Evaluation of the use of standardized methods to identify mental health problems among refugees

Abstract Background The number of refugees arriving and residing in Sweden remains high. They represent one of the most vulnerable sub-populations in the country, who carry a disproportional part of the disease burden. Information on health status, health determinants and the extent to which refugees get access to needed services is limited. In Sweden refugees are offered a free-of -charge health examination (HE). Yet, standardized mental health screening is often neglected as a part of the HE. A pilot project aimed to initiate early mental health screening was implemented. Methods The Refugee Health Screener-13 (RHS-13) was identified as an efficient, valid, and reliable tool for assessing mental health in this population and was integrated into the HE. The RHS-13 was administrated by nurses conducting the HE at two primary health care centers in Stockholm. Results During the one-month pilot 80 individuals were screened. The majority originated from Syria, DR Congo and Afghanistan and the distribution by migration background were 58% quota refugees, 35% asylum seekers and 8% others (family reunification and undocumented migrants). Of those screened, 30% screened positive for risk of mental health (cut off ≥11). Out of those who screened positive, 29% screened for mild mental health, 33% for moderate mental health and 38% for severe mental health problems. No statistically significant differences in RHS score were found according to country of origin, sex and age. The results are preliminary. Implementation will continue for 12 months at 4 primary health care centers. Conclusions This pilot demonstrated feasibility of RHS-13 in routine care. The findings reinforce the need for standardized guidelines and procedures for mental health screening of refugees. Routine mental health screening should be a part of the overall comprehensive HE, which could improve systematic monitoring of mental health care needs for refugees and ensure access to appropriate mental health care. Key messages Standardized procedures for identifying mental health problems among refugees is feasible and can identify health needs while ensuring equitable health examinations. Standardized procedures for identifying mental health problems among refugees is feasible and can identify health needs while ensuring equitable health examinations.