title: Measuring trauma and health status in refugees: a critical review.
abstract: BACKGROUND
  Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret.
  
  
  OBJECTIVE
  To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements.
  
  
  METHODS
  MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database.
  
  
  METHODS
  Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status.
  
  
  METHODS
  Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature.
  
  
  RESULTS
  Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria.
  
  
  CONCLUSIONS
  The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 2400 Tucker Ave NE, Albuquerque, NM 87131, USA. mhollifield@salud.unm.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Hollifield
authors.forename: Teddy D
authors.initials: TD
authors.lastname: Warner
authors.forename: Nityamo
authors.initials: N
authors.lastname: Lian
authors.forename: Barry
authors.initials: B
authors.lastname: Krakow
authors.forename: Janis H
authors.initials: JH
authors.lastname: Jenkins
authors.forename: James
authors.initials: J
authors.lastname: Kesler
authors.forename: Jayne
authors.initials: J
authors.lastname: Stevenson
authors.forename: Joseph
authors.initials: J
authors.lastname: Westermeyer
mesh_terms: D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008603:Mental Health; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014104:Torture / Q000523:psychology; D014754:Violence / Q000523:psychology; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology*