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Entwicklung einer Kultursensiblen Version des Mini-International Neuropsychiatric Interview (MINI) in Hocharabischer Sprache
Abstract
Zusammenfassung
Ziel der Studie Trotz des erheblichen Bedarfs nach einer schnellen und effizienten Diagnostik aufgrund von aktuellen humanitären Krisen in der arabischen Welt, steht bisher keine validierte, hocharabische Version des Mini International Neuropsychiatric Interview (MINI) für die Versorgungsforschung zur Verfügung. Das Ziel der vorliegenden Pilotstudie war es daher, eine Übersetzung und kultursensible Adaptation des MINI ins Hocharabische zur Verfügung zu stellen sowie erste Validierungsversuche in einer arabischsprachigen Geflüchtetenstichprobe vorzunehmen. *
Methodik An dem mehrstufigen Adaptationsprozess waren mehrere psychiatrisch-psychotherapeutische ExpertInnen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut sind. N = 20 arabischsprachige geflüchtete PatientInnen nahmen an der Pilotstudie teil, die an der Clearingstelle der Charité, Universitätsmedizin Berlin rekrutiert werden konnten. Für die Feststellung der Kriteriumsvalidität wurden Diagnosen von ExpertInnen, die gegenüber den MINI Diagnosen ‚verblindet’ waren und Screeninginstrumente für Depression (Patient Health Questionnaire 9, PHQ-9) und die posttraumatische Belastungsstörung (PTBS) (Harvard Trauma Questionnaire, HTQ) herangezogen.
Ergebnisse Aufgrund der ausführlichen Dokumentation kann der Prozess der kulturellen Adaptation detailliert nachvollzogen werden. Kappa Werte zeigten keine Übereinstimmung der MINI Diagnosen mit den ExpertInnendiagnosen, jedoch konnten hohe Übereinstimmungen zwischen den MINI Diagnosen und dem PHQ-9 (κ = .69) und dem HTQ (κ = .68) festgestellt werden.
Schlussfolgerungen Die Ergebnisse der Pilotstudie werden als erste Hinweise für die Validität der hocharabischen Übersetzung des MINI gewertet und bilden die Grundlage für weitere, ausführliche Validierungsstudien. Darüber hinaus zeigt diese Studie einen Modellprozess für die kulturelle Adaptation psychometrischer Instrumente auf.
Supplementary resource (1)
Data
February 2021
... Die kulturelle Adaptation beinhaltete die Hin-und Rückübersetzung von Englisch in Arabisch; Expert*innen bestimmten Dauer und Anzahl der Sitzungen sowie die Interventionen zur Erreichung der Therapieziele [11]. Churbaji et al. [12] beschrieben die Übersetzung und kultursensible Adaptation eines klinischen Interviews zur Diagnostik psychischer Störungen auf Hocharabisch und führten eine Validierungsstudie an einer Arabisch sprechenden Geflüchtetenstichprobe in Deutschland durch. An dem mehrstufigen Adaptationsprozess waren psychiatrisch-psychotherapeutische Expert*innen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut waren; eine Pilotstudie liefert erste Hinweise für die Validität der Übersetzung des Interviews [12]. ...
... Churbaji et al. [12] beschrieben die Übersetzung und kultursensible Adaptation eines klinischen Interviews zur Diagnostik psychischer Störungen auf Hocharabisch und führten eine Validierungsstudie an einer Arabisch sprechenden Geflüchtetenstichprobe in Deutschland durch. An dem mehrstufigen Adaptationsprozess waren psychiatrisch-psychotherapeutische Expert*innen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut waren; eine Pilotstudie liefert erste Hinweise für die Validität der Übersetzung des Interviews [12]. ...
... Zudem rekrutierten sie für ihre Studie mehr weibliche als männliche Patientinnen, beschrieben einerseits die positive Reaktion geflüchteter Frauen auf die Einladung zur Therapie sowie andererseits Verpflichtungen der Männer als Familienoberhaupt und Ernährer der Familie als Hindernisgrund für eine Therapieteilnahme. Allerdings nahmen in der Studie von Churbaji et al.[12], in der die Übersetzung und kultursensible Adaptation eines diagnostischen Verfahrens zur Erfassung psychischer Störungen ins Hocharabische durch einen mehrstufigen Adaptationsprozess beschrieben wurde, mehr männliche als weibliche Patient*innen teil; erklärt wurde der Unterschied in der Teilnahmebereitschaft zwischen beiden Geschlechtern mit dem Geschlechterverhältnis der in Deutschland ankommenden Geflüchteten. In zukünftigen Studien zum kulturell adaptierten D-MKT sollten daher Schwächen und Optimierungsoptionen bei den Rekrutierungsstrategien geprüft werden, um explizit auch Männer anzusprechen und für das Training motivieren. ...
