ContextRefugees experience multiple traumatic events and have significant associated
health problems, but data about refugee trauma and health status are often
conflicting and difficult to interpret.ObjectivesTo assess the characteristics of the literature on refugee trauma and
health, to identify and evaluate instruments used to measure refugee trauma
and health status, and to recommend improvements.Data SourcesMEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and
Cochrane Systematic Reviews (searched through OVID from the inception of each
database to October 2001), and the New Mexico Refugee Project database.Study SelectionKey terms and combination operators were applied to identify English-language
publications evaluating measurement of refugee trauma and/or health status.Data ExtractionInformation extracted for each article included author; year of publication;
primary focus; type (empirical, review, or descriptive); and type/name and
properties of instrument(s) included. Articles were excluded from further
analyses if they were review or descriptive, were not primarily about refugee
health status or trauma, or were only about infectious diseases. Instruments
were then evaluated according to 5 criteria (purpose, construct definition,
design, developmental process, reliability and validity) as described in the
published literature.Data SynthesisOf 394 publications identified, 183 were included for further analyses
of their characteristics; 91 (49.7%) included quantitative data but did not
evaluate measurement properties of instruments used in refugee research, 78
(42.6%) reported on statistical relationships between measures (presuming
validity), and 14 (7.7%) were only about statistical properties of instruments.
In these 183 publications, 125 different instruments were used; of these,
12 were developed in refugee research. None of these instruments fully met
all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria.
Another 8 standard instruments were designed and developed in nonrefugee populations
but adapted for use in refugee research; of these, 2 met all 5 criteria and
6 met 4 criteria.ConclusionsThe majority of articles about refugee trauma or health are either descriptive
or include quantitative data from instruments that have limited or untested
validity and reliability in refugees. Primary limitations to accurate measurement
in refugee research are the lack of theoretical bases to instruments and inattention
to using and reporting sound measurement principles.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=195170&pdfFileName=jrv20018.pdf

Measuring Trauma and Health Status in Refugees: A Critical Review

Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation.

The Children's Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scale's validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75-83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.

/pdf/the-children-s-revised-impact-of-event-scale-cries-validity-26m0g7r18k.pdf

The Children’s Revised Impact of Event Scale (CRIES): Validity as a screening instrument for PTSD.

The Impact of Event Scale (IES; M. J. Horowitz, N. Wilner, & W. Alvarez, 1979) is a worldwide-used self-report measure to assess the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The purpose of this article is to assess the psychometric value of the Dutch version of the IES (D. Brom & R. J. Kleber, 1985) in several samples of individuals who had experienced various traumatic stressors. The reliability and structure of the IES were evaluated in 3 different samples (total N 1,588). The reliability of the Dutch version of the IES was adequate across the various stressors. The construct validity was assessed by using confirmatory factor analyses. Outcomes revealed a robust structure over the various samples, generally supporting the composition of the original IES.

Construct Validation of the Dutch Version of the Impact of Event Scale.

A total of 3030 children age 8-19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

Trauma exposure and psychological reactions to genocide among rwandan children

To evaluate the psychometric properties of the Impact of Event Scale (IES scale) in children a study was conducted on 1787 children exposed to the warfare in Croatia, Bosnia and Herzegovina. The study group comprised 877 girls and 910 boys ranging in age from 6 to 15 years attending 28 arbitrary selected schools in Zagreb. High levels of posttraumatic reactions were found in the group of children. The pattern of endorsement and the factor structure of the IES scale were similar to that found in other samples. This supports the use of the IES in the assessment of posttraumatic stress reactions in children. Two factors emerged from a Principal Component Analysis, labeled intrusion (9 items), and avoidance (4 items). As in other studies, this study documented problems with several items (items 2, 12 and 15), items that should be considered omitted from the IES. Girls reported significantly more distress on 13 out of the 15 items. Both the overall IES score as well as the intrusion and avoidance score were significantly higher in girls than boys. The factor structure for boys and girls were very similar, and the reliability of the scale was adequate across different age groups and for subgroups of displaced and refugee children.

Arpad Barath

Papers

Factor analysis of the impact of event scale with children in war