Despite increasing numbers of traumatised asylum-seekers and refugees arriving in host countries, there is no extant screening tool specifically for use by non-mental health professionals to facilitate the referral process into appropriate treatment. We aimed to develop a brief, highly sensitive screening tool (STAR-MH) easily administrable by non-mental health workers to screen for mental disorders in adult asylum-seekers and new refugees (ASR).
An initial 12-item version of the STAR-MH was developed using items from validated scales via data from a previous study. It was refined to nine items through an iterative pilot process. Adult ASR who had not received a psychiatric diagnosis or treatment since arriving in Australia were recruited through two Melbourne-based agencies (Asylum Seeker Resource Centre, ASRC; Monash Health Refugee Health Clinic) which provide for the health and psychosocial needs of ASR. All consenting participants were administered the STAR-MH by one of 28 non-mental health workers and were subsequently interviewed by the researcher -- who was blind to the screening results -- using the MINI 6.0 to determine psychiatric morbidity. Data was analysed using CART, Rasch, and ROC curve analyses, and sensitivity/ specificity analyses determined the most accurate cut-off score to detect PTSD &/or Major Depressive Disorder (MDD).
Findings are based on 192 ASR from 36 countries. The median age was 33 (IQR 36--43) and the majority was male (70%), had arrived by boat (54%), and required an English language interpreter (62%). Screening time was 6 mins (IQR 5--7) and the time between screening and validation interview was 5.5 days (IQR 0--9). 32% met criteria for at least one clinical diagnosis: 30% for MDD, 20% for PTSD. 99% of other mental disorders were secondary to MDD/PTSD. Only 27% of MDD/PTSD sufferers had received mental health treatment in Australia. A cut-off score of ≥ 2 produced .94 (SN) and .75 (SP) for PTSD &/or MDD with a ROC of .91 p<.0001 (95% CI = 0.87--0.96). The STAR-MH is of relevance to policy, research and practice. It has demonstrated efficacy in its aim to fill a service gap of detecting mental disorders in ASR through its brevity and sensitivity.
Funding & No Conflicts Declaration
Funding: Cabrini Health (Australia); Australian Communities Foundation. The authors declare no conflict of interests.