Zusammenfassung
Ziel der Studie Trotz hohem Bedarf sind kulturell adaptatierte Therapien für Arabisch sprechende geflüchtete Patient*innen mit Depression selten. Ziel der Studie war, das Gruppenprogramm Metakognitives Training bei Depression (D-MKT) für sie kulturell anzupassen und zu erproben.
Methodik Die kulturelle Adaptation des D-MKTs umfasste die Übersetzung und Oberflächenadaptation sowie eine Expert*innendiskussion. Anschließend wurden in einer unkontrollierten Pilotstudie mit n=11 geflüchtete Patient*innen die Verständlichkeit, Akzeptanz und Durchführbarkeit des ambulant durchgeführten, kulturell adaptierten D-MKTs (KA-D-MKT) geprüft.
Ergebnisse Die Expert*innen bewerteten 83% der Übersetzungen und 78% der Abbildungen als unproblematisch hinsichtlich der Äquivalenz. Die Akzeptanz und Durchführbarkeit der acht Module wurden überwiegend positiv bewertet.
Schlussfolgerung Das adaptierte Training weist aus Sicht der Patient*innen eine hohe Akzeptanz und Verständlichkeit für den kultursensiblen, Dolmetscher*innen-gestützten Einsatz auf.
... Final degree was calculated for each patient with the final score ranging from zero to 52. The following scale was used to determine severity of symptoms: (0-7) no depression symptoms, (8-13) mild depression, (14-18) moderate depression, (19)(20)(21)(22) severe depression and (≥ 23) very severe depression [15,16] Hamilton anxiety scale (HAM-A) is composed of 14 symptoms with a scale from zero to four for each symptom where four is the severe degree. Total score for each patient was calculated. ...
... Total score for each patient was calculated. The range is from zero to fifty six and it was divided as follow: (0-17) no or mild depression, (18)(19)(20)(21)(22)(23)(24) mild to moderate depression, (25)(26)(27)(28)(29)(30) moderate to severe depression [17,18]. ...
... (B) Psychiatric evaluation: including Mini International Neuropsychiatric Interview [21,22] with application of the above-mentioned psychometric tests for depression, anxiety and female sexual function. Participants were asked to fill in or answer all questions in the scale sections. ...
Objectives
The present study seeks to deepen understanding of the negative impacts of infertility, with a spotlight on the experiences of Egyptian women who faced prolonged periods of infertility, and emphasizing the role that faliures of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles may play in exacerbating their psychiatric disorders and impairing their sexual functions.
Methods
Embarking on a cross-sectional approach, this study was operationalized within the outpatient sectors of the Obstetrics and Gynecology Departments, synchronized with Psychiatry Departments, at Tanta University Hospitals from September 1, 2018, to December 31, 2022. The targeted population encompassed women experiencing prolonged infertility (≥ 5 years), categorically divided into two groups for meticulous analysis: Group I (with a history of IVF/ICSI failure) and Group II (without any IVF/ICSI attempts). Diagnostic tools, including the Arabic versions of the Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), and the Female Sexual Function Index (FSFI), were deployed to scrutinize the mental health and sexual function outcomes of the participants.
Results
A total of 236 women participated in this study (126 in Group I and 110 in Group II), with primary infertility prevalent in 73.31% of cases, averaging a duration of 9.28 ± 3.40 years. Our findings indicated a substantial presence of depression (58.47%), anxiety disorders (35.17%), and sexual dysfunctions (43.64%). Notably, significant differences ( p < 0.0001) emerged between the groups on the HAM-D, HAM-A, and FSFI scales, with endometriosis showcasing the worst effects.
Conclusions
The findings conclusively pinpoint a pronounced link between prolonged infertility and exacerbated mental health conditions, alongside impaired sexual functions, thereby negatively affecting the quality of life of the affected women. This revelation underscores the pressing need for integrated psychiatric consultations in the therapeutic protocols of women grappling with infertility, particularly those with a history of endometriosis or failed IVF/ICSI cycles, to foster a more holistic approach to infertility management and care.
... Furthermore, moderate validity with both the extensive Composite International Diagnostic Interview (CIDI) [12,14] and the Structured Clinical Interview for DSM-4 (SCID) [12,14] have been exhibited. Through a previous trial by our research group with a pilot sample size (N = 20), initial validity has been shown for the translated M.I.N.I.-AR [25]. ...
... In a pilot trial published by our research group [25], a translation and cultural/linguistic adaptation of the M.I.N.I. 5.0.0 version was carried out. As a follow-up project, the validation of the most recent M.I.N.I. 7.0.2 ...
... In a final evaluation and revision, five psychologists and three psychiatrists discussed and adjusted outcomes until an agreement for a final version was reached. For a more detailed description of the cultural and linguistic adaptation and translation, see Churbaji et al. [25]. ...
