Screening asylum seekers and new refugees for mental disorders using the STAR-MH
Despite the high prevalence of mental disorders in asylum-seekers and refugees (ASR) globally, there is no brief and sensitive screening tool designed to be administered by non-health trained workers in receiving nations.
The STAR-MH was developed and piloted with adult ASR without a known current psychiatric diagnosis through two agencies in Melbourne, Australia. 192 ASR from 37 countries were administered the STAR-MH by non-mental health workers and subsequently undertook a structured psychiatric interviewed to determine their mental health status. The majority was male, had arrived in Australia by boat, and required an English language interpreter. The average screening time was 6 minutes, regardless of whether an interpreter was used. 32% met criteria for major depression (MDD) and/or posttraumatic stress disorder (PTSD) – 30% for MDD, 20% for PTSD. Referrals were offered to all who met criteria for a clinical diagnosis, and 84% accepted the referral. A STAR-MH cut-off score of ≥ 2 produced 0.93 (sensitivity) and 0.74 (specificity) for PTSD &/or MDD, with diagnostic accuracy of 81%.
- The 9-item STAR-MH is a sensitive and efficient screening tool for use by non-mental health workers, to facilitate mental health referrals for adult asylum-seekers and refugees at their agency of first presentation.
- The STAR-MH screens for PTSD and depression – the two most prevalent psychiatric disorders in forced migrant populations. Other psychiatric conditions almost exclusively co-occur with PTSD or depression, indicating that screening for PTSD and depression will identify the majority of those who are psychiatrically unwell.
- A web-based electronic platform is currently being developed to enable the dissemination of written and aural translations of the STAR-MH in common languages, which will be freely available worldwide for use by registered individuals and agencies.
Key take-outs from the ISHHR 2017 Conference (industry feedback, networking, peer presentations):
UNHCR Serbia funded research to screen for mental disorders in refugees passing through Serbia. There was interest in the STAR-MH tool to screen refugees in the peri-migration phase of their migration journey. To date, the mental health focus has predominantly been on pre- and/or post-migration screening/assessment. It is encouraging to see assessment and treatment of mental health conditions during the migration process, thus promoting earlier intervention.
Future goals — what’s next?
There are approximately 25 million asylum seekers and refugees (ASR), with those under the age of 18 years comprising half of the total refugee population. Despite their increasing numbers, and coupled with their significant risk of mental health (MH) disorders, ASR youth are frequently an under-diagnosed and overlooked population, evidenced by a lack of best practice guidelines for mental health screening and the underutilisation of mental health services. To meet this need, our team is currently developing a mental health screening tool for asylum seeking and refugee youth, as there is an international need, but no extant tool for this population.
How can local / national / international media better assist in bringing the vital issues discussed at ISHHR 2017 to light, and further encourage real, positive change and understanding?
Asylum seekers and refugees are frequently portrayed by the media as hapless victims. In actuality, generally only the most resilient individuals successfully embark on the refugee journey. This resilience, however, can result in individuals not recognising mental health problems within themselves, which, in turn, contributes to mental disorders not being identified by those working with them. Screening for mental health disorders not only identifies those likely to have a mental health condition, but also provides an opportunity for psycho-education about common mental health symptoms and how to manage these.