The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees.
OBJECTIVE
Screening for emotional distress in newly arrived refugees is not a standard practice due to multiple barriers, one being the absence of a valid screening instrument for multiple refugee populations. The Refugee Health Screener-15 (RHS-15) was empirically developed to be a valid, efficient and effective screener for common mental disorders in refugees.


METHODS
Development followed published methods. Two hundred fifty-one refugees from three countries were screened at their public health visit with a pilot instrument, and 190 were administered diagnostic proxy instruments (DPs). Data analyses using multiple methods selected the best items for classification on DPs. Follow-up clinical service data were obtained.


RESULTS
Post hoc analyses of the developed RHS-15 showed good sensitivity(range .81 to .95) and specificity (range .86 to .89) to DP's in two of three ethnic groups. Seventy-four percent of positive cases accepted treatment services. Of those, 79% engaged in treatment, and 92% continued treatment more than 3 months.


CONCLUSIONS
The RHS-15 is a screener for common mental disorders in newly-arrived refugees in public health. The RHS-15appears to be effective, but further prospective research in a broad range of refugee groups is required to establish generalizability. Strengths, limitations, methods to apply the RHS-15 for optimal performance, and future directions for research and implementation are discussed.
Pacific Institute for Research and Evaluation, Albuquerque, NM, USA. mhollifield@pire.org
Michael
M
Hollifield
Sasha
S
Verbillis-Kolp
Beth
B
Farmer
Eric C
EC
Toolson
Tsegaba
T
Woldehaimanot
Junko
J
Yamazaki
Annette
A
Holland
Janet
J
St Clair
Janet
J
SooHoo
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D011446:Prospective Studies; D011594:Psychometrics; D012036:Refugees / Q000523:psychology*; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D014481:United States; D055815:Young Adult