The assessment of psychopathology among refugees: Construct validity of PTSS, anxiety and depression Dr. Tim Wind Courtesy to Dr. Niels van der Aa, Dr. Simone de la Rie and Dr. Jeroen Knipscheer

Stichting Centrum ’45 The national institute for specialist diagnostics and the treatment of people with complex psychotrauma complaints Complaints due to persecution, war or repeated (job-related) violence 9/10/2018

Rationale for study Questionnaires are widely used to assess the mental health status of refugees. - Individual level: triage, target symptoms and track treatment outcomes - Group level: obtain MH information of group, target vulnerable subsamples, and compare/monitor different interventions Yet, the question is whether mental health concepts hold the same meaning across refugee groups (i.e. construct validity). 9/10/2018

Objective Test construct validity across groups (Dutch and refugee patients) Posttraumatic stress: Harvard Trauma Questionnaire Depression and anxiety: Hopkins Symptom Check List-25 9/10/2018

Construct invariance – three levels Configural invariance: Does the concept hold the same meaning across groups? Strong invariance: Are the items interpreted in the same way across groups (factor loadings and threshold)? If so, you can compare scores (mean and sum scores). Strict invariance: Is the measurement model exactly identical (including error variances)? If this level of MI is not met, means measured with different amount of error between groups 9/10/2018

Linguistic groups Participants (n=1,256): Indo-Iranian [n=262] Niger-Congo [n=134] Semitic [n=288] South Slavic languages [n=199] Germanic languages; [n=373] 9/10/2018

Results - HTQ Traditional three factor structure (exploratory factor analysis). Partial strong invariance. Yet, threshold is not the same across Germanic group. Thus: 1. Concept is the same across groups 2. Comparison mean and sum scores across refugees is meaningful 3. Research on cut-off scores needed 9/10/2018

Results - HSCL Traditional two factor structure (exploratory factor analysis). Yet, one item (headaches) did not pertain to anxiety or depression Partial strong invariance. Yet, one item (nervousness/shakiness) loaded differently across groups. Thus, minus the two items comparison of mean and sum scores are meaningful across refugee groups when item is deleted. 9/10/2018

Conclusion – clinical implications Mental health constructs of PTSD, anxiety, and depression, as measured by the HTQ and HSCL-25, are to a large extent interpreted in a similar way by refugee patients. - Individual level: no absolute triage, target symptoms and track treatment outcomes Group level: obtain MH information of group, target vulnerable subsamples, and compare/monitor different interventions Local idioms of distress and inherent response patterns may not play an insurmountable obstacle when examining PTSS (HTQ) and anxiety and depression (HSCL-25) in non-western refugee patient populations. 9/10/2018

Limitations We did not conduct the HSCL-25 to Dutch patients. Linguistic groups differ in sample size and this may have biased the outcomes of our multigroup CFA. A simulation study of Meade and Bauer (2007) indicated that the precision of estimated factor loading differences is high for sample sizes of 400, but varied somewhat by condition at sample sizes of 100 and 200. 9/10/2018

Conclusion – implications for research Whereas traditionally configural invariance is studies, our study is just one of the few to provide evidence for (partial) strong measurement invariance of mental health screeners among refugees. Future studies need to establish whether the commonly used cut-off scores of both questionnaires apply for refugee patients with non western linguistic backgrounds. 9/10/2018

T I T E L V A N D E P R E S E N T A T I E Questions T I T E L V A N D E P R E S E N T A T I E 9/10/2018