Efficient identification of mental health problems in refugees in Germany: the Refugee Health Screener

Figures & data

Figure 1. Flow of participants.

Table 1. RHS, mental health, and traumatic experiences.

	% PC	(n)	M (SD)
RHS-15 self-rating	52	(45)^c	∑1–14:14.09 (12.51)/DT: 3.29 (3.13)
RHS-15 interview	54	(30)^b	∑1–14:12.59 (12.24)/DT: 3.93 (2.97)
RHS-13 self-rating	42	(36)^c	13.00 (12.11)
RHS-13 interview	41	(23)^b	11.55 (11.92)
Psychological distress (BSI-18)	35	(19)^a	10.75 (13.46)
Suicidal thoughts (MINI-C)	16	(9)^a
PTSD (PCL-5)	13	(7)^a	9.85 (11.58)
Sub-syndromal PTSD	22	(12)^a
Exposure to traumatic events (LEC-5) ≥ 2	100	(56)^b	9.79 (4.93)

% PC = percentage of positive cases (above the according cutoff/fulfilling the diagnosis), ^a n = 55, ^b n = 56, ^c n = 86, RHS = Refugee Health Screener, DT = distress thermometer, BSI-18 = Brief Symptom Inventory-18, MINI-C = MINI International Neuropsychiatric Interview, Module C Suicidality, PTSD = Posttraumatic stress disorder, PCL-5 = Posttraumatic Stress Disorder Checklist-5, LEC-5 = Life Events Checklist-5.

Table 2. Predictive validity of RHS-13 and RHS-15 cases.

		Comparison RHS self-rating to clinical rating						Comparison RHS interview to clinical rating
		BSI and/or PCL case		PCL case		BSI case		BSI and/or PCL case		PCL case		BSI case
		positive	negative	positive	negative	positive	negative	positive	negative	positive	negative	positive	negative
RHS-13 case	positive	15	8	6	16	15	8	18	5	7	15	18	5
	negative	4	29	1	32	4	28	1	32	0	33	1	31
	Statistic	LR χ^2 = 17.65, p < .001		p < .05^a		LR χ^2 = 17.07, p < .001		LR χ^2 = 38.70, p < .001		p < .001^a		LR χ^2 = 37.92, p < .001
	Effect size	ⱷ = .55		ⱷ = .36		ⱷ = .55		ⱷ = .78		ⱷ = .47		ⱷ = .78
	PPV/NPV	.65/.88		.27/.97		.65/.88		.78/.97		.32/1.00		.78/.97
	Sens/Spec	.79/.78		.86/.67		.79/.78		.95/.87		1.00/.69		.95/.86
RHS-15 case	positive	17	11	6	21	17	11	19	11	7	22	19	11
	negative	2	26	1	27	2	25	0	26	0	26	0	25
	Statistic	LR χ^2 = 19.81, p < .001		p = .051^a		LR χ^2 = 19.13, p < .001		LR χ^2 = 32.31, p < .001		p < .05^a		LR χ^2 = 31.48, p < .001
	Effect size	ⱷ = .57		ⱷ = .28		ⱷ = .56		ⱷ = .67		ⱷ = .36		ⱷ = .66
	PPV/NPV	.61/.93		.22/.96		.61/.93		.63/1.00		.24/1.00		.63/1.00
	Sens/Spec	.90/.70		.86/.56		.90/.69		1.00/.70		1.00/.54		1.00/.69

RHS = Refugee Health Screener, BSI = Brief Symptom Inventory-18, PCL = Posttraumatic Stress Disorder Checklist-5, BSI and/or PCL case = BSI-18 or PCL-5 OR BSI-18 and PCL-5 are positive, PCL case = PTSD diagnosis (DSM-5) fulfilled, BSI case = above BSI-18 cutoff, RHS-13 case = above RHS-13 cutoff, RHS-15 case = above RHS-15 cutoff, PPV = positive predictive value, NPV = negative predictive value, Sens = sensitivity, Spec = specificity, LR χ² = likelihood ratio χ², ⱷ = effect size phi, ^a Fisher’s exact test.

Figure 2. Correlations between the Brief Symptom Inventory-18 (BSI-18) and the Refugee Health Screener-13 (RHS-13) self-rating (A) and interview version (B), and between the Posttraumatic Stress Disorder Checklist-5 (PCL-5) and the RHS-13 self-rating (C) and interview version (D).

Table 3. Correlations between RHS and other mental health measures.

	RHS-13 self-rating	RHS-15 self-rating	RHS-13 interview	RHS-15 interview
BSI-18	.74*** ^b	.77*** ^c	.91*** ^b	.90*** ^b
Depression	.65*** ^b	.69*** ^c	.86*** ^b	.87*** ^b
Anxiety	.69*** ^b	.72*** ^c	.85*** ^b	.84*** ^b
Somatization^1	.57*** ^b	.59*** ^c	.72*** ^b	.72*** ^b
Functioning	.52*** ^a	.58*** ^b	.62*** ^a	.64*** ^a
PCL-5	.37** ^b	.42*** ^c	.62*** ^b	.65*** ^b
LEC-5	.36** ^a	.38** ^b	.39** ^a	.41** ^a

^an = 56, ^bn = 55, ^cn = 54, **p < .01, ***p < .001, ¹Spearman rank order correlation, RHS = Refugee Health Screener, BSI-18 = Brief Symptom Inventory-18, PCL-5 = Posttraumatic Stress Disorder Checklist-5, LEC-5 = Life Events Checklist-5, Functioning = daily functioning.