title: Cross-cultural use of the predetermined scale cutoff points in refugee mental health research.
abstract: BACKGROUND
  Cross-cultural use of the cutoff points determined in Indo-Chinese refugees of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ) is common in refugee mental health research but it might have caused misclassifications.
  
  
  METHODS
  We assessed the validity of the predetermined cutoff points in identifying depression and post-traumatic stress disorder (PTSD) cases among Afghan refugees, with the algorithm method as a gold standard. We estimated the prevalence of depression and PTSD, using the HSCL-25 and the HTQ with the cutoff points and the algorithm method, and calculated sensitivity, specificity, positive and negative predictive values of the cutoff points.
  
  
  RESULTS
  Nine in ten PTSD cases/non-cases were correctly identified as cases/non-cases, and nine in ten respondents classified as PTSD cases/non-cases were actually cases/non-cases. In contrast, only one in three non-depression cases was correctly identified as a non-case, and three in five respondents who were classified as depression cases was actually a case. The prevalence of depression was estimated to be 86% with the cutoff points and 53% with the algorithm method, and that of PTSD 46% and 44%, respectively.
  
  
  CONCLUSIONS
  The cutoff point approach might have low specificity and positive predictive value particularly for depression in our study. Cross-cultural use of the scale cutoff points determined in one cultural group to another needs to be reconsidered.
authors.affiliation: Dept. of Community Health, School of International Health Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bukyo-ku Tokyo, Japan. masao@m.u-tokyo.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakahara
authors.forename: Susumu
authors.initials: S
authors.lastname: Wakai
mesh_terms: D000346:Afghanistan / Q000208:ethnology; D003431:Cross-Cultural Comparison; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology*; D006801:Humans; D007564:Japan; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012016:Reference Values; D012036:Refugees / Q000523:psychology*; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000208:ethnology*