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A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

BACKGROUND: Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms...

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Autores principales: Llosa, Augusto E., Van Ommeren, Mark, Kolappa, Kavitha, Ghantous, Zeina, Souza, Renato, Bastin, Pierre, Slavuckij, Andrej, Grais, Rebecca F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241938/
https://www.ncbi.nlm.nih.gov/pubmed/28100197
http://dx.doi.org/10.1186/s12888-016-1154-5
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author Llosa, Augusto E.
Van Ommeren, Mark
Kolappa, Kavitha
Ghantous, Zeina
Souza, Renato
Bastin, Pierre
Slavuckij, Andrej
Grais, Rebecca F.
author_facet Llosa, Augusto E.
Van Ommeren, Mark
Kolappa, Kavitha
Ghantous, Zeina
Souza, Renato
Bastin, Pierre
Slavuckij, Andrej
Grais, Rebecca F.
author_sort Llosa, Augusto E.
collection PubMed
description BACKGROUND: Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting. METHODS: Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010. RESULTS: The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity. CONCLUSIONS: Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-1154-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-52419382017-01-23 A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study Llosa, Augusto E. Van Ommeren, Mark Kolappa, Kavitha Ghantous, Zeina Souza, Renato Bastin, Pierre Slavuckij, Andrej Grais, Rebecca F. BMC Psychiatry Research Article BACKGROUND: Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting. METHODS: Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010. RESULTS: The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity. CONCLUSIONS: Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-1154-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-18 /pmc/articles/PMC5241938/ /pubmed/28100197 http://dx.doi.org/10.1186/s12888-016-1154-5 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Llosa, Augusto E.
Van Ommeren, Mark
Kolappa, Kavitha
Ghantous, Zeina
Souza, Renato
Bastin, Pierre
Slavuckij, Andrej
Grais, Rebecca F.
A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title_full A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title_fullStr A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title_full_unstemmed A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title_short A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study
title_sort two-phase approach for the identification of refugees with priority need for mental health care in lebanon: a validation study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241938/
https://www.ncbi.nlm.nih.gov/pubmed/28100197
http://dx.doi.org/10.1186/s12888-016-1154-5
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