Screening for post-traumatic stress disorder among refugees in Stockholm

A screening procedure (The Health Leaflet; HL) to assist social workers in finding subjects with possible post-traumatic stress disorder (PTSD) in recently resettled refugees is presented. It is compared with two established self-rating instruments, the Harvard Trauma Questionnaire (HTQ) and Impact of Event Scale-22 (IES-22), as well as structured clinical interview.

To validate the screening interview and the rating scales in comparison to a clinical assessment for PTSD, and examine the feasibility of lay screening for PTSD.

The Health Screening Interview with a cut-off value of 10 points identified cases with fully developed PTSD with both sensitivity and specificity about 0.7. Only two items--difficulties concentrating and having been exposed to torture--contributed to the discriminatory performance of the HL interview. In the HTQ symptom subscale, emotional detachment and a feeling of going mad contributed to the discriminatory performance. In the IES-22, recurring strong affects about the events, as well as intrusive memories, were the items with the highest canonical correlation coefficients. In the HL, the single screening question about difficulties concentrating identified 31/32 individuals diagnosed with PTSD in this group, with a relative risk of 24.

A mental health screening procedure during refugee reception performed by lay persons is clearly feasible and can assist in identifying subjects with trauma-related healthcare needs, thus leading to more realistic demands in refugee reception.