Measuring trauma and health status in refugees: a critical review.
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.
Hollifield
Michael
M
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
Warner
Teddy D
TD
Lian
Nityamo
N
Krakow
Barry
B
Jenkins
Janis H
JH
Kesler
James
J
Stevenson
Jayne
J
Westermeyer
Joseph
J
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*