Transcultural Validity of a Structured Diagnostic Interview to Screen for Major Depression and Posttraumatic Stress Disorder Among Refugees

Adult Psychiatry Service, Department of Psychiatry, Geneva University Hospitals, Chêne-Bourg, Switzerland.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 10/2007; 195(9):723-8. DOI: 10.1097/NMD.0b013e318142c9f6
Source: PubMed


Refugees and asylum seekers have a high risk of developing mental health problems and appropriate screening in people from diverse origins remains a challenge. The aim of this study was to validate a structured diagnostic interview, adapted from the Major Depressive Episode (MDE) and Posttraumatic Stress Disorder (PTSD) sections of the Mini International Neuropsychiatric Interview, to detect these disorders among newly arrived asylum seekers. The adapted questionnaire was administered by nurses in a primary care context and its performance was judged against the expert opinion of a mental health specialist. One hundred one subjects were included in the study (mean age: 30; origin: Africa 58%, Europe: 37%, Asia: 5%). MDE and PTSD were diagnosed among 33% and 30% of them respectively. The questionnaire demonstrated moderate sensitivity (MDE: 79%; PTSD: 69%), but high specificity (MDE: 95%; PTSD: 94%). These characteristics remained stable despite cultural differences and use of interpreters. This instrument could be used for systematic screening of MDE and PTSD in refugees from various origins.

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    • "More specifically, current GAD, PD, Obsessive-Compulsive Disorder (OCD), social phobia, and agoraphobia were assessed. The MINI is a structured diagnostic psychiatric interview instrument and has been translated and used in many languages, and applied in various cultures and settings [43]. "
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    ABSTRACT: The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.
    Full-text · Article · Jan 2014 · BMC Psychiatry
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    • "The terrifying traumatic experience of torture is a strong risk factor for mental health problems. A variety of psychiatric diagnoses according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) such as major depressive episode (MDE), posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD) have been shown to be associated with torture (Başoğlu, Paker, Özmen, Taşdemir, & Sahin, 1994; Eytan, Durieux-Paillard, Whitaker-Clinch, Loutan, & Bovier, 2007; Holtz, 1998; Maercker & Schützwohl, 1997; Mollica, McInnes, Pham et al., 1998; Mollica, McInnes, Poole, & Tor, 1998; Shrestha et al., 1998). A recent meta-analysis, reviewing 161 articles (pooled sample of N=81,866 refugees), reported that the prevalence rates for MDE and PTSD in this population were of 30.8 and 30.6%, respectively (Steel et al., 2009). "
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    ABSTRACT: To date no validated instrument in the French language exists to screen for posttraumatic stress disorder (PTSD) in survivors of torture and organized violence. The aim of this study is to adapt and validate the Harvard Trauma Questionnaire (HTQ) to this population. The adapted version was administered to 52 French-speaking torture survivors, originally from sub-Saharan African countries, receiving psychological treatment in specialized treatment centers. A structured clinical interview for DSM was also conducted in order to assess if they met criteria for PTSD. Cronbach's alpha coefficient for the HTQ Part 4 was adequate (0.95). Criterion validity was evaluated using receiver operating characteristic curve analysis that generated good classification accuracy for PTSD (0.83). At the original cut-off score of 2.5, the HTQ demonstrated high sensitivity and specificity (0.87 and 0.73, respectively). Results support the reliability and validity of the French version of the HTQ.
    Full-text · Article · Dec 2012 · European Journal of Psychotraumatology
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    • "MINI International Neuropsychiatric Interview (MINI) [43] is a structured diagnostic psychiatric interview instrument and has been translated and used in many languages, including Arabic; it has also been applied in various cultures and settings [44]. The Major Depressive Episode section of the MINI (Arabic version) was used to detect major depressive episode (here after referred to as depression). "
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    ABSTRACT: Background Limited data exists on the association of war trauma with comorbid posttraumatic stress disorder (PTSD)-depression in the general population of low-income countries. The present study aimed to evaluate socioeconomic and trauma-related risk factors associated with PTSD, depression, and PTSD-depression comorbidity in the population of Greater Bahr el Ghazal States, South Sudan. Methods In this cross-sectional community study (n=1200) we applied the Harvard Trauma Questionnaire (HTQ) and MINI International Neuropsychiatric Interview (MINI) to investigate the prevalence of PTSD, depression, and PTSD-depression comorbidity. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, sociodemographic, and socioeconomic factors. Results PTSD only was found in 331 (28%) and depression only in 75 (6.4%) of the study population. One hundred and twelve (9.5%) of the participants had PTSD-depression comorbid diagnosis. Exposure to traumatic events and socioeconomic disadvantage were significantly associated with having PTSD or PTSD-depression comorbidity but not with depression. Participants with a comorbid condition were more likely to be socioeconomic disadvantaged, have experienced more traumatic events, and showed higher level of psychological distress than participants with PTSD or depression alone. Conclusions In individuals exposed to war trauma, attention should be given to those who may fulfill criteria for a diagnosis of both PTSD and depression.
    Full-text · Article · Oct 2012 · BMC Psychiatry
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