Migrant and refugee populations often do not receive adequate mental health care due to lacking clinical information that leaves many disorders undiagnosed. The evaluation of mental health should be reliable, culturally appropriate and sensitive to change. Unfortunately, language barriers, compounded by the cost of interpreters and the inaccuracy resulting from ad-hoc interpretation of tests often limit the effectiveness of self-assessment instruments. Advances in information technology provide innovative ways to address these issues. STARTTS has trialled a multilingual computer assisted self-interview (MultiCASI, Knaevelsrud & Müller, 2008) that allows clinical standard assessment of people speaking different languages and with varying literacy.
Data were collected from a convenience sample of clients over the age of 18, seeking services through STARTTS services. AIM: 1) To assess the feasibility, validity and acceptability of Multi-CASI (MC) compared with clinician administered paper-and-pencil assessment method (CAPP); 2) To assess the time consumption and cost effectiveness in the means of number of therapists, interpreters and translations needed for each client. 3) To identify areas which need improvement for future computerized self-report assessment methods. Participants: Sixty one treatment seeking traumatized refugees recruited from STARTTS client population were randomly assigned to either the clinician administered paper and pencil assessment (n=31) or the Multi-CASI assessment mode (n=30). Materials: a) MultiCASi software; Berlin Centre for Torture and the Outpatient Clinic for Victims of Torture and war, Univerity of Zurich, a standardized computer-based assessment for refugees who are illiterate or have limited reading/writing skills. b) A posttraumatic stress diagnosis scale, Harvard Trauma Questionnaire (HTQ), a self-report questionnaire assessing 17 trauma related events/experiences; c) Assessing symptoms of anxiety and depression using the Hopkins Symptoms Checklist-25 (HTQ-25) a self-rating scale measuring 10 anxiety symptoms and 15 depression symptoms; d) Acceptability Questionnaire by Knaevelsrud and Mueller 2007 designed for MultiCASI, e)Eurohis -- Quality of Life.
No significant differences were found between the two diagnostic conditions (MC and CAPP) with regard to indicated number or nature of reported traumatic event types, PTSD severity, depression, anxiety or quality of life. While 24.1% of participants in the pen and paper group reported that completing a computerised questionnaire would be `uncomfortable' compared to pen and paper, only 6.2% of those in the computerised group agreed, Χ² (1, N=61) =3.87, p =.05, supporting the hypothesis that using the computerised questionnaire would be less uncomfortable than initially anticipated. Fewer participants reported problems in computerised (21.9%) than in pen and paper questionnaire group (41.4%), Χ² (1, N=61) = 2.69, p=.17. No significant difference was found in the average length of time taken to complete the questionnaires, between the computerised group (M =53.06 minutes, SD = 21.40) and the pen-and-paper group (M = 51.03 minutes, SD = 21.52), t(59) = -0.37, p =.71.
Funding & No Conflicts Declaration
The information & data presented was collected in the absence of any commercial or financial relationships that could be construed as a conflict of interest.