This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (61)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Psychiatry  • Violence and Human Rights  • War  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Critical Review

Michael Hollifield, MD; Teddy D. Warner, PhD; Nityamo Lian, DOM,(NM); Barry Krakow, MD; Janis H. Jenkins, PhD; James Kesler, MD; Jayne Stevenson, MD; Joseph Westermeyer, MD,PhD

JAMA. 2002;288:611-621.

Context  Refugees 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.

Objectives  To 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 Sources  MEDLINE, 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 Selection  Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status.

Data Extraction  Information 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 Synthesis  Of 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.

Conclusions  The 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.

Author Affiliations: Departments of Family and Community Medicine (Dr Hollifield) and Psychiatry (Drs Hollifield, Warner, Lian, and Stevenson), University of New Mexico Health Sciences Center, Albuquerque; Sleep and Human Health Institute, Albuquerque, NM (Dr Krakow); Departments of Anthropology and Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Jenkins); Northern Colorado Family Practice Center, Greeley (Dr Kesler); University of Minnesota and the Minneapolis Veterans Affairs Center, Minneapolis, Minn (Dr Westermeyer).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Research on the Mental Health Effects of Terrorism
Carol S. North and Betty Pfefferbaum
JAMA. 2002;288(5):633-636.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Growth in the Shadow of War: The Case of Social Workers and Nurses Working in a Shared War Reality
Lev-Wiesel et al.
Br J Soc Work 2009;39:1154-1174.
ABSTRACT | FULL TEXT  

Supportive and Unsupportive Social Interactions in Relation to Cultural Adaptation and Psychological Distress Among Somali Refugees Exposed to Collective or Personal Traumas
Jorden et al.
Journal of Cross-Cultural Psychology 2009;40:853-874.
ABSTRACT  

Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis
Steel et al.
JAMA 2009;302:537-549.
ABSTRACT | FULL TEXT  

What Research tells us about the Mental Health and Psychosocial Wellbeing of Sudanese Refugees: A Literature Review
Tempany
Transcultural Psychiatry 2009;46:300-315.
ABSTRACT  

Difficulties and Coping Strategies of Sudanese Refugees: A Qualitative Approach
Khawaja et al.
Transcultural Psychiatry 2008;45:489-512.
ABSTRACT  

Measuring Cumulative Trauma Dose, Types, and Profiles Using a Development-Based Taxonomy of Traumas
Kira et al.
Traumatology 2008;14:62-87.
ABSTRACT  

How scientifically valid is the knowledge base of global mental health?
Summerfield
BMJ 2008;336:992-994.
FULL TEXT  

Symptoms and coping in Sri Lanka 20-21 months after the 2004 tsunami
Hollifield et al.
Br. J. Psychiatry 2008;192:39-44.
ABSTRACT | FULL TEXT  

Meaning or Measurement? Researching the Social Contexts of Health and Settlement among Newly-Arrived Refugee Youth in Melbourne, Australia
Gifford et al.
Journal of Refugee Studies 2007;0:fem004v1-fem004.
ABSTRACT | FULL TEXT  

Validation of a Tibetan Translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire
Lhewa et al.
Assessment 2007;14:223-230.
ABSTRACT  

Global Evidence for a Biopsychosocial Understanding of Refugee Adaptation
Porter
Transcultural Psychiatry 2007;44:418-439.
ABSTRACT  

Living in Religious Time and Space: Iraqi Refugees in Dearborn, Michigan
Shoeb et al.
Journal of Refugee Studies 2007;20:441-460.
ABSTRACT | FULL TEXT  

Emergency Conflict-related Psychosocial Interventions in Sierra Leone and Uganda: Lessons from Medecins Sans Frontieres
De Jong and Kleber
J Health Psychol 2007;12:485-497.
ABSTRACT  

`Major depression' in Ethiopia: validity is the problem
Summerfield
Br. J. Psychiatry 2007;190:362-362.
FULL TEXT  

Classifying the Torture Experiences of Refugees Living in the United States
Hooberman et al.
J Interpers Violence 2007;22:108-123.
ABSTRACT  

Psychological Distress among Recent Russian Immigrants in the United States
Hoffmann et al.
Int J Soc Psychiatry 2006;52:29-40.
ABSTRACT  

Enhancing Research With Migrant Women Through Focus Groups
Ruppenthal et al.
West J Nurs Res 2005;27:735-754.
ABSTRACT  

Historical Reflections on Mental Health Care in Sweden: The Welfare State and Cultural Diversity
Baarnhielm et al.
Transcultural Psychiatry 2005;42:394-419.
ABSTRACT  

Mental Health of Cambodian Refugees 2 Decades After Resettlement in the United States
Marshall et al.
JAMA 2005;294:571-579.
ABSTRACT | FULL TEXT  

Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons: A Meta-analysis
Porter and Haslam
JAMA 2005;294:602-612.
ABSTRACT | FULL TEXT  

Reexamining What We Think We Know: A Lesson Learned From Tamil Refugees
Weaver
Affilia 2005;20:238-245.
ABSTRACT  

Dental Caries of Refugee Children Compared With US Children
Cote et al.
Pediatrics 2004;114:e733-e740.
ABSTRACT | FULL TEXT  

Somali and Oromo Refugees: Correlates of Torture and Trauma History
Jaranson et al.
AJPH 2004;94:591-598.
ABSTRACT | FULL TEXT  

Posttraumatic Symptoms and the Complexity of Responses to Trauma
Kroll
JAMA 2003;290:667-670.
FULL TEXT  

Accurate Measurement in Cultural Psychiatry: Will we Pay the Costs?
Hollifield
Transcultural Psychiatry 2002;39:419-421.
 

Research on the Mental Health Effects of Terrorism
North and Pfefferbaum
JAMA 2002;288:633-636.
FULL TEXT