Background
Arabic represents one of the most frequently spoken languages worldwide, especially among refugee populations. There is a pressing need for specialized diagnostic tools corresponding to the DSM-5 criteria in Modern Standard Arabic, which can be administered on Arabic speakers in the West and Arab region alike.
Objectives
To develop and validate the culturally-adapted version of the most recent M.I.N.I. 7.0.2 into Modern Standard Arabic—a form of Arabic commonly used across all Arab countries.
Methods
102 participants were recruited between April 2019 to March 2020 at the Charité - Universitätsmedizin in Berlin. Symptoms were assessed with Arabic versions of rater-based and self-rated measures, including Mini International Neuropsychiatric Interview (M.I.N.I.), Patient Health Questionnaire (PHQ-9), and Harvard Trauma Questionnaire (HTQ). Arabic-speaking psychiatrists saw participants for diagnostic assessment.
Results
Cohen’s kappa (κ) values were moderate for major depression, and slight for post-traumatic stress disorder, as well as generalized anxiety disorder. Moreover, kappa values indicated moderate agreement between M.I.N.I.-AR and PHQ-9 for depression, as well as HTQ for post-traumatic stress disorder, respectively.
Conclusion
The translated and culturally adapted version of the M.I.N.I. addresses an existing need for a reliable, efficient, and effective comprehensive diagnostic tool using the most recent DSM-5 criteria in Modern Standard Arabic (MSA). Based on the obtained results, only a validation of the depression module (Module A) of the M.I.N.I-AR was possible. Study outcomes also show evidence for the validation of Module H covering Post-Traumatic Stress Disorder. Potential valuable contributions can be extended to this translation and validation.
... Primary Health Questionnaire (PHQ-9): This is a widely used psychometric tool in the assessment of depressive disorder in primary health care settings in Arabic-speaking communities. [23,24] It was found to have robust psychometric properties and satisfactory sensitivity in capturing depressive patients. However, specificity analysis was suboptimum, meaning that it may include healthy subjects as depressed in many cases. ...
A BSTRACT
Background
Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity.
Method
Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms.
Results
The current survey analyzed data pertaining to ( n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach’s α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage ( t = 3.337, P = 0.0009937), diabetes complications ( t = 5.257, P < 0.00001), pain ( r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was ( n = 367, 68.5%) and for anxiety was ( n = 173, 30.3%). Illness uncertainty correlated with depressive ( r = 0.2484, P < 0.00001) and anxiety ( r = 0.2548, P < 0.00001) symptoms’ scores. Illness uncertainty exerted a partial moderating effect on both anxiety (β = 0.060, P < 0.001) and depressive symptoms (β =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms.
Discussion
We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.
Background
Bipolar disorder (BD) is a common mental illness that is usually associated with significant morbidity causing critical impairment in socio-occupational functioning and even mortality. Social rhythm therapy (SRT) has been suggested as an adjunctive psychotherapy in BD treatment protocols, with its proposed benefits of accelerating recovery from bipolar episodes, delaying relapses, and upgrading patients’ functioning. This study aimed to investigate the outcomes of combining SRT with pharmacological treatment, as compared to pharmacotherapy alone, in a sample of Egyptian BD patients. Sixty eligible bipolar patients were enrolled in this comparative study by convenience sampling and randomly divided into two groups for comparison; group I included 30 BD-I patients treated as usual (TAU) with pharmacological treatment only, while group II included 30 BD patients treated with social rhythm therapy in addition to the traditional psychotropic medications. Manic and depressive symptoms as well as socio-occupational functioning were assessed at baseline and after 3 months of treatment using the Mood Disorder Questionnaire (MDQ), Hamilton Depression Rating Scale (HDRS), and Socio-occupational Functioning Assessment Scale (SOFAS).
Results
Patients treated with SRT therapy showed significant improvement in their manic and depressive symptoms as well as socio-occupational functioning after 3 months of treatment by 65.76%, 55.87%, and 52.5%, respectively. Linear regression analysis showed that the gender and age of the patient could significantly predict improvement of MDQ% in group II, while none of the studied variables could significantly predict the percentage of change in HDRS or SOFAS.
Conclusion
SRT could be a promising adjunctive therapy promoting early recovery of BD patients compared to standalone pharmacological treatment.
Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.
In recent years, Mindfulness-Based Interventions (MBI) have gained popularity as a
modern psychotherapeutic approach, primarily in English-speaking countries. A growing body of evidence demonstrates the clinical benefits of MBI for a wide range of symptoms
experienced in Schizophrenia Spectrum Disorders (SSD). However, research in German speaking countries remains scarce. Against this background, the present dissertation aims to contribute to the available body of literature by developing and validating a Mindfulness-Based Group Therapy (MBGT) for the treatment of inpatients with schizophrenia spectrum disorders. This comprehensive research study will include both qualitative and quantitative data analysis concerning the three subprojects revealed below. A qualitative research design based on inductive thematic analysis in the form of a semistructured interview guide was developed and 27 interviews were conducted with inpatients having SSD after attending a mindfulness-based intervention in study one. Analyses revealed two domains (content and function) of MBI. The domain content had further subcategories, including core elements, as well as effects on emotions, cognition, and symptoms changes. The second domain was related to the relevance of perception of context and transfer to everyday life. Overall, individuals reported improvements on several clinical parameters and gave an indepth understanding of underlying processes and mechanisms at action. Based on these outcomes, a novel Mindfulness-Based Group Therapy (MBGT) was developed for the first time in the German language through a fundamental participatory and iterative research process and finally published in a manual's printed book form. Moreover, historical concerns regarding the therapeutic utility of mindfulness for SSD are discussed, while recommendations and careful adaptations are given to implement MBI in inpatient and outpatient settings as a part of an editorial article. In study two, the newly translated German version of the Southampton Mindfulness Questionnaire (SMQ) was validated regarding convergent and divergent validity, reliability, factor structure, and treatment sensitivity while providing evidence for clinical practice and research for healthy individuals, mediators, and clinical groups. In the third study, a rater-blinded randomized controlled trial was conducted to assess the feasibility, acceptability, and preliminary outcomes of MBGT with inpatients having SSD. Results showed high protocol adherence and retention rates indicating feasibility and acceptability. Furthermore, various improvements were revealed on clinical- and process dimensions compared with treatment-as-usual. Overall, the present dissertation gives compelling evidence regarding the effects of mindfulness for SSD and adds a modern psychological treatment option for this marginalized patient group.
The sudden arrival of culturally diverse asylum seekers and refugees into Germany has created a strong demand for recognizing and appropriately treating those suffering from mental health issues. Due to many systemic, organizational, cultural and socio-linguistic barriers, psychiatric treatment of refugees is posing a major challenge to Germany’s mental health care system. Thus, there is a need for alternative models that allow for increased access to adequate, effective and efficient culturally sensitive mental health care services. Here, we describe the Mental Health in Refugees and Asylum Seekers (MEHIRA) project, a multicentre randomized controlled trial investigating a stepped collaborative care model (SCCM) for providing mental health treatment in this vulnerable population. The proposed SCCM aims to decrease the aforementioned barriers. Adult and adolescent participants will be screened for depressive symptoms and matched to appropriate psychological interventions, including group-level interventions (START intervention, Empowerment/Gender-sensitive/Peer to peer), and other innovative, digital treatment approaches (Smartphone application). The therapeutic effect of the SCCM will be compared to TAU (treatment-as-usual). All interventions have been designed to be culturally sensitive, and offered in two different languages: Arabic and Farsi. The outcome of this study may contribute significantly to future clinical and legal guidelines in developing parallel and efficient new structures of treatment. Collected data will inform primary and secondary mental health care providers with recommendations concerning the design and implementation of effective treatment models and programmes. Guidelines and recommendations may also potentially be adopted by other host countries, developing countries and also in humanitarian aid programmes.
Using back translation as a quality assessment tool in multilingual survey research is now deemed obsolete or on its way to becoming so, although it is still widely practiced. This paper will argue that back translation may be still useful as a documentation tool, not as a quality control tool. To support this premise, a review of literature that uses back translation to illustrate inevitable differences between the source and the target text is provided. This paper proposes a baseline for using back translation as a documentation tool, using examples of “good” and “bad” back translations. The value of using back translation is further demonstrated using examples from recent studies that integrated back translation into their documentation. This less-discussed use of back translation in questionnaire translation methodology merits the attention of translators and researchers. Although the utility of back translation as a quality control tool is deemed obsolete, it still has the potential for useful application as a documentation tool.
Background: High rates of prevalence of mental distress among the Syrian refugee population have been repeatedly confirmed. However, little is known about the influence of length of stay, living conditions, and residence permission in the host country or about the duration of the escape journey and travel conditions on mental health in this refugee population. This study examines the mental health of Syrian refugees, taking into account the circumstances in their country of origin and host country, as well as their escape conditions.
Methods: This investigation formed part of a registry-based study. A sample of 518 adult Syrian refugees in Erlangen, Germany, who have residence permission was identified. The response rate was 38.6%; a total of 200 Syrian refugees thus participated in the study. The respondents were investigated for post-traumatic stress disorder (ETI), depression (PHQ-9), generalized anxiety (GAD-7) and post-migration variables.
Results: The prevalence of participants who had personally experienced and/or witnessed traumatic events was 75.3%. Symptoms of PTSD were found in 11.4% of the participants. Moderate to severe depression was confirmed in 14.5% and moderate to severe generalized anxiety in 13.5% of the sample. The criteria for at least one diagnosis were met by 30.5% of the participants. More severe PTSD symptoms were associated with older age, shorter validity of the residence permit, larger number of traumatic events (TEs) and higher generalized anxiety symptoms. Depression symptoms were associated with younger age, shorter duration of escape journey, larger number of TEs and higher generalized anxiety symptoms. Generalized anxiety symptoms correlated with female gender, PTSD, and depression symptoms.
