Refugee youth encounter a wide range of stress and trauma in their home countries, during their migration journey, and throughout the resettlement process, and are therefore at elevated risk for mental health problems. Although many service providers are well-positioned to recognize and intervene with refugee youth who may present with complex psychosocial and psychological challenges, there is limited research and guidance on well-validated measures for use with this diverse population. This makes it challenging, if not impossible, to well-characterize presenting problems or track progress resulting from interventions with refugee youth. The purpose of this study was to synthesize and describe findings regarding assessment tools from a systematic review of the literature on resettled refugee youth mental health.
The systematic review utilized the following databases for the comprehensive search: PsycINFO (ProQuest), CINAHL (EBSCO), Academic Search Complete (EBSCO), Sociological Abstracts, and Social Work Abstracts databases. Search terms pertained to youth, refugees, and mental health. Inclusion criteria were: resettled refugees in the US, ages ≤ 25, published after 1999, and in English. Findings yielded 30 primary data manuscripts meeting these criteria. Information regarding the instruments used, samples they were used with, implementation methodology, and demonstrated psychometric properties, were extracted and grouped by concepts, variables, and specific instruments.
Mental health problems, particularly PTSD and depression, were the most assessed variables of interest. The most widely used scales with strong psychometric properties included: UCLA PTSD Index for DSM-IV (Cronbach’s alpha = .85–.92, test-retest reliability = .84); UCLA PTSD Reaction Index (Cronbach’s alpha = .85–.90, test-retest reliability = .84); and Depression Self Rating Scale (Cronbach’s alpha = .76–.81). In addition to these diagnostic scales, the War Trauma Screening Scale for identification of exposure to trauma was used with several groups and reportedly performed adequately with Somali and Bosnian youth (Cronbach’s alpha = 0.78; “good psychometrics”). For most other concepts, it was rare to find the same instruments used twice. Many studies did not report psychometric properties. Two articles focused on instrument validation for specific populations: acculturative stress in Soviet Jewish refugees and the Refugee Health Screener-15 in refugee youth from Bhutan, Burma, and Iraq. A range of methodological strategies were reported that addressed language and cultural barriers in implementing measurement tools, such as translation, cultural brokers, and bilingual interviewers. However, many studies indicated that participants were required to be English-speakers, and many did not report on this issue.
Conclusions & Implications:
This study identified specific instruments demonstrating strong psychometric properties, particularly for assessing mental health diagnoses and trauma. Major gaps in evidence regarding measurement were also revealed. Toward informing and evaluating interventions that promote well-being in refugee youth, research is needed that increases understanding of the factors involved. Psychometrically sound measures are critically important, both in practice and research. More work should be conducted and disseminated on psychometric evidence for scales used with refugee youth, focusing on concepts that are broadly implicated in refugee youth well-being. Recommendations are made regarding priorities and reporting standards.