Pathways to Wellness for Refugees

Biological Psychiatry Home


March-April 2013

Michael Hollifield, M.D.
Sasha Verbillis-Kolp, M.S.W., 
Beth Farmer, L.I.C.S.W., 
Eric C. Toolson, Ph.D.,
Tsegaba Woldehaimanot, M.S.W., 
Junko Yamazaki, L.I.C.S.W., 
Annette Holland, B.S., 
Janet St. Clair, L.I.C.S.W., 
Janet SooHoo, M.S.W.



Screening for emotional distress in newly arrived refugees is not a standard practice due to multiple barriers, one being the absence of a valid screening instrument for multiple refugee populations. The Refugee Health Screener-15 (RHS-15) was empirically developed to be a valid, efficient and effective screener for common mental disorders in refugees.


Development followed published methods. Two hundred fifty-one refugees from three countries were screened at their public health visit with a pilot instrument, and 190 were administered diagnostic proxy instruments (DPs). Data analyses using multiple methods selected the best items for classification on DPs. Follow-up clinical service data were obtained.


Post hoc analyses of the developed RHS-15 showed good sensitivity(range .81 to .95) and specificity (range .86 to .89) to DP's in two of three ethnic groups. Seventy-four percent of positive cases accepted treatment services. Of those, 79% engaged in treatment, and 92% continued treatment more than 3 months.


The RHS-15 is a screener for common mental disorders in newly-arrived refugees in public health. The RHS-15appears to be effective, but further prospective research in a broad range of refugee groups is required to establish generalizability. Strengths, limitations, methods to apply the RHS-15 for optimal performance, and future directions for research and implementation are discussed.

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