Conclusions: These findings suggest that Syrian refugees in Germany are a vulnerable population, especially if they have experienced and/or witnessed multiple traumatic events. However, post-migration conditions and positive future prospects in the host country can be protective factors for this population.
Background:
In the study, the frequency and nature of asylum seekers' psychiatric diagnoses in a German admission center were examined. Additional aims were to identify changes in those diagnoses over time and to investigate health care utilization of mentally ill asylum seekers in the community.
Methods:
The sample for the study "Psychiatric Examination of Asylum Seekers" in Bavaria consisted of a total of 283 asylum seekers and included 2 subsamples: help-seeking individuals and a randomly selected group. 34 of all asylum seekers were part of an extensive psychiatric follow-up examination (t2) about six months after the first examination (t1). Here, we used psychometric tools and a psychiatric interview by a medical doctor and a psychologist with the help of translators.
Results:
79% of help-seekers and 45% of the random group received at least one psychiatric diagnosis at t1. The most frequent diagnoses were trauma- and stress-related disorders, affective disorders, and insomnia. Men and Muslims were underrepresented in the help-seeking group. In the follow-up subsample, the rate of psychiatric diagnoses went down from 74% at t1 to 38% at t2. In contrast, the number of PTSD cases increased from 4 at t1 to 7 at t2. The severity of PTSD symptoms such as hyperarousal and avoidance also increased. Of the 13 persons in the follow-up-sample diagnosed with depression at t1, only 2 still fit the criteria of the disease at t2. Only 5 subjects had received some sort of psychotherapy or counseling.
Conclusion:
The prevalence of mental illness in asylum seekers reported here corresponds to the usual range in the literature. It is significantly higher than in European civil society, especially regarding PTSD. At t2, the diagnoses of PTDS had increased within several months without evident additional traumatic events. Asylum seekers' psychiatric diagnoses soon after arrival should be recorded carefully and examination should be repeated after six months. The psychiatric and psychotherapeutic treatment of asylum seekers is still insufficient. Psychoeducative steps should be taken to relieve the stigma on mental illness, especially among males and Muslims.
Background:
Psychological disorders including depression and anxiety are not rare in primary care clinics. The Patient Health Questionnaire (PHQ) is a clinical diagnostic tool that is widely utilized by primary health care physicians worldwide because it provides a practical in-clinic tool to screen for psychological disorders. This study evaluated the validity of the Arabic version of the PHQ in all six modules including depression, anxiety, somatic, panic, eating, and alcohol abuse disorders.
Methods:
This is a quantitative observational cross-sectional study that was conducted by administrating the translated Arabic version of PHQ to a sample of King Saud University students in Riyadh, Saudi Arabia.
Results:
The sample was 731 university students who participated in this study including 376 (51.6%) females and 354 (48.4%) males with a mean age of 21.30 years. Eight mental health experts carried out the face validation process of the PHQ Arabic version. The internal consistency reliability was measured using Cronbach's alpha for the PHQ9, GAD7, PHQ15, and panic disorder modules. The results were 0.857, 0.763, 0.826, and 0.696, respectively. In comparison, the eating disorders and alcohol abuse modules demonstrated poor internal consistency due to small number of participants in these modules.
Conclusion:
This study demonstrates that the Arabic version of the PHQ is a valid and reliable tool to screen for depression, anxiety, somatic, and panic disorders in a Saudi sample.
The Beck Depression Inventory (BDI-II), Hopkins Symptom Checklist (HSCL-25), and Posttraumatic Diagnostic Scale (PDS) are three widely applied clinical instruments for assessing depression, anxiety, and posttraumatic stress symptoms, respectively. Use of online-based psychological help and assessment is rapidly growing which necessitates the need for the validation of online assessment. To address these needs, data from 1,544 Arabic mother tongue treatment-seeking participants, who filled in the Arabic versions of these instruments online, was analyzed in two steps. In the first step, exploratory structural equation modeling (ESEM) was used to scrutinize factorial validity and eliminate items. In the second step, we examined the interrelationships between the latent factors (dimensions) using confirmatory factor analysis (CFA) of multitrait-multimethod (MTMM) data. Results show an acceptable to good fit of the hypothesized model, providing some first insights into the factorial and construct validity of the Arabic versions of BDI-II, HSCL-25, and PDS under consideration of cultural-specific aspects. Present evidence speaks for construct validity of the three instruments and the reliability and usefulness of online assessment.
There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
Background
There is a need for psychiatric assessment instruments that enable reliable diagnoses in persons with hearing loss who have sign language as their primary language. The objective of this study was to assess the validity of the Norwegian Sign Language (NSL) version of the Mini International Neuropsychiatric Interview (MINI).
