soldiers who had been abducted by the northern Ugandan rebellion movement Lord's Resistance Army. All the children were abducted at a young age (mean 12.9 years) and for a long time (mean 744 days). Almost all the children experienced several traumatic events (mean six events); 233 (77%) saw someone being killed, and 118 (39%) had to kill someone themselves. 71 children also filled in the impact of event scale--revised to assess their post-trauma stress reactions. 69 (97%) reported post-traumatic stress reactions of clinical importance. The death of a parent, especially of the mother, led to an important increase in score for avoidance symptoms (mother alive 16.4, mother not alive 21.6; p=0.04), with a high increase for girls (from 15.1 to 25.8), but almost no change for boys (from 17.7 to 17.4; p=0.02). Our findings shed light on the nature of severe trauma experienced by this group of children, and show a high rate of post-traumatic stress reactions.The Lancet 04/2004; 363(9412):861-3. · 39.06 Impact Factor
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ABSTRACT: Programmes costing millions of dollars to address 'posttraumatic stress' in war zones have been increasingly prominent in humanitarian aid operations, backed by UNICEF, WHO, European Community Humanitarian Office and many nongovernmental organisations. The assumptions underpinning this work, which this paper critiques with particular reference to Bosnia and Rwanda, reflect a globalisation of Western cultural trends towards the medicalisation of distress and the rise of psychological therapies. This paper argues that for the vast majority of survivors posttraumatic stress is a pseudocondition, a reframing of the understandable suffering of war as a technical problem to which short-term technical solutions like counselling are applicable. These concepts aggrandise the Western agencies and their 'experts' who from afar define the condition and bring the cure. There is no evidence that war-affected populations are seeking these imported approaches, which appear to ignore their own traditions, meaning systems, and active priorities. One basic question in humanitarian operations is: whose knowledge is privileged and who has the power to define the problem? What is fundamental is the role of a social world, invariably targeted in today's 'total' war and yet still embodying the collective capacity of survivor populations to mourn, endure and rebuild.Social Science [?] Medicine 06/1999; 48(10):1449-62. · 2.73 Impact Factor