Validation of the Psychometric Properties of the Hopkins Symptom Checklist (HSCL-10) for Resettled Burmese in the United States

Background and Purpose: Refugees often endure traumatic experiences before, during, and after migration, leading to increased risks of depression and anxiety. Delays in receiving mental health support can further exacerbate these issues. The Hopkins Symptom Checklist (HSCL-10) has been widely used for detecting symptoms of anxiety and depression across diverse populations, including refugees. However, the HSCL's psychometric properties among resettled Burmese are unknown. This study aims to evaluate the psychometric properties and factor structures of the HSCL-10 among resettled Burmese adults in the United States. The key research questions are: What is the factor structure of the HSCL-10 in this group? Is the HSCL-10 a valid and reliable tool for measuring symptoms of depression and anxiety among them?

Methods: This study analyzed data from 171 resettled Burmese adults aged 18 and older who have lived in the United States for an average of 27.11 years. The Hopkins Symptom Checklist-10 (HSCL-10) was used to assess symptoms of anxiety and depression, with respondents rating items on a 4-point scale from 1 (not at all) to 4 (extremely) over the past week. An exploratory factor analysis (EFA) was conducted to evaluate the scale's dimensionality, employing an eigenvalue cutoff of 1.00 and a loading threshold of 0.30 to determine factor retention. A confirmatory factor analysis (CFA) was performed using SPSS AMOS (version 26) to validate the two-factor structure of the HSCL-10. Internal consistency was evaluated using Cronbach’s alpha.

Results: Respondents ranged in age from 18 to 65, with a mean age of 27.11 (SD=9.30). Most were males (60%), married (57%), employed (85%), and have a college degree or higher (69%). The mean years in the US is 9.38 (SD = 9.01). An exploratory factor analysis revealed a two-factor solution aligned with the original HSCL-10 dimensions: Depression (6 items) and Anxiety (4 items). All items showed loadings of.76 or higher. Factor 1 (Depression) explained 52.57% of the variance (eigenvalue = 5.26), and Factor 2 (Anxiety) accounted for 12.61% (eigenvalue = 1.26), together explaining 65.19% of the total variance. Intercorrelation analysis revealed a significant correlation between the two subscales, r=.59. A confirmatory factor analysis indicated acceptable fit (χ² = 126.55, df = 34, p < .001; GFI = .897; NFI = .912; TLI = .912; CFI = .933; RMSEA = .112). The Cronbach’s alpha was .88 for Depression and .92 for Anxiety, demonstrating good reliability.

Conclusions and Implications: The HSCL's two-factor structure has been confirmed, allowing respondents to distinguish between depression and anxiety symptoms. The confirmatory factor analysis showed an acceptable fit, with all ten items of the HSCL-10 loading onto two higher-order factors. These findings suggest that the HSCL-10 is a valid and reliable tool for screening depression and anxiety symptoms among resettled Burmese individuals.