Methods
The MINI was translated into NSL. Forty-one signing patients consecutively referred to two specialised psychiatric units were assessed with a diagnostic interview by clinical experts and with the MINI. Inter-rater reliability was assessed with Cohen’s kappa and “observed agreement”.
Results
There was 65% agreement between MINI diagnoses and clinical expert diagnoses. Kappa values indicated fair to moderate agreement, and observed agreement was above 76% for all diagnoses. The MINI diagnosed more co-morbid conditions than did the clinical expert interview (mean diagnoses: 1.9 versus 1.2). Kappa values indicated moderate to substantial agreement, and “observed agreement” was above 88%.
Conclusion
The NSL version performs similarly to other MINI versions and demonstrates adequate reliability and validity as a diagnostic instrument for assessing mental disorders in persons who have sign language as their primary and preferred language.
Aim:
All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations.
Methods:
This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions.
Results:
Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques.
Conclusions:
Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.
Several culturally specific practical considerations should inform social work interventions with ethnic Arab peoples in Arab countries or in Western nations. These include taking into account gender relations, individuals' places in their families and communities, patterns of mental health services use, and, for practice in Western nations, the client's level of acculturation. Such aspects provide the basis for specific guidelines in working with ethnic Arab mental health clients. These include an emphasis on shortterm, directive treatment; communication patterns that are passive and informal; patients' understanding
of external loci of control and their use of ethnospecific idioms of distress; and, where appropriate, the integration of modern and traditional healing systems.
Background:
Mental health assessments in post-conflict zones have relied heavily on Western psychiatric scales. Yet, a strict dependence on the paradigms of Western psychiatry risks inappropriately prioritizing syndromes, such as PTSD, which, however important, are eclipsed by local concerns.
Material and discussion:
In Dearborn, Michigan, home to the largest population of Iraqi refugees in the United States, 60 Iraqi refugee life stories were collected in order to adapt the Harvard Trauma Questionnaire (HTQ) to the Iraqi context.
Conclusion:
The methodology described proved to be a useful approach to developing a trauma measure that is culturally grounded in a multi-dimensional model of mental health.
Zusammenfassung
Ziele der Studie Untersuchung der Sicht von Asylbewerbern auf rechtliche Situation, Asylverfahren und Lebensbedingungen und deren Einfluss auf psychische Belastungen.
Methode 650 Asylbewerber in Berlin erhielten einen Fragebogen.
Ergebnisse 76,3 % (N = 496) beantworteten den Fragebogen vollständig. Von diesen hatten 74,6 % Symptome einer psychischen Erkrankung, und dies mit signifikantem Zusammenhang zu unsicherem Aufenthaltsstatus. Sehr belastete Personen nahmen Hilfsangebote, integrationsfördernde Maßnahmen und ihre Rechte im Asylverfahren weniger wahr. In unserer Stichprobe befanden sich nur 11,6 % der Asylbewerber mit krankheitswertiger psychischer Symptomatik in psychiatrischer Behandlung.
Schlussfolgerung Die Daten zeigen die hohe Relevanz psychischer Belastungen bei Geflüchteten.
Modern war conflicts, evolutionizing from large-scale collisions of armed forces to local, low-intensity, surrogate, terroristic and information wars, are associated with less direct mortality but with growing and long-lasting mental health consequences. These consequences can be traced in not only combatants and other military contingents and veterans but even to greater extent in the civilian populations, given that many modern war conflicts have signs of civil wars or religious conflicts. While active duty military undergo preliminary selection and resilience training, civilians in the war zone or as refugees and asylum-seeking victims are even at higher risk with the greater probability of transgenerational transmission, which implies long-lasting (decades) effects. Both military and civilians suffer from a similar set of disorders and psychological consequences caused by extreme trauma, including PTSD, depression, anxiety, addictions, somatization with chronic pain, dissociation, psychosocial dysfunctions, suicidal behavior, etc. War conflicts, terroristic acts, and information wars, amplified by technologically developing mass media, the internet and social networks, seem to add to a general feeling of instability and promote more anxiety, covering even wider contingents worldwide. Military psychiatry has accumulated knowledge and practical experience that, though not always can be applied directly, are useful for identification, management, prevention, and treatment of mental health consequences of war in wider contingents. This knowledge is a one more relevant and strong reason for advocating lowering of international tension and reducing the probability of war conflicts worldwide for the sake of preserving mental health of the humanity. It also has a potential of lowering the burden of this type of diseases worldwide.
