Developing a Culturally Grounded Mental Health Screening Tool for Refugees in Minnesota

Background and Purpose: In 2009 1,268 refugees from more than 20 different countries resettled in Minnesota. An overwhelming number of refugees have experienced severe forms of war trauma including torture, rape and witnessing the murder of family members. Some refugees have spent decades living in refugee camps under brutal conditions. Exposure to these types of trauma can increase refugees' risk of PTSD, depression, and other psychosocial issues. While new refugees may receive comprehensive physical health screenings upon arrival in the US, screening for potential mental health issues is currently offered in only a few states. One reason for this omission is the lack of culturally appropriate and valid screening tools for use with refugees and the lack of culturally appropriate treatment methodologies. Historically, researchers have utilized Western mental health measures for screening refugees in public health settings. This research builds on international efforts toward developing culturally grounded mental health measures and appropriate treatments for refugees. The main objective of the study was to create a culturally grounded mental health screening tool for use with refugees in the public health setting. The screening tool will be pilot tested and validated for use in multiple ethnic communities. Methods: Twelve focus group interviews (FGIs) were conducted with 103 participants from four refugee communities, Karen, Bhutanese, Somali and Oromo. Each group was divided according to ethnicity and gender. Among them three FGIs were conducted with youth (ages 18 to 25). Participants were recruited through cultural leaders from each group, using a snowball sampling design. Participants were asked to answer questions about cultural concepts/meaning of mental illness/disorder, expression and intuitive diagnosis of mental illness symptoms and contextual explanationd of mental distress in each refugee community. Focus groups were conducted in English or native languages with interpreters. They were recorded and transcribed and resulting transcripts were analyzed using grounded theory and ethno-cultural methodologies to code and interpret results. A 27-item screening tool was developed from the analyses and cultural leaders from all of the ethnic groups provided member-checking. The tool was then pilot tested in a clinic setting. Results: The results of the study revealed cross-group similarities in expression of traumatic symptoms, such as sleeping problems, loss of cognitive ability, hopelessness, and somatic symptoms. It was also found that these signs of psychological distress often cannot be separated from specific contexts of traumatic events. In addition to cross-cultural commonalities, findings indicate that there are additional culturally grounded symptoms that must be addressed, such as the level of distinction or specification of mental disorders differing across cultures. Conclusions and Implications: A pilot screening tool was developed and tested as the first stage of a tiered program of research involving the development and cultural adaptation of the tool, training of local cultural leaders and mainstream mental health professionals, and the implementation of a multi-component systemic approach to trauma treatment and resettlement adjustment. Pilot data and screening processes will be presented from collaborating clinics and community agencies.