In research on refugee mental health, focus has predominately been on pre-migratory factors, such as traumatic experiences, while less attention has been given to post-migratory factors. However, several studies have shown an association between post-migratory living difficulties and elevated levels of anxiety, depression and post-traumatic stress symptoms among refugees and asylum-seekers. In the clinical practice at the Swedish Red Cross Treatment Centers (SRCTC), it is widely noted that post-migration stress interferes with treatment. The current presentation describes the development of a new self-assessment scale for measuring post-migration stress among refugees.
The construction of the scale followed several steps. (1): Qualitative and quantitative studies relating to stressful experiences during the post-migration phase were reviewed in search for commonly reported difficulties. Post-migration difficulties commonly presented by patients at the SRCTC were also taken into account. (2): An abductive approach was used, where identified difficulties were organized to find overarching categories in which all relevant difficulties were encircled. Some of the initially identified difficulties were at this stage omitted or revised, as the ambition was to create domains relevant for all refugee populations, regardless of cultural origin or resettlement place. (3): When a fit between individual difficulties and categories was achieved, difficulties were formulated into specific items, and an item pool was created. (4): The scale was tested on refugees by means of cognitive interviewing, and revised accordingly. (5): The scale was administrated to a small pilot sample to explore its basic psychometric properties. (6): Content validity rating by an expert group was conducted. (7): Items to include in the final version of the scale were chosen based on results from cognitive interviews, pilot data, and CVR’s. (8): The scale was tested on a large sample, and advanced psychometric tests will be performed.
The final scale features 24 items with sound psychometric properties, across seven domains; perceived discrimination (e.g. discrimination by Swedish authorities), lack of host country-specific competence (e.g. bothering difficulties communicating in Swedish), economic strain (e.g. being unable to buy necessities), loss of home country or heimat (e.g. missing my social life from back home), home country and family concerns (e.g. worry about family members that I am separated from), social strain (e.g. frustration due to loss of status in the Swedish society) and family conflicts (e.g. distressing conflicts in my family).
Funding & No Conflicts Declaration
Funding: Swedish Red Cross Migrant Health Care Unit & Swedish Red Cross University College.
No Conflicts Declaration: No conflict of interests.