Back translation – the ‘re-translation’ of a translated questionnaire back into the original language and the subsequent comparison of the original version and the back translation – is a controversial assessment method for questionnaire translations. Recently, cross-cultural survey methodologists have followed the call for more empirical research on this method. This article adds to the small body of research by drawing on the back translation documentation from the 2012 European Quality of Life Survey (EQLS). First, results from the official EQLS back translation step are contrasted with results when additional persons perform the same comparison step between back translation and original. We note inconsistency in the detection of presumed flaws. Second, the back translation outcome is contrasted with additional native speaker checks of the actual translation. While back translation can uncover problems, it causes quite a number of false alarms, and even more importantly, many problems remain hidden.
This chapter presents analytic methods for matched studies with multiple risk factors of interest. We consider matched sample designs of two types, prospective (cohort or randomized) and retrospective (case-control) studies. We discuss direct and indirect parametric modeling of matched sample data and then focus on conditional logistic regression in matched case-control studies. Next, we describe the general case for matched samples including polytomous outcomes. An illustration of matched sample case-control analysis is presented. A problem solving section appears at the end of the chapter.
The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the Mini the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-IH-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxietydisorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Inter-rater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-HI-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.
Aims:To describe the translation process of nursing instruments into Arabic and discuss the equivalence issues arising from this process. Method: Review of the literature.
The Arabic language is essentially three different languages: Classical Arabic; Modern Standard Arabic (fuS-Ha or MSA); and colloquial Arabic (Lahja A'mmeya), which is itself divided into five different regional Arabic dialects. The Arabic fuS-Ha language is the dialect most widely used in the translation of instruments into Arabic. The literature reveals that only a few studies focused on the linguistic issues in the translation of instruments into Arabic. Brislin's back-translation emerged as the most common method widely used by researchers in studies with Arabic-speaking subjects, but not the perfect one. Conclusion: Linguistic issues in nursing research have not been sufficiently described and discussed in the context of Arabic language and culture. Although there is no standard guideline for instrument translation, the combined translation model is the most recommended procedure to use in cross-cultural research. Linguistic differences between the source culture and the target Arabic culture should be taken into account. Finally, we recommend the use of the fuS-Ha dialect and trilingual translators in the translation of nursing instruments into Arabic.
Two aspects of translation were investigated: (1) factors that affect translation quality, and (2) how equivalence between source and target versions can be evaluated. The variables of language, content, and difficulty were studied through an analysis of variance design. Ninety-four bilinguals from the University of Guam, representing ten languages, translated or back-translated six essays incorporating three content areas and two levels of difficulty. The five criteria for equivalence were based on comparisons of meaning or predictions of similar responses to original or translated versions. The factors of content, difficulty, language and content-language interaction were significant, and the five equivalence criteria proved workable. Conclusions are that translation quality can be predicted, and that a functionally equivalent translation can be demonstrated when responses to the original and target versions are studied.
Aim: To determine the psychometric properties in terms of sensitivity, specificity, positive predictive value and negative predictive value of the Spanish version of the M.I.N.I. when diagnosis by the psychiatrist is used as the gold standard.Patients and Methods: A total of 126 primary health care patients from two Spanish provincees (Asturias and Alava) were included. First evaluations were made by the general practitioner using the GHQ-12 and those scoring greater than 2 were then evaluated using the MINI. Following this those interviewed with the MINI were then evaluated by a psychiatrist within a 3-day period.Results: Out of the total of 126 patients 78 scored greater than 2 on the GHQ-12. The mean age of these 78 patients was 47.8 (SD 16.4), 28.2% were male, 66.7% were married and 25.6% were employed. The diagnoses most frequently found on the MINI were major depression (50%) followed by generalised anxiety disorder (44.9%) and social phobia (17.9%). The most common diagnoses made by the psychiatrist were major depression (21.8%) followed by generalised anxiety disorder (16.7%) and dysthymia (16.7%). The sensitivity and the specificity of the most common diagnoses were major depression 94.1 and 62.2, generalised anxiety disorder 92.3 and 64.6, and social phobia 100 and 84.2 respectively. The positive predictive value and negative predictive for these disorders were as follows: major depression 41.0 and 97.4, generalised anxiety disorder 34.2 and 97.6, and social phobia 14.2 and 100 respectively.Conclusion: The agreement between the MINI and the psychiatrist's diagnostic judgement may be considered as acceptable for the most prevalent disorders at the level of primary health care.
Individuals of Arab descent residing within the United States currently number between 1.2 million and 3.9 million. These families are characterized by considerable diversity depending upon their nationality, religion, and extent of acculturation to both Western and Arab cultures. More recently, Arab families have immigrated to the United States in response to traumatic events, such as war, a situation that has complicated their subsequent adjustment and acculturation to life in the United States. The growth in the Arab American population suggests that school psychologists are increasingly likely to work with their children and families. However, despite the National Association of School Psychologists (NASP; 2000) and American Psychological Association (APA; 2002) ethical guidelines requiring culturally competent practice, little has been written to guide the school psychologist's work with this population. This article draws on the available literature on Arab cultural values and acculturation to enhance culturally sensitive school psychology practice at the individual and systems levels. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 183–198, 2007.
