title: Validation of a brief mental health screener for Karen refugees in primary care.
abstract: BACKGROUND
  Karen refugees from Burma are one of the largest refugee groups currently resettling in the USA. Karen people have endured decades of civil war and human rights violations, leaving them more likely to develop serious mental health disorders. There is a noted lack of brief, culturally validated tools present in primary care settings for detecting posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in Karen refugees.
  
  
  OBJECTIVE
  To create the Karen Mental Health Screener, a five-question screening tool used to identify depression and PTSD and to validate it against a clinical reference standard.
  
  
  METHODS
  This validation study was conducted during a primary care visit. Participants completed a 20-item questionnaire using a 4-point visual aid and the PTSD and MDD portions of the Structured Clinical Interview for DSM Disorders (SCID-CV for DSM-IV) as the reference standard. Both the questionnaire and the relevant sections of the SCID-IV were rigorously translated and administered by trained researchers along with a trained Karen interpreter.
  
  
  RESULTS
  Logistic regression models and receiver operating characteristic curve analyses were used to determine a subset of items that could be used to construct a screener to identify Karen patients who were most likely to have PTSD and/or MDD. A final five-question screener was created with very strong performance characteristics. With a clinical cut score of 4, these items displayed very strong performance characteristics with sensitivity = 0.96, specificity = 0.97, positive predicted value = 0.83 and negative predicted value = 0.99.
  
  
  CONCLUSIONS
  The Karen Mental Health Screener is a valid measure for detecting PTSD and major depression in Karen people from refugee backgrounds presenting in a primary care setting.
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, drbrink@umn.edu.
authors.forename: Darin R
authors.initials: DR
authors.lastname: Brink
authors.affiliation: School of Social Work, University of Minnesota, Minneapolis, MN, Center for Victims of Torture, Saint Paul, MN and.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Shannon
authors.affiliation: Independent Research Consultant, Minneapolis, MN, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Vinson
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D002052:Myanmar / Q000208:ethnology; D011320:Primary Health Care / Q000379:methods*; D012372:ROC Curve; D012036:Refugees / Q000523:psychology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States
keywords: Immigrant health; major depressive disorder; mental health; posttraumatic stress disorder; primary health care; trauma.