Mental Health Screening Tool For Asylum Seekers And Refugees: The STAR-MH

There is no extant brief and sensitive mental health screening tool for asylum seekers and new refugees (ASR) designed to be administered by non-mental-health trained workers in receiving host nations.

The STAR-MH was iteratively developed and piloted with adult ASR without a known current psychiatric diagnosis. 192 participants from 37 countries were administered the STAR-MH by non-mental health workers, and subsequently underwent a validation interview (structured psychiatric assessment, MINI 6.0) to determine psychiatric morbidity. Statistical analyses were conducted using item response theory methods. Sensitivity/specificity analyses determined the most accurate cut-off score to detect PTSD &/or Major Depressive Disorder (MDD).

The majority was male, had arrived by boat, and required an English language interpreter. Median screening time was 6 minutes (IQR=5–7). 33% met criteria for ≥ 1 clinical diagnosis (MDD, 30%; PTSD, 20%) and 99% of other psychiatric disorders were co-morbid with MDD or PTSD. A cut-off score of ≥ 2 produced 0.93 (SN) and 0.74 (SP) for PTSD &/or MDD with a ROC of 0.91 p<.001. The STAR-MH is a sensitive and efficient screening tool to facilitate mental health assessment and referral for adult ASR at their agency of first presentation.