Psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia

ABSTRACT

Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.

Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.

Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.

Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).

Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

HIGHLIGHTS

• We investigated the psychometric properties of the 8-item Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia living in Europe.

• We found support for the CRIES-8 as a suitable assessment tool for Afghan, Syrian, and Somali adolescents.

• The reliability of the CRIES-8 was low among Afghan and Syrian adolescents, whereas among Somali adolescents, reliability was higher.

Antecedentes: Niveles altos de estrés postraumático en refugiados están bien documentados. Sin embargo, los adolescentes refugiados muestran una alta heterogeneidad en el tipo de trauma y sus niveles de sintomatología.

Objetivo: Siguiendo la petición recurrente de herramientas validadas para pesquisa de trauma, este estudio investigó las propiedades psicométricas de la Escala Revisada del Impacto de Eventos en Niños (CRIES-8 por sus siglas en inglés) en adolescentes refugiados de Afganistán (n = 148), Siria (n = 234) y Somalia (n = 175) que viven en Europa.

Método: Se probó el ajuste del modelo para las estructuras factoriales confirmatorias, así como la invarianza de medición entre los tres grupos. La solidez de los resultados también se evaluó probando la invarianza de medición entre adolescentes recién llegados y los ya establecidos, y entre las diferentes opciones de respuestas etiquetadas. Se calculó la confiabilidad (α, ω y α ordinal), la validez de criterio y las estimaciones de prevalencia.

Resultados: La subescala de intrusión mostró un mejor ajuste estable del modelo que la subescala de evitación, pero la estructura de dos factores fue principalmente respaldada. Se logró una invarianza de medición configural entre adolescentes afganos y somalíes, y una fuerte invarianza de medición entre adolescentes sirios y somalíes. Los resultados fueron robustos considerando el tiempo vivido en el país anfitrión y los estilos de respuestas etiquetadas. La confiabilidad fue baja entre los adolescentes afganos y sirios (.717–.856), mientras que fue mayor entre los adolescentes somalíes (.831–.887). La puntuación total tuvo correlaciones de tamaño mediano con problemas emocionales (.303–.418) y correlaciones bajas con hiperactividad (.077–.155). Hubo diferencias estadísticamente significativas en la prevalencia de los síntomas: los adolescentes afganos tuvieron una alta prevalencia (55.5%) en comparación con los adolescentes sirios (42.8%) y somalíes (37%), y los refugiados menores de edad no acompañados (URMs por sus siglas en inglés) (63.5%) en comparación con los adolescentes acompañados (40.7%).

Conclusiones: Este estudio respaldó mayoritariamente el uso de la CRIES-8 en adolescentes de Afganistán, Siria y Somalia, e incluso el análisis comparativo de medias grupales. Sin embargo, la variación en las estimaciones de confiabilidad dificulta las predicciones diagnósticas, ya que el riesgo de clasificación errónea es alto.

KEYWORDS:

• Post-traumatic stress symptoms
• CRIES-8
• psychometric properties
• refugees
• adolescents

PALABRAS CLAVE:

• Síntomas de estrés postraumático
• CRIES-8
• propiedades psicométricas
• refugiados
• adolescentes

Acknowledgements

We are grateful to all the adolescents who participated in this study, and to the teachers and other school authorities who helped us with the data collection in schools.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

The data analysed in this study are subject to the following licences/restrictions. The participants provided their informed consent to allow only certain researchers to use the data. This was based on the requirements for data usage of the ethical boards of the participating organizations. Requests concerning data should be directed to the corresponding author.

Author contributions

RK, with the support of KP and MV, conceived of the presented research idea and hypotheses. RK formulated the initial drafts of the manuscript and revised them in collaboration with KP, MV, MO, CS, ID, SSJ, MS, ND, and FO. RK, KP, MV, MO, CS, SSJ, MS, ND, FO, AA, PKH, SA, and RL contributed towards collecting the empirical data. RK conducted all data preparation and statistical analyses. All of the authors contributed to this study, and read and approved the final manuscript.

Additional information

Funding

This study is part of the Refugees WellSchool (RWS) study Horizon 2020 research project [grant number 754849 (https://cordis.europa.eu/project/id/754849)].