The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview, developed in clinician (MINI-CR) and patient-rated (MINI-PR) formats, for 17 Diagnostic and Statistical Manual (DSM)-III-R Axis I psychiatric disorders. This study, which investigates the validity of the MINI in relation to the Structured Clinical Interview for DSM-III-R Patients (SCID-P), was conducted in conjunction with a similar study, investigating the validity of the MINI in relation to the Composite International Diagnostic Interview (CIDI) for International Statistical Classification of Disease (ICD)-10. Both studies also examined the inter-rater and test-retest reliability of the MINI. Three hundred and seventy subjects (330 in Florida and 40 in Paris) participated in the validation of the MINI versus the SCID-P. Of these, 308 had at least one psychiatric disorder and 62 were non-patient adult controls. Eighty of the subjects (40 in Florida and 40 in Paris) also participated in the parallel study of the validity of the MINI versus the CIDI. The 330 Florida subjects first completed the patient-rated version of the MINI. All subjects were administered the MINI-CR (after the MINI-PR in the case of the Florida subjects), followed by the SCID-P. The MINI-CR was rated by two interviewers for 42 subjects in Florida and 42 in Paris (inter-rater reliability test) and readministered by a third blind interviewer one to two days after the initial rating (test-retest reliability test). Overall, the results supported the validity and reliability of the MINI. In addition, administration of the MINI-CR took half as long as administration of corresponding sections of the SCID-P. The application of short structured interviews in clinical and research settings is discussed.
Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.
Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.
The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15.
The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
An omnibus index offers a single summary expression for a fourfold table of binary concordance among two observers. Among the available other omnibus indexes, none offers a satisfactory solution for the paradoxes that occur with p0 and kappa. The problem can be avoided only by using ppos and pneg as two separate indexes of proportionate agreement in the observers' positive and negative decisions. These two indexes, which are analogous to sensitivity and specificity for concordance in a diagnostic marker test, create the paradoxes formed when the chance correction in kappa is calculated as a product of the increment in the two indexes and the increment in marginal totals. If only a single omnibus index is used to compared different performances in observer variability, the paradoxes of kappa are desirable since they appropriately "penalize" inequalities in ppos and pneg. For better understanding of results and for planning improvements in the observers' performance, however, the omnibus value of kappa should always be accompanied by separate individual values of ppos and pneg.
The growth of cross-cultural psychiatry is now occurring at a time when psychiatry in general is emphasizing diagnostic clarity and the use of quantifiable and reliable methods of collecting clinical and research data. It is now imperative that cross-cultural psychiatry also examine its methods for developing instruments for use in cross-cultural research. This paper outlines a method for developing instruments designed in one culture for use in a second, and particular attention is given to cross-cultural validity or equivalence. Five types of equivalence are enumerated and defined: content, semantic, technical, criterion, and conceptual equivalence. These concepts are illustrated by examples from the authors' experience in research on internal migrants in Peru.
The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI's and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test-retest were excellent with kappa values above 0.80 and 0.90, respectively.
The Mini-International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview used as a tool to diagnose 16 axis I (Diagnostic and Statistical Manual) DSM-IV disorders and one personality disorder. Its original version was developed by Sheehan and Lecrubier. We translated the MINI into Japanese, and investigated the reliability and validity of the Japanese version of MINI. Eighty-two subjects participated in the validation of the MINI versus the Structured Clinical Interview for DSM-III-R (SCID-P). One hundred and sixty-nine subjects participated in the validation of the MINI versus an expert's professional opinion. Seventy-seven subjects were interviewed by two investigators and subsequently readministered by a third interviewer blind to the results of initial evaluation 1-2 days later. In general, kappa values indicated good or excellent agreement between MINI and SCID-P diagnoses. Kappa values indicated poor agreement between MINI and expert's diagnoses for most diagnoses. Interrater and test-retest reliabilities were good or excellent. The mean durations of the interview were 18.8 min for MINI and 45.4 min for corresponding sections of SCID-P. Overall, the results suggest that the MINI Japanese version succeeds in reliably and validly eliciting symptom criteria used in making DSM-III-R diagnoses, and can be performed in less than half the time required for the SCID-P.
To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers.
A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist). Second, we submitted the reworded and original versions of the MINI to 14 interpreters' who tested for general and cultural acceptability. Each diagnostic criterion was rated according to interpreters' comments on a 4-point Likert scale (1 = an item good for translation and 4 = an unusable or completely inadequate item). In the third step, we rephrased the most problematic items identified by the interpreters.
Some original items were considered particularly ill-adapted for this context, and 4 had to be dropped. This final rewording took into account cultural inadequacies and lack of structure (including temporal organization) of the everyday life of newly arrived asylum seekers.
The reworded MINI was successfully tested, and its items are presented in the final part of the study.
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