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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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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. |
format | Online Article Text |
id | pubmed-